Reduced growth velocity at term is associated with adverse neonatal outcomes in non-small for gestational age infants

Background and Objectives: Mild gestational diabetes (GDM) refers to the gestational hyperglycemia, which does not fulfill the diagnostic criteria for GDM. The results of studies on adverse pregnancy outcomes among women with mild GDM are controversial. Therefore, the aim of this systematic review and meta-analysis was to investigate the impact of mild GDM on the risk of adverse maternal and neonatal outcomes.Methods: A thorough literature search was performed to retrieve articles that investigated adverse maternal and neonatal outcomes in women with mild GDM in comparison with non-GDM counterparts. All populations were classified to three groups based on their diagnostic criteria for mild GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed/random effects models. Publication bias was assessed using the Harbord test. DerSimonian and Laird, and inverse variance methods were used to calculate the pooled relative risk of events. Subgroup analysis was performed based on mild GDM diagnostic criteria. Quality and risk of bias assessment were performed using standard questionnaires.Results: Seventeen studies involving 11,623 pregnant women with mild GDM and 53,057 non-GDM counterparts contributed to the meta-analysis. For adverse maternal outcomes, the results of meta-analysis showed that the women with mild GDM had a significantly higher risk of cesarean section (pooled RR: 1.3, 95% CI 1.2–1.5), pregnancy-induced hypertension (pooled RR: 1.4, 95% CI 1.1–1.7), preeclampsia (pooled RR: 1.3, 95% CI 1.1–1.5) and shoulder dystocia (pooled RR: 2.7, 95% CI 1.5–5.1) in comparison with the non-GDM population. For adverse neonatal outcomes, the pooled relative risk of macrosomia (pooled RR = 0.4, 95% CI: 1.1–1.7), large for gestational age (pooled RR = 1.7, 95% CI: 1.3–2.3), hypoglycemia (pooled RR = 1.6, 95% CI: 1.1–2.3), hyperbilirubinemia (pooled RR = 1.1, 95% CI: 1–1.3), 5 min Apgar <7 (pooled RR = 1.6, 95% CI: 1.1–2.4), admission to the neonatal intensive care unit (pooled RR = 1.5, 95% CI: 1.1–2.1), respiratory distress syndrome (pooled RR = 3.2, 95% CI: 1.8–5.5), and preterm birth (pooled RR = 1.4, 95% CI: 1.1–1.7) was significantly increased in the mild GDM women as compared with the non-GDM population. However, the adverse events of small for gestational age and neonatal death were not significantly different between the groups. Analysis of composite maternal and neonatal outcomes revealed that the risk of those adverse outcomes in the women with mild GDM in all classifications were significantly higher than the non-GDM population. Also, the meta-regression showed that the magnitude of those increased risks in both composite maternal and neonatal outcomes was similar.Conclusion: The risks of sever adverse neonatal outcomes including small for gestational age and neonatal mortality are not increased with mild GDM. However, the increased risks of most adverse maternal and neonatal outcomes are observed. The risks have similar magnitudes for all mild GDM diagnostic classifications.

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Prenatal serum sFlt-1/PlGF ratio predicts the adverse neonatal outcomes among small-for-gestational-age fetuses in normotensive pregnant women

Medicine ◽

10.1097/md.0000000000024681 ◽

2021 ◽

Vol 100 (8) ◽

pp. e24681

Author(s):

So Hyun Shim ◽

Haeng Jun Jeon ◽

Hye Jin Ryu ◽

So Hyun Kim ◽

Seung Gi Min ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Outcomes ◽

Adverse Neonatal Outcomes ◽

Plgf Ratio

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Short interpregnancy intervals, maternal folate levels, and infants born small for gestational age: a preliminary study in a Canadian supplement-using population

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2017-0292 ◽

2017 ◽

Vol 42 (10) ◽

pp. 1092-1096 ◽

Cited By ~ 1

Author(s):

Buffy Chen ◽

Prescilla Carrion ◽

Ravneet Grewal ◽

Angela Inglis ◽

Catriona Hippman ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Folic Acid Supplementation ◽

Neonatal Outcomes ◽

Exact Test ◽

Second Child ◽

Previous Birth ◽

Adverse Neonatal Outcomes ◽

Interpregnancy Intervals ◽

Using Data

Short interpregnancy intervals (SIPI) have been associated with increased risks for adverse neonatal outcomes including preterm delivery and infants small for gestational age (SGA). It has been suggested that mechanistically, adverse neonatal outcomes after SIPI arise due to insufficient recovery of depleted maternal folate levels prior to the second pregnancy. However, empirical data are lacking regarding physiological folate levels in pregnant women with SIPI and relationships between quantified physiological folate levels and outcomes like SGA. Therefore, we sought to test 2 hypotheses, specifically that compared with controls women with SIPI would: (i) have lower red blood cell folate (RBCF) levels and (ii) be more likely to have SGA infants (defined as <10th percentile). Using data collected in British Columbia, Canada, for a larger study on perinatal psychopathology, we documented supplementation use and compared prenatal RBCF levels and proportion of SGA infants between women with SIPI (second child conceived ≤24 months after previous birth, n = 26) and matched controls (no previous pregnancies, or >24 months between pregnancies, n = 52). There were no significant differences in either mean RBCF levels (Welch’s t test, p = 0.7) or proportion of SGA infants (Fisher’s exact test, p = 0.7) between women with SIPI and matched controls. We report the first data about RBCF levels in the context of SIPI. If confirmed, our finding of no relationship between these variables in this population suggests that continued folic acid supplementation following an initial pregnancy mitigates folate depletion. We found no relationship between SIPI and SGA.

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Insulin Responses During Catch-up Growth of Infants Who Were Small for Gestational Age

PEDIATRICS ◽

10.1542/peds.57.3.363 ◽

1976 ◽

Vol 57 (3) ◽

pp. 363-371

Author(s):

Eleanor Colle ◽

David Schiff ◽

Gail Andrew ◽

Charles B. Bauer ◽

Pamela Fitzhardinge

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Growth Velocity ◽

Insulin Response ◽

Growth Characteristics ◽

Term Infants ◽

The Mean ◽

Catch Up ◽

Insulin Responses ◽

Permissive Role

Growth characteristics of 15 full-term infants, selected because of weights more than 2 SD below the mean for gestational age, are described. The response to an intravenous injection of glucose was utilized to measure the insulin response of the infants at 6 months. Infants small for gestational age grow at a faster rate than appropriate-for-age infants during the first six months of life. There was a positive correlation between the growth velocity of the period and insulin release and a negative correlation between growth velocity and birth length. There was no correlation between these variables and increases in weight during the same period. Growth velocity during catch-up growth is related to the degree of preceding retardation but insulin may play a permissive role.

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