Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia

Athukorala, Chaturica; Crowther, Caroline A; Willson, Kristyn

doi:10.1111/j.1479-828x.2006.00676.x

Cited by 61 publications

(43 citation statements)

References 39 publications

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“…40 Whilst increasing maternal BMI is a well recognised risk factor for the development of gestational diabetes, 2, 41, 42 increasing BMI with normal glucose tolerance does not preclude the existence of metabolic abnormalities associated with increased fetal growth. 40 …”

Section: Discussionmentioning

confidence: 99%

Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial

Grivell

Yelland

Deussen

et al. 2015

BJOG

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Objective To report the influence of maternal overweight and obesity on fetal growth and adiposity and effects of an antenatal dietary and lifestyle intervention among these women on measures of fetal growth and adiposity as secondary outcomes of the LIMIT Trial. Design Randomised controlled trial. Setting Public maternity hospitals in metropolitan Adelaide, South Australia. Population Pregnant women with a BMI ≥25kg/m2, and singleton gestation between 10+0–20+0 weeks. Methods Women were randomised to Lifestyle Advice or continued Standard Care and offered two research ultrasound scans at 28 and 36 weeks gestation. Main Outcome Measures Ultrasound measures of fetal growth and adiposity. Results For each fetal body composition parameter, mean Z-scores were substantially higher when compared with population standards. Fetuses of women receiving Lifestyle Advice demonstrated significantly greater mean mid thigh fat mass, when compared with fetuses of women receiving Standard Care (Adjusted Difference in Means 0.17; 95% Confidence Intervals (CI) 0.02 to 0.32; p=0.0245). While subscapular fat mass increased between 28 and 36 weeks gestation in fetuses in both treatment groups, the rate of adipose tissue deposition slowed among fetuses of women receiving Lifestyle Advice, when compared with fetuses of women receiving Standard Care (p=0.0160). No other significant differences were observed. Conclusions These findings provide the first evidence of changes to fetal growth following an antenatal dietary and lifestyle intervention among women who are overweight or obese.

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Section: Discussionmentioning

confidence: 99%

Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial

Grivell

Yelland

Deussen

et al. 2015

BJOG

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“…Both maternal overweight and obesity are risk factors for the subsequent development of gestational diabetes [7,9,32]. Metabolically, obesity and gestational diabetes share similar characteristics, including insulin resistance, hyperglycemia, hyperlipidemia, and a low-grade state of chronic inflammation, which in turn has been shown to alter the availability and the placental transfer of nutrients to the developing fetus [31].…”

Section: Tablementioning

confidence: 99%

Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial

Dodd¹

2014

Ann Nutr Metab

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Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant. However, robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking. We conducted a multicenter, randomized trial, recruiting 2,212 women (from 3 public maternity hospitals across South Australia) with a singleton pregnancy between 10⁺⁰ and 20⁺⁰ weeks' gestation and a BMI ≥25. The women were randomized to lifestyle advice (n = 1,108) or standard care (n = 1,104). Women randomized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy (delivered by research staff), while women randomized to standard care received pregnancy care according to local guidelines, which did not include such information. Provision of the lifestyle intervention was associated with a significant 18% relative risk reduction in the chance of infants being born with a birth weight above 4 kg. No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups. Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity. Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective, while ongoing interrogation of the biospecimens and measurements, including ongoing childhood follow-up, will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity.

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“…Acute maternal effects include pregnancy-induced hypertension and increased risk of Caesarian-section, while long-term consequences include increased risks of T2DM and CVD. Neonatal complications include fetal macrosomia and the associated risk of shoulder dystocia (Athukorala et al, 2007) which in turn can lead to neonatal musculoskeletal and brachial plexus injury (Christoffersson & Rydhstroem, 2002), while long-term sequelae are childhood obesity (Metzger, 2007), metabolic syndrome, and higher risk of T2DM and hypertension (Athukorala et al, 2007;Boney et al, 2005;Joffe et al, 1998;Leon, 1998;Metzger, 2007;Reece et al, 2009). Though practices vary, many countries recommend that all pregnant women be screened at 24 to 28 weeks' gestation with a 1-hour 50-g glucose challenge test (GCT), followed by a confirmatory 2-hour 75-g, or 3-hour 100-g oral glucose tolerance test (OGTT).…”

Section: Gestational Diabetes Mellitus (Gdm)mentioning

confidence: 99%

Gestational Diabetes and the Metabolic Syndrome

Souza¹,

Ray²,

Retnakaran³

2011

Gestational Diabetes

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Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia

Abstract: Fetal macrosomia is the strongest independent risk factor for shoulder dystocia. Effective preventative strategies are needed.

Cited by 61 publications

References 39 publications

Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial

Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomised trial

Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial

Gestational Diabetes and the Metabolic Syndrome

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