Normal Fetal Growth and Fetal Macrosomia

Placental lactogen (PL) is a peptide hormone secreted throughout pregnancy by both animal and human specialized endocrine cells. PL plays an important role in the regulation of insulin secretion in pancreatic β-cells, stimulating their proliferation and promoting the expression of anti-apoptotic proteins. Cases of pregnancy affected by metabolic conditions, including obesity and diabetes, are related to alterations in the PL secretion pattern. Whereas obesity is most often associated with lower PL serum concentrations, diabetes results in increased PL blood levels. Disruptions in PL secretion are thought to be associated with an increased prevalence of gestational complications, such as placental dysfunction, diabetic retinopathy, and abnormalities in fetal growth. PL is believed to be positively correlated with birth weight. The impaired regulation of PL secretion could contribute to an increased incidence of both growth retardation and fetal macrosomia. Moreover, the dysregulation of PL production during the intrauterine period could affect the metabolic status in adulthood. PL concentration measurement could be useful in the prediction of fetal macrosomia in women with normal oral glucose tolerance test (OGTT) results or in evaluating the risk of fetal growth restriction, but its application in standard clinical practice seems to be limited in the era of ultrasonography.

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The influence of maternal glycaemia and dietary glycaemic index on pregnancy outcome in healthy mothers

British Journal Of Nutrition ◽

10.1017/s0007114510000425 ◽

2010 ◽

Vol 104 (2) ◽

pp. 153-159 ◽

Cited By ~ 42

Author(s):

Ciara A. McGowan ◽

Fionnuala M. McAuliffe

Keyword(s):

Blood Glucose ◽

Birth Weight ◽

Fetal Growth ◽

Maternal Blood ◽

Glycaemic Index ◽

Fetal Macrosomia ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Blood Glucose Concentrations ◽

Infant Birth

Infant birth weight has increased in Ireland in recent years along with levels of childhood overweight and obesity. The present article reviews the current literature on maternal glycaemia and the role of the dietary glycaemic index (GI) and its impact on pregnancy outcomes. It is known that maternal weight and weight gain significantly influence infant birth weight. Fetal macrosomia (birth weight >4000 g) is associated with an increased risk of perinatal trauma to both mother and infant. Furthermore, macrosomic infants have greater risk of being obese in childhood, adolescence and adulthood compared to normal-sized infants. There is evidence that there is a direct relationship between maternal blood glucose levels during pregnancy and fetal growth and size at birth, even when maternal blood glucose levels are within their normal range. Thus, maintaining blood glucose concentrations within normal parameters during pregnancy may reduce the incidence of fetal macrosomia. Maternal diet, and particularly its carbohydrate (CHO) type and content, influences maternal blood glucose concentrations. However, different CHO foods produce different glycaemic responses. The GI was conceived by Jenkins in 1981 as a method for assessing the glycaemic responses of different CHO. Data from clinical studies in healthy pregnant women have documented that consuming a low-GI diet during pregnancy reduces peaks in postprandial glucose levels and normalises infant birth weight. Pregnancy is a physiological condition where the GI may be of particular relevance as glucose is the primary fuel for fetal growth.

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P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1040 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Elena Prokopenko ◽

Andrey Vatazin ◽

Vera Gurieva ◽

Irina Nikol`skaya ◽

Fatima Burumkulova ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Cesarean Section ◽

Preterm Delivery ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Adverse Outcomes ◽

Growth Restriction ◽

Fetal Macrosomia ◽

Ckd Stage

Abstract Background and Aims Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN. Method 61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated. Results Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5). Conclusion DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.

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Early Onset Acceleration of Fetal Growth in Gestational Diabetes Mellitus: Deciding About When and Whom to Screen for Preventing Fetal Macrosomia

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.719 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A353-A353

Author(s):

Maria Mirabelli ◽

Eusebio Chiefari ◽

Paola Quaresima ◽

Federica Visconti ◽

Daniela Foti ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fetal Growth ◽

Early Onset ◽

Abdominal Circumference ◽

Fetal Macrosomia ◽

Screening Strategies ◽

Initial Acceleration ◽

Current Screening

Abstract The precise time into pregnancy at which women are screened for gestational diabetes mellitus (GDM) is crucial for determining the benefits of diagnosis. However, this issue remains a source of intense debate among guidance authorities and there is no consensus about when and whom to screen. Since 2010, the IADPSG recommends universal screening with 75g OGTT at 24–28 weeks’ gestation (WG), due to evidence of a positive linear correlation between maternal blood glucose levels around 28 WG and risk of fetal macrosomia. Nonetheless, emerging evidence indicates that initial acceleration of fetal growth (FG) related to GDM, predicting fetal macrosomia, is already underway at 20 WG, thereby suggesting that screening strategies for GDM earlier than the recommended 24–28 WG should be reconsidered (1). By exploiting the routine 19–21 WG obstetrical assessment of FG (anomaly scan), along with the risk stratification system endorsed by the Italian NHS, which offers, in addition to the usual GDM screening test at 24–28 WG, an early 75g OGTT at 16–18 WG to women who are classified as at high risk (HR) for GDM (i.e. previous GDM, pre-gravid obesity, or FPG at first prenatal visit between 5.6–6.9 mmol/L), we aimed to verify whether an early onset acceleration of FG related to GDM would be observed in our pregnant population, and if reversion could occur with current screening recommendations. For this, 769 consecutive women in singleton pregnancies, subjected to both anomaly scan and GDM screening, were retrospectively enrolled at our Institution between Jan 2018-Feb 2020. At a mean time of 20.8 WG, the percentiles of estimated fetal weight (EFW) and abdominal circumference (AC) were significantly higher in women who tested positive for GDM at late screening than in women with normal glucose tolerance (NGT). However, while no differences in the birthweight (BW) percentiles of neonates born to non-HR women diagnosed with GDM at 24–28 WG, with respect to NGT women were observed (p=0.416), neonates born to HR women diagnosed with GDM at 24–28 WG (due to refusal to comply with early screening advices) were significantly heavier (p<0.001). In contrast, both the EFW and AC percentiles, as well as the BW percentiles, were significantly lower in infants born to HR women diagnosed with GDM at 16–18 WG with respect to their late diagnosis counterparts (EFW p=0.001, AC p=0.002, BW p=0.048), and not dissimilar to those of NGT women (EFW p=0.824, AC p=0.873, BW p=0.242). These results were confirmed by regression analysis, while adjusting for maternal confounders. Although an initial acceleration of FG related to GDM can be detected at anomaly scan in non-HR women, reversion occurs with current screening recommendations. Earlier screening strategies should be reserved to HR women, as the acceleration of FG related to GDM in these cases is less responsive to treatment delays. (1) Ref: Li et al. Lancet Diabetes Endocrinol. 2020;8(4):292–300.

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