Glycaemic status during pregnancy and longitudinal measures of fetal growth in a multi-racial US population: a prospective cohort study

Li, Mengying; Hinkle, Stefanie; Grantz, Katherine L.; Kim, Sungduk; Grewal, Jagteshwar; Grobman, William A.; Skupski, Daniel; Newman, Roger B.; Chien, Edward K.; Sciscione, Anthony; Zork, Noelia; Wing, Deborah A.; Nageotte, Michael P.; Tekola‐Ayele, Fasil; Louis, Germaine M. Buck; Albert, Paul S.; Zhang, Cuilin

doi:10.1016/s2213-8587(20)30024-3

Cited by 78 publications

(70 citation statements)

References 25 publications

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“…It has been ascertained that the fetal pancreas is sensitive to maternal blood glucose changes already at 14-20 weeks of gestation and that the detection of increased fetal insulin levels at this early pregnancy stage can anticipate the diagnosis of GDM at 24-28 weeks of gestation and predict macrosomic births [ 32 ]. Consistent with these observations, US evidences of fetal growth acceleration between 20 and 28 weeks into gestation, preceding the diagnosis of GDM at the usual screening, have been recently provided in prospective cohort studies [ 14 , 15 ], as well as in a previous report from our group in relation to HR women [ 18 ]. In the present study, we demonstrate that, at anomaly scan time, AC and EFW percentiles indicative of fetal adiposity and growth [ 14 , 33 ] are slightly but significantly higher in MR and LR women subsequently diagnosed with GDM at 24-28 weeks of gestation than those in normal glucose-tolerant pregnant women.…”

Section: Discussionsupporting

confidence: 85%

“…Consistent with these observations, US evidences of fetal growth acceleration between 20 and 28 weeks into gestation, preceding the diagnosis of GDM at the usual screening, have been recently provided in prospective cohort studies [ 14 , 15 ], as well as in a previous report from our group in relation to HR women [ 18 ]. In the present study, we demonstrate that, at anomaly scan time, AC and EFW percentiles indicative of fetal adiposity and growth [ 14 , 33 ] are slightly but significantly higher in MR and LR women subsequently diagnosed with GDM at 24-28 weeks of gestation than those in normal glucose-tolerant pregnant women. Nonetheless, in MR and LR women, diagnosis and treatment of GDM at 24-28 weeks of gestation can still efficiently reverse fetal growth acceleration, resulting in normal neonatal BW.…”

Section: Discussionsupporting

confidence: 85%

“…Similar to the risk factor-based selective screening approach endorsed by NICE guidance [ 40 ], controversies surrounding the NHS recommendations could be raised due to the inability to identify all women with increased susceptibility to GDM, along with its related maternal and fetal complications, depending on which combination of risk factors is being used [ 7 , 44 ]. Notably, given the exclusion of potential confounders (e.g., maternal pregravid BMI, age, familial history of T2D, and parity) with respect to differences in fetal biometric parameters between MR and LR women who tested positive for GDM and normal glucose-tolerant women, our results in this study confirm the direct role of maternal glucose status as the sole driver for the acceleration of fetal growth in early pregnancy [ 14 , 18 , 38 ].…”

Section: Discussionsupporting

confidence: 63%

“…Nonetheless, it has become clear that high maternal blood glucose levels can be detected before 24 weeks of gestation in a relevant proportion of women with GDM (15-70%) [ 6 – 12 ], and this relates to poorer pregnancy outcomes [ 13 ]. Besides, large prospective cohort studies have revealed the initial acceleration of fetal growth and fat deposition, predicting fetal macrosomia, is already underway at 20 weeks of gestation, thereby indicating that screening strategies for GDM earlier than the recommended 24-28 weeks of gestation should be considered [ 14 , 15 ]. Based on a cost-benefit analysis, universal screening for GDM is not currently recommended by the National Institute for Health and Care Excellence (NICE) guidance [ 16 ] and the close Italian National Healthcare Service (NHS) position [ 17 ], both favoring a risk factor-based selective approach with an earlier 75 g OGTT screening for women more prone to GDM complications.…”

Section: Introductionmentioning

confidence: 99%

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Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Quaresima

Visconti

Chiefari

et al. 2020

Journal of Diabetes Research

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Background. Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. Patients and Methods. We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined. Results. 219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates’ BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles (P<0.05), while there was no significant difference in neonatal BW percentiles. Conclusion. In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Quaresima

Visconti

Chiefari

et al. 2020

Journal of Diabetes Research

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“…Therefore, any dysregulation in the maternal metabolism already in the first trimester of pregnancy may result in pregnancy complications ( 3 , 4 ). Maternal metabolic disturbances such as obesity and type 2 diabetes mellitus (T2DM) are associated with decreased fetal growth early in pregnancy, followed by a catch-up growth ( 5 , 6 ), suggesting a central role of the maternal glucose-insulin axis in the metabolic and endocrine adaptations required for a healthy pregnancy. Indeed, impaired fasting glucose levels at weeks 9–10 positively associate with an increased risk of developing gestational diabetes mellitus (GDM) and giving birth to large for gestational age (LGA) offspring ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Maternal Obesity Affects the Glucose-Insulin Axis During the First Trimester of Human Pregnancy

et al. 2020

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Background and objective: The maternal glucose-insulin axis is central for metabolic adaptations required for a healthy pregnancy. Metabolic changes in obese mothers in early pregnancy have been scantly described. Here we characterized the glucose-insulin axis in the first trimester of human pregnancy and assessed the effect of maternal obesity and fat mass. Methods: In this cross-sectional study, maternal blood samples ( N = 323) were collected during voluntary pregnancy termination (gestational age 4 +0 –11 +6 weeks) after overnight fasting. Smokers ( N = 198) were identified by self-report and serum cotinine levels (ELISA). Maternal BMI (kg/m 2 ) and serum leptin (ELISA) were used as proxy measures of obesity and maternal fat mass, respectively. BMI was categorized into under-/normal weight (BMI < 25.0 kg/m 2 ), overweight (BMI 25.0–29.9 kg/m 2 ) and obese (BMI ≥ 30.0 kg/m 2 ), and leptin in tertiles (1st tertile: leptin < 6.80 ng/ml, 2nd tertile: leptin 6.80–12.89 ng/ml, 3rd tertile: leptin > 12.89 ng/ml). IS HOMA insulin sensitivity index was calculated from glucose and C-peptide (ELISA) serum concentrations. Analyses of covariance including multiple confounders were performed to test for differences in glucose, C-peptide and IS HOMA between gestational age periods, BMI and leptin groups. C-peptide and IS HOMA were log-transformed before analyses. Results: At weeks 7–9, fasting glucose and C-peptide levels were lower ( P < 0.01 and P < 0.001, respectively) and insulin sensitivity higher ( P < 0.001) than at weeks 4–6. Glucose levels were not significantly different between BMI or leptin categories. In contrast, C-peptide increased by 19% ( P < 0.01) between the normal weight and the overweight group and by 39% ( P < 0.001) between the overweight and obese group. In the leptin groups, C-peptide increased by 25% ( P < 0.001) between the 1st and 2nd leptin tertile and by 15% ( P < 0.05) between the 2nd and 3rd leptin tertile. IS HOMA decreased with higher BMI and fat mass. IS HOMA decreased by 18% ( P < 0.01) between the normal weight and the overweight group and by 30% ( P < 0.01) between the overweight and the obese group. In the leptin groups, IS HOMA decreased by 22% ( P < 0.001) between the 1st and 2nd leptin tertile and by 14% ( P < 0.05) between the 2nd and 3rd leptin tertile. Conclusions: At the group level, fasting glucose, C-peptide and insulin sen...

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Screening for Gestational Diabetes

Zhang

Catalano

2021

JAMA

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Glycaemic status during pregnancy and longitudinal measures of fetal growth in a multi-racial US population: a prospective cohort study

Cited by 78 publications

References 25 publications

Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Appropriate Timing of Gestational Diabetes Mellitus Diagnosis in Medium- and Low-Risk Women: Effectiveness of the Italian NHS Recommendations in Preventing Fetal Macrosomia

Maternal Obesity Affects the Glucose-Insulin Axis During the First Trimester of Human Pregnancy

Screening for Gestational Diabetes

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