Sonographic and other nonglycemic factors can predict large‐for‐gestational‐age infants in diet‐managed gestational diabetes mellitus: A retrospective cohort study

Abstract

BackgroundGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Left untreated or poorly controlled, GDM results in adverse infant outcomes such as large for gestational age (LGA). This study aims to identify nonglycemic maternal and fetal factors predictive of LGA outcomes in pregnancies complicated by diet‐managed GDM.MethodsThis was a retrospective cohort study of singleton pregnancies complicated by diet‐managed GDM from 2004 to 2015. Multiple logistic regression analysis was performed on maternal and perinatal factors to identify risk factors for LGA. In addition, a subset univariate analysis was conducted for pregnancies in which fetal ultrasound abdominal circumference measurements were available at gestational weeks 18 to 22, 24 to 28, and 29 to 33.ResultsA total of 1064 women were included, delivering 123 LGA infants. Women with higher parity (odds ratio [OR] 1.44; CI, 1.23‐1.68; P < .001) and higher prepregnancy body mass index (BMI) (OR 1.09; CI, 1.06‐1.12; P < .001) were more likely to have LGA infants. Maternal smoking (OR 0.30; CI, 0.14‐0.62; P = .001) and higher gestational age at birth (OR 0.91; CI, 0.84‐0.99; P = .018) were associated with reduced risk. Subset univariate analysis showed that fetal abdominal circumference measurements at weeks 24 to 28 and 29 to 33 beyond the 75th percentile (OR 5.92 and 13.74, respectively) and 90th percentile (OR 4.57 and 15.89, respectively) were highly predictive of LGA.ConclusionsParity, smoking status, maternal BMI, gestational age, and ultrasound fetal abdominal circumference measurements were identified as useful predictors of LGA. Presence of these predictors may prompt closer monitoring of pregnancy and early therapeutic intervention to improve management and reduce the risk of adverse fetal and maternal outcomes.

Rethinking third trimester ultrasound measurements and risk of adverse neonatal outcomes in pregnancies complicated by hyperglycaemia: A retrospective study

“…In pregnancies with GDM it has been reported that the AC is a more accurate predictor of macrosomia than the EFW; 2,13,20,29 however, our study showed similar associations (unadjusted OR F I G U R E 1 (A) Fetal abdominal circumference percentile distribution for women with gestational and type 2 diabetes. (B) Estimated fetal weight percentile distribution for women with gestational and type 2 diabetes.…”

“…Hyperglycaemia in pregnancy is increasingly common 1 and poses significant risks to the neonate, including both excessive and restricted growth, neonatal hypoglycaemia, shoulder dystocia, intensive care admission, acidosis, jaundice, respiratory distress, prematurity, as well as long-term metabolic consequences. [2][3][4] Identifying infants antenatally who may be large for gestational age (LGA) or small for gestational age (SGA) can reduce neonatal morbidity and mortality. [5][6][7] Studies of antenatal ultrasound have described accuracy in predicting birth weight; 8,9 however, few have quantified the association between growth parameters and other markers of neonatal morbidity and mortality, 6 particularly in pregnancies complicated by hyperglycaemia.…”

Gestational Diabetes and Risk Assessment of Adverse Perinatal Outcomes and Newborns Early Motoric Development

“…Our study showed that all fetal biometric growth parameters were significantly higher in women with gestational diabetes than in women with normal blood glucose status, and these results are supported with the findings of other studies as well [ 36 ]. Both GDM and maternal pre-pregnancy obesity might have an individual as well as cumulative effects on fetal as well as on neonatal anthropometric parameters [ 37 , 38 ]. Additionally, in the study published by Chee et al fetal AC was identified as a predictor of LGA.…”

“…We have also found strong positive correlation between AC and GDM, leading us to believe that AC might be a potent parameter in early assessment of both GDM and LGA. Therefore, this parameter could be used also as a potential marker for the fetal monitoring and surveillance during pregnancy [ 37 ].…”

Refining the diagnosis of Gestational Diabetes Mellitus: A systematic review to inform efforts in precision medicine

“…Among the studies with a fetal biometry ultra-sound measure near the time of GDM diagnosis, six of the eight studies found that larger fetal abdominal [81][82][83][84][85] or biparietal circumference 22 was positively associated with greater neonatal size (birthweight, LGA, macrosomia).…”