Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight

Abstract

Objectives To assess how maternal body mass index and gestational weight gain are related to on fetal venous liver flow and birthweight in pregnancies with pre-gestational diabetes mellitus. Methods In a longitudinal observational study, 49 women with pre-gestational diabetes mellitus were included for monthly assessments (gestational weeks 24–36). According to the Institute Of Medicine criteria, body mass index was categorized to underweight, normal, overweight, and obese, while gestational weight gain was classified as insufficient, appropriate or excessive. Fetal size, portal flow, umbilical venous flow and distribution to the fetal liver or ductus venosus were determined using ultrasound techniques. The impact of fetal venous liver perfusion on birthweight and how body mass index and gestational weight gain modified this effect, was compared with a reference population (n = 160). Results The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population. Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population. Fetuses of overweight women with pre-gestational diabetes mellitus had higher umbilical (p = 0.02) and total venous liver flows (p = 0.02), and a lower portal flow fraction (p = 0.04) than in the reference population. In pre-gestational diabetes mellitus pregnancies with excessive gestational weight gain, the umbilical flow to liver was higher than in those with appropriate weight gain (p = 0.02). Conclusions The results support the hypothesis that umbilical flow to the fetal liver is a key determinant for fetal growth and birthweight modifiable by maternal factors. Maternal pre-gestational diabetes mellitus seems to augment this influence as shown with body mass index and gestational weight gain.

Neonatal Adiposity is Largely Driven by Maternal Hyperglycemiain utero: Analysis of Routine Clinical Data from a Diabetes Clinic in India

“…Finally, studies show that the liver plays a key role in fetal growth regulation and fat deposition. In pregnancies with pre-gestational diabetes, an increase in umbilical flow to the liver in combination with hyperglycemia augments fetal growth (35). Interestingly, even the small and thin Indian babies are relatively more adipose than English babies (36).…”

Value of foetal umbilical vein standardised blood flow volume in predicting weight gain in the third trimester: a prospective case-cohort study

“…However, various biochemical substances in the blood play crucial roles as biological and chemical factors for foetal blood and nutrient acquisition, including vascular growth factors and blood sugar ( 32 , 33 ). Scholars from different countries have investigated the biochemical substances in foetal umbilical vein blood flow and concluded that multiple biochemical substances jointly affect foetal weight gain ( 34 ).…”

Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

“…Fetal liver dimensions are correlated with fetal size and weight, like other fetal biometric measurements, including biparietal diameter, head circumference, AC, and femur length. 16 In macrosomic fetuses, AC and therefore liver sizes are also large. The majority of the nutrient-rich blood carrying from the mother to the fetus through the umbilical vein in fetal life first comes to the liver.…”