Small-for-gestational age placentas associate with an increased risk of adverse outcomes in pregnancies complicated by either type I or type II pre-gestational diabetes mellitus

The incidence of gestational diabetes mellitus (GDM) is increasing rapidly worldwide. Many women with gestational diabetes mellitus are likely to have type 2 diabetes. With the extensive management protocol for GDM we are able to obtain a good glycaemic control but still excess morbidity prevails among GDM pregnancy compared to normal pregnancy. This may be due to the dysfunction of lipid metabolism. Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake. Exaggerated reduction in insulin sensitivity in the peripheral tissues combined with peripheral adipose tissue lipolysis in GDM pregnancy than normal pregnancy results in increased maternal lipoprotein concentrations and elevated lipoprotein triglyceride content. An altered lipid profile on the maternal side would modulate the quantity and quality of lipids being transferred to the fetus. Hypertriacylglycerolemia in gestational diabetes mellitus has been related to a significant risk of having neonates that are large for gestational age and it is considered as a major cause of preeclampsia in the late gestational age. So, the recent researchers emphasize on targeting lipid metabolism in pregnant women with GDM to avoid the adverse outcomes of pregnancy.

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A High Adherence to Six Food Targets of the Mediterranean Diet in the Late First Trimester is Associated with a Reduction in the Risk of Materno-Foetal Outcomes: The St. Carlos Gestational Diabetes Mellitus Prevention Study

Nutrients ◽

10.3390/nu11010066 ◽

2018 ◽

Vol 11 (1) ◽

pp. 66 ◽

Cited By ~ 8

Author(s):

Carla Assaf-Balut ◽

Nuria García de la Torre ◽

Manuel Fuentes ◽

Alejandra Durán ◽

Elena Bordiú ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Small For Gestational Age ◽

Virgin Olive Oil ◽

First Trimester ◽

Prevention Study ◽

High Adherence ◽

Tract Infections

A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern—based on six food targets—on a composite of materno-foetal outcomes (CMFCs). The CMFCs were defined as having emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age, and/or small-for-gestational-age. A total of 874 women were stratified into three groups according to late first-trimester compliance with six food targets: >12 servings/week of vegetables, >12 servings/week of fruits, <2 servings/week of juice, >3 servings/week of nuts, >6 days/week consumption of extra virgin olive oil (EVOO), and ≥40 mL/day of EVOO. High adherence was defined as complying with 5–6 targets; moderate adherence 2–4 targets; low adherence 0–1 targets. There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational-age (SGA) newborns (all p < 0.05). The odds ratios (95% CI) for GDM and CMFCs in women with a high adherence were 0.35((0.18–0.67), p = 0.002) and 0.23((0.11–0.48), p < 0.001), respectively. Late first-trimester high adherence to the predefined six food targets is associated with a reduction in the risk of GDM, CMFCs, UTI, prematurity, and SGA new-borns.

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Maternal Body Mass Index and Ethnicity in Relation to The Adverse Outcomes of Large for Gestational Age and Gestational Diabetes Mellitus in a Retrospective Cohort of Australian Pregnant Women.

10.21203/rs.3.rs-152021/v1 ◽

2021 ◽

Author(s):

Catherine Knight-Agarwal ◽

Jani Rati ◽

Meisa Al-Foraih ◽

Dionne Eckley ◽

Carrie Ka Wai Lui ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Body Mass ◽

Gestational Age ◽

Retrospective Cohort ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Maternal Body Mass Index

Abstract Background: The prevalence of maternal overweight and obesity has been increasing. This research explored the association between maternal body mass index and ethnicity in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus. Method: A retrospective cohort study was undertaken with 27 814 Australian women of various ethnicities, who gave birth to a singleton infant between 2008 and 2017. Variables were examined using logistic regression. Results: A significantly higher proportion of large for gestational age infants were born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women with a body mass index of ≥ 40kg/m2 had an adjusted odds ratio of 9.926 (3.859 - 25.535) for birthing a large for gestational age infant whereas Australian-born women had an adjusted odds ratio of 2.661 (2.256 - 3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin controlled gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational infant, in either the diet controlled, or insulin controlled gestational diabetes mellitus groups. Conclusion: Large for gestational age and gestational diabetes mellitus are adverse pregnancy outcomes that can lead to significant maternal and neonatal morbidity. Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period.

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Pregnancy Complications and Risk of Uterine Rupture Among Women With Singleton Pregnancies in China

10.21203/rs.3.rs-424294/v2 ◽

2021 ◽

Author(s):

Jing Tao ◽

Yi Mu ◽

Peiran Chen ◽

Yanxia Xie ◽

Juan Liang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Pregnancy Complications ◽

Uterine Rupture ◽

Placental Abruption ◽

Placenta Percreta ◽

Near Miss ◽

Increased Risk

Abstract Background: The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. Methods: We obtained all data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. Results: Compared with women without pregnancy complications, those with different complications (except for preeclampsia) had a 1- to 3-fold greater risk of UR. These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. A large for gestational age (LGA) foetus increased the risk of UR in women with gestational diabetes mellitus, especially at 32 to 36 weeks gestation. Conclusions: Better quality antenatal care and early intervention for women with these pregnancy complications are needed to minimize the incidence of UR.

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A Mediterranean Diet with an Enhanced Consumption of Extra Virgin Olive Oil and Pistachios Improves Pregnancy Outcomes in Women Without Gestational Diabetes Mellitus: A Sub-Analysis of the St. Carlos Gestational Diabetes Mellitus Prevention Study

Annals of Nutrition and Metabolism ◽

10.1159/000495793 ◽

2018 ◽

Vol 74 (1) ◽

pp. 69-79 ◽

Cited By ~ 12

Author(s):

Carla Assaf-Balut ◽

Nuria García de la Torre ◽

Alejandra Duran ◽

Manuel Fuentes ◽

Elena Bordiú ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Small For Gestational Age ◽

Virgin Olive Oil ◽

Caloric Intake ◽

Extra Virgin Olive Oil ◽

Large For Gestational Age ◽

Prevention Study

Aims: The aim of the study was to evaluate the effect of a Mediterranean diet (MedDiet), enhanced with extra virgin olive oil (EVOO) and nuts, on a composite of adverse maternofoetal outcomes of women with normoglycemia during pregnancy. Methods: This was a sub-analysis of the St Carlos gestational diabetes mellitus Prevention Study. Only normoglycemic women were analysed (697). They were randomized (at 8–12th gestational weeks) to: standard-care control group (337), where fat consumption was limited to 30% of total caloric intake; or intervention group (360), where a MedDiet, enhanced with EVOO and pistachios (40–42% fats of total caloric intake) was recommended. The primary outcome was a composite of maternofoetal outcomes (CMFOs): at least having 1 event of emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age and small-for gestational-age. Results: Crude relative risk showed that the intervention was associated with a significant reduction in the risk of CMFOs (0.48 [0.37–0.63]; p = 0.0001), with a number-needed-to-treat = 5. Risk of urinary tract infections, emergency C-sections, perineal trauma, large-for-gestational-age and small-for gestational age new-borns were also significantly reduced. Conclusion: A MedDiet, enhanced with EVOO and nuts, was associated with a risk reduction of CMFOs in over 50% in normoglycemic pregnant women. Therefore, it might be a potentially adequate diet for pregnant women. Trial registration: Identifier ISRCTN84389045. The study was registered on September 27, 2013. Last edited on September 26, 2018

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Gestational Diabetes Mellitus and Macrosomia: A Literature Review

Annals of Nutrition and Metabolism ◽

10.1159/000371628 ◽

2015 ◽

Vol 66 (Suppl. 2) ◽

pp. 14-20 ◽

Cited By ~ 179

Author(s):

Kamana KC ◽

Sumisti Shakya ◽

Hua Zhang

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Type Ii Diabetes ◽

Neonatal Intensive Care ◽

Fetal Macrosomia ◽

Large For Gestational Age ◽

Type Ii ◽

Increased Risk ◽

The Impact

Background: Fetal macrosomia, defined as a birth weight ≥4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called ‘large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. Summary: Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern.

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The significance of placental ratios in pregnancies complicated by small for gestational age, preeclampsia, and gestational diabetes mellitus

Obstetrics & Gynecology Science ◽

10.5468/ogs.2014.57.5.358 ◽

2014 ◽

Vol 57 (5) ◽

pp. 358 ◽

Cited By ~ 13

Author(s):

Hee Sun Kim ◽

Soo Hyun Cho ◽

Han Sung Kwon ◽

In Sook Sohn ◽

Han Sung Hwang

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Small For Gestational Age

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Conception via Assisted Reproductive Techniques: an Independent Risk Factor for Poor Perinatal Outcome

Journal of Gynecology & Reproductive Medicine ◽

10.33140/jgrm.04.02.04 ◽

2020 ◽

Vol 4 (2) ◽

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Small For Gestational Age ◽

Post Partum ◽

Assisted Reproductive Techniques ◽

Reproductive Techniques ◽

Post Partum Haemorrhage

Assisted Reproductive Techniques (ART) are well established treatments offered in the sub-fertile couple. As a consequence, obstetricians increasingly have to manage high risk pregnancies without any formal guidelines to follow. We carried out a retrospective cohort study to evaluate the risks of ART using data from 11875 women (11326 spontaneously conceived pregnancies and 549 using ART) in order to propose a policy to better manage them antenatally. Outcome measures included induction of labour, method of and gestation at delivery, gestational diabetes mellitus, and small for gestational age, anal sphincter injury, post-partum haemorrhage and neonatal morbidity and mortality. The ART group had higher rates of gestational diabetes mellitus (18.9% vs 9.4%, P <0.0001), small for gestational age (9.1% vs 5.6%, P=0.001), instrumental delivery (19.6 vs 11.8%, P<0.0001), emergency caesarean section (26.8% vs 15%, P<0.0001) and post-partum haemorrhage >1500mL (6.9% vs 3%, P<0.0001). Lower Apgar scores (2.6% vs 1.4%, P=0.03) and admission to neonatal unit were more likely in the ART group (10.2% vs 5.4%, P<0.0001). Our results suggest that antenatal monitoring for gestational diabetes mellitus and fetal growth, appropriate counselling regarding mode and timing of delivery and active management of 3rd stage of labour, are essential when managing high risk ART pregnancies.

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