Is gestational diabetes mellitus an independent risk factor for macrosomia: a meta-analysis?

He, Xiu-Jie; Qin, Fengyun; Hu, Chuanlai; Zhu, Meng; Tian, Chao-Qing; Li, Li

doi:10.1007/s00404-014-3545-5

Cited by 90 publications

(60 citation statements)

References 33 publications

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“…Association between neonatal birth weight and maternal gestational diabetes is a well-studied topic and recently a meta-analysis shows that GDM can be an independent factor for increased neonatal birth weight [33]. Similar to our findings, Watson et al showed 29% NICU admission, 47% preterm delivery, and 38% respiratory distress in infants of mothers with GDM [34].…”

Section: Discussionsupporting

confidence: 91%

Maternal Obesity, Maternal Gestational Diabetes Mellitus, and Maternal and Neonatal Outcomes

AT¹

2016

J Obes Weight Loss Ther

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We aimed to investigate the co-morbid effects of maternal obesity, Gestational Diabetes Mellitus (GDM), and GDM treatment options on maternal and neonatal outcomes in an inner-city population. This is a retrospective chart review study of singleton mothers with new diagnosis of GDM and their infants during a 3-year period. During the study period, 356 women ages 13-48 years with GDM gave birth to 180 males and 175 females. Majority of mothers were African American (50.8%) and had Medicaid insurance (75.8%). Obese mothers constituted 48.3% of the study population, had a higher prevalence of pregnancy induced hypertension/preeclampsia, more commonly were managed with medication and delivered by C-section than non-obese mothers. Infants of obese GDM mothers had significantly higher mean birth weight, lower mean blood glucose, and were less at risk for Small for Gestational Age (SGA). In obese mothers, heaviest mothers had infants with higher bilirubin levels than less heavy mothers. We also observed a high rate of feeding difficulty in infants of GDM mothers (12.4%). Our study emphasizes the burden of maternal obesity as a major risk factor for both maternal and neonatal poor outcomes in the context of GDM and calls for further prospective and interventional research.

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Section: Discussionsupporting

confidence: 91%

Maternal Obesity, Maternal Gestational Diabetes Mellitus, and Maternal and Neonatal Outcomes

AT¹

2016

J Obes Weight Loss Ther

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“…In addition, obesity rates are high in these regions (119), and obesity has been shown to be associated with low vitamin B-12 (79,(120)(121)(122). The link between obesity, gestational diabetes, and low vitamin B-12 concentrations has not been fully explored, but because the former 2 conditions are independently associated with fetal macrosomia, they may partly compensate for or mask the associations between vitamin B-12 and LBW (123,124).…”

Section: B-12 Insufficiency In Pregnancy and Birth Weightmentioning

confidence: 99%

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

Sukumar

Rafnsson

Kandala

et al. 2016

The American Journal of Clinical Nutrition

107

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Background: Vitamin B-12 and folate are micronutrients essential for normal embryogenesis. Vitamin B-12 insufficiency in pregnancy is high in certain parts of the world, such as India, and although this has been linked to low birth weight (LBW) in these populations, the relation between vitamin B-12 and birth weight (BW) elsewhere is unknown. Objectives: We performed a systematic review to assess 1) the worldwide prevalence of vitamin B-12 insufficiency in pregnancy and 2) its association with BW. Design: A search of 5 electronic databases was performed to identify eligible articles. Random-effects meta-analysis was conducted according to geographic regions and pregnancy trimesters for the prevalence subreview and by categorical measures of BW. Results: A total of 57 and 23 articles were included for the prevalence and BW subreviews, respectively. The pooled estimates of vitamin B-12 insufficiency were 21%, 19%, and 29% in the first, second, and third trimesters, respectively, with high rates for the Indian subcontinent and the Eastern Mediterranean. The large heterogeneity between studies was partially addressed by creating a standardized score for each study (mean vitamin B-12 insufficiency O cutoff value), which internally corrected for geographic region, trimester, and assay type. Twelve of the 13 longitudinal studies included showed a decrease in mean or median vitamin B-12 across trimesters. Pooled analysis showed nonsignificantly lower maternal vitamin B-12 concentrations in LBW than in normal-BW infants and higher odds of LBW with lower vitamin B-12 values (adjusted OR: 1.70; 95% CI: 1.16, 2.50), but studies from India largely contributed to the latter. Conclusions: Our review indicates that vitamin B-12 insufficiency during pregnancy is common even in nonvegetarian populations and that concentrations of vitamin B-12 decrease from the first to the third trimester. There is no consistent association between vitamin B-12 insufficiency and LBW. However, given the long-term risks of LBW, this observation warrants further cohort studies and randomized controlled trials.Am J Clin Nutr 2016;103:1232-51.

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“…The relationship between GDM and severe PPH may be explained by fetal macrosomia, a recognized risk factor for PPH. 47 In the intrapartum CD cohort, women with a history of one prior CD had a lower adjusted odds of severe PPH compared to women with no prior CDs. Because of concern of uterine rupture, it is possible that obstetric providers are less likely to consider long periods of labor or augmentation for women undergoing trial of labor after prior CD.…”

Section: Discussionmentioning

confidence: 89%

Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies

Butwick

Ramachandran

Hegde

et al. 2017

Anesthesia &Amp; Analgesia

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Background Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared to those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. Methods To identify risk factors for severe PPH within two distinct CD populations: prelabor CD and intrapartum CD, we performed two case-control studies. Women in each study cohort delivered at a tertiary obstetric center in the United States between 2002 and 2012. For each study, cases were women who had a blood loss ≥1500 ml or who received an intraoperative or postoperative transfusion up to 48 hr after delivery. Risk factors for severe PPH among women undergoing prelabor CD or intrapartum CD were examined in separate logistic regression models. Results For prelabor CD, we identified 269 cases and 550 controls. Clinical factors with the highest adjusted odds for severe PPH during prelabor CD were: general anesthesia (adjusted odds ratio (aOR) = 22.3; 95% confidence intervals (CI) = 4.9 – 99.9; reference group = spinal anesthesia), multiple pregnancy (aOR = 8.0; 95% CI = 4.2 – 15.0; reference group = singleton pregnancy), and placenta previa (aOR = 6.3; 95% CI = 3.4 – 11.8). For intrapartum CD, we identified 278 cases and 572 controls. Clinical factors with the highest adjusted odds for severe PPH during intrapartum CD were: general anesthesia (aOR = 5.4; 95% CI = 1.7 – 17.1); multiple pregnancy (aOR = 3.2; 95% CI = 1.7 – 6.3); and a predelivery hemoglobin≤9.9 g/dl (aOR = 3.0; 95% CI = 1.3 – 6.9; reference group = predelivery hemoglobin≥11 g/dl). Conclusion Women who undergo prelabor CD and intrapartum CD have several shared risk factors for severe PPH (general anesthesia and multiple pregnancy). However, the risk factor profiles for severe PPH differed between these CD cohorts. Recognizing these differences may be important when planning resources and interventions for high-risk patients undergoing either prelabor or intrapartum CD.

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Is gestational diabetes mellitus an independent risk factor for macrosomia: a meta-analysis?

Abstract: Our findings indicate that GDM should be considered as an independent risk factor for newborn macrosomia. To adequately evaluate the clinical evolution of GDM need to be carefully assessed and monitored.

Cited by 90 publications

References 33 publications

Maternal Obesity, Maternal Gestational Diabetes Mellitus, and Maternal and Neonatal Outcomes

Maternal Obesity, Maternal Gestational Diabetes Mellitus, and Maternal and Neonatal Outcomes

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies

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