Translation of fetal abdominal circumference-guided therapy of gestational diabetes complicated by maternal obesity to a clinical outpatient setting

Quevedo, Stephen F.; Bovbjerg, Marit L.; Kington, Randi L.

doi:10.1080/14767058.2016.1219987

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…Normalizing glucose levels in all patients with GDM may result in unnecessary insulin treatment in pregnancies not at increased risk for fetal complications and may result in intrauterine growth restriction [3,4]. Studies have suggested that limiting insulin therapy to fetuses with increased AC for gestational age is associated with good outcomes, without increasing the risks for both macrosomia and SGA [6,13,14]. Despite having research results and evidence-based recommendations, ultrasonography-based therapy for GDM is still not commonly practiced [13,15].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have suggested that limiting insulin therapy to fetuses with increased AC for gestational age is associated with good outcomes, without increasing the risks for both macrosomia and SGA [6,13,14]. Despite having research results and evidence-based recommendations, ultrasonography-based therapy for GDM is still not commonly practiced [13,15]. In our study, the proportion of women with fetal AC below the 10th percentile in underweight women with GDM increased from 12% at the time of GDM diagnosis to 18% at delivery.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

et al. 2022

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This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

et al. 2022

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“…However, when insulin therapy had to be initiated in at risk pregnancies, strict blood glucose targets (4.4 and 6.1 mmol/L, 80 and 110 mg/dl, fasting and after meals, respectively) were set to reduce the risk of macrosomia ( 77 ). Although this approach has been validated in a real life setting ( 78 ), its benefits have been questioned in a recent review ( 79 ) and it is not part of the current guidelines on the management of gestational diabetes ( 1 ).…”

Section: Management Of Pregnancy In Women With Gck ...mentioning

confidence: 99%

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

et al. 2022

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Heterozygous loss-of-function variants of the glucokinase (GCK) gene are responsible for a subtype of maturity-onset diabetes of the young (MODY). GCK-MODY is characterized by a mild hyperglycemia, mainly due to a higher blood glucose threshold for insulin secretion, and an up-regulated glucose counterregulation. GCK-MODY patients are asymptomatic, are not exposed to diabetes long-term complications, and do not require treatment. The diagnosis of GCK-MODY is made on the discovery of hyperglycemia by systematic screening, or by family screening. The situation is peculiar in GCK-MODY women during pregnancy for three reasons: 1. the degree of maternal hyperglycemia is sufficient to induce pregnancy adverse outcomes, as in pregestational or gestational diabetes; 2. the probability that a fetus inherits the maternal mutation is 50% and; 3. fetal insulin secretion is a major stimulus of fetal growth. Consequently, when the fetus has not inherited the maternal mutation, maternal hyperglycemia will trigger increased fetal insulin secretion and growth, with a high risk of macrosomia. By contrast, when the fetus has inherited the maternal mutation, its insulin secretion is set at the same threshold as the mother’s, and no fetal growth excess will occur. Thus, treatment of maternal hyperglycemia is necessary only in the former situation, and will lead to a risk of fetal growth restriction in the latter. It has been recommended that the management of diabetes in GCK-MODY pregnant women should be guided by assessment of fetal growth by serial ultrasounds, and institution of insulin therapy when the abdominal circumference is ≥ 75th percentile, considered as a surrogate for the fetal genotype. This strategy has not been validated in women with in GCK-MODY. Recently, the feasibility of non-invasive fetal genotyping has been demonstrated, that will improve the care of these women. Several challenges persist, including the identification of women with GCK-MODY before or early in pregnancy, and the modalities of insulin therapy. Yet, retrospective observational studies have shown that fetal genotype, not maternal treatment with insulin, is the main determinant of fetal growth and of the risk of macrosomia. Thus, further studies are needed to specify the management of GCK-MODY pregnant women during pregnancy.

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“…Since prenatal ultrasonography is frequently used to monitor fetal growth in GDM patients in obstetric practice, fetal biometric findings such as abdominal circumference (AC) could be readily utilized to assess the adverse outcome of neonates in GDM and are being incorporated in recent reports [ 11 ]. In fact, fetal ultrasound-guided therapy of GDM was already suggested to be used to limit excess macrosomia and large for gestational age (LGA) neonates [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center

et al. 2018

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ObjectiveTo investigate the change of maternal characteristics, delivery and neonatal outcomes in gestational diabetes mellitus (GDM) over recent 10 years and to identify the risk factors associated with adverse outcome.MethodsConsecutive GDM patients (n=947) delivered in our institution were included. Research period was arbitrarily divided into 2 periods (period 1: from 2006 to 2010, period 2: from 2011 to 2015). Multiple pregnancies or preexisting diabetes were excluded. Maternal baseline characteristics, delivery and neonatal outcomes were reviewed. Fetal biometric findings by prenatal ultrasonography were collected. Adverse pregnancy outcome (APO) was defined by the presence of one of the followings; shoulder dystocia, neonatal macrosomia (>4 kg), neonatal hypoglycemia (<35 mg/dL), respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU) in term pregnancy.ResultsPeriod 2 was associated with older maternal age (34 vs. 33, P<0.001) and higher proportion of GDM A2 compared to period 1 (30.9% vs. 23.0%, P=0.009). By univariate analysis, APO was associated with increased body mass index (BMI) at pre-pregnancy (23.4 kg/m2 vs. 21.8 kg/m2, P=0.001) or delivery (27.9 kg/m2 vs. 25.8 kg/m2, P<0.001), higher HbA1c at diagnosis (5.6% vs. 5.3%, P<0.001) or delivery (5.8% vs. 5.5%, P=0.044), and larger fetal biometric findings (abdominal circumference [AC] and estimated fetal weight, P=0.029 and P=0.007, respectively). Multivariate analysis showed pre-pregnancy BMI (odds ratio [OR], 1.101; 90% confidence interval [CI], 1.028–1.180) and fetal AC (OR, 1.218; 90% CI, 1.012–1.466) were independently associated with adverse outcomes.ConclusionOur study demonstrated the trends and relevant factors associated with the adverse outcomes.

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Translation of fetal abdominal circumference-guided therapy of gestational diabetes complicated by maternal obesity to a clinical outpatient setting

Abstract: Ultrasound-guided therapy of GDM, in general clinic use, can limit excess macrosomia and LGA, even in a population with significant maternal obesity.

Cited by 9 publications

References 27 publications

Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

Pregnancy in Women With Monogenic Diabetes due to Pathogenic Variants of the Glucokinase Gene: Lessons and Challenges

The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center

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