Neonatal outcomes among offspring of obese women diagnosed with gestational diabetes mellitus in early versus late pregnancy

2018 ◽  
Vol 41 (3) ◽  
pp. 535-542 ◽  
Author(s):  
N E Grotenfelt ◽  
K Rönö ◽  
J G Eriksson ◽  
A Valkama ◽  
J Meinilä ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Late Pregnancy ◽  
Neonatal Outcomes ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Diabetes Diagnosis ◽  
Obese Women ◽  
Diabetes Group

Abstract Background Maternal metabolic derangements associated with early pregnancy gestational diabetes may affect the fetus differently compared with gestational diabetes diagnosed later in pregnancy. The aim of this observational study was to assess neonatal outcomes according to timing of gestational diabetes diagnosis in obese women. Methods Women ≥18 years of age with a pre-pregnancy body mass index ≥30 kg/m2 were grouped according to the results of a 75 g 2-h oral glucose tolerance test performed at 13.1 weeks of gestation and repeated at 23.4 weeks if normal at first testing. The main outcomes were birthweight and large for gestational age. Results Out of 361 women, 164 (45.4%) were diagnosed with gestational diabetes, 133 (81.1%) of them in early pregnancy. The mean offspring birthweight was 3673 g (standard deviation (SD) 589 g) in the early and 3710 g (SD 552 g) in the late gestational diabetes group. In a multivariate logit model, the odds ratio for large for gestational age was 2.01 (95% CI: 0.39–10.39) in early compared with late gestational diabetes. Conclusions We observed no statistically significant differences in neonatal outcomes according to timing of gestational diabetes diagnosis. In addition to lack of power, early treatment of hyperglycemia may partly explain the results.

scholarly journals Plasma Glycated CD59 Predicts Early Gestational Diabetes and Large for Gestational Age Newborns

2020 ◽  
Vol 105 (4) ◽  
pp. e1033-e1040 ◽  
Author(s):  
DongDong Ma ◽  
Miguel Angel Luque-Fernandez ◽  
Delia Bogdanet ◽  
Gernot Desoye ◽  
Fidelma Dunne ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Early Pregnancy ◽  
Gestational Age ◽  
International Association ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Blood Levels ◽  
Oral Glucose ◽  
Index Test

Abstract Context Gestational diabetes mellitus (GDM) diagnosed in early pregnancy is a health care challenge because it increases the risk of adverse outcomes. Plasma-glycated CD59 (pGCD59) is an emerging biomarker for diabetes and GDM. The aim of this study was to assess the performance of pGCD59 as a biomarker of early GDM and its association with delivering a large for gestational age (LGA) infant. Objectives To assess the performance of pGCD59 to identify women with GDM in early pregnancy (GDM < 20) and assess the association of pGCD59 with LGA and potentially others adverse neonatal outcomes linked to GDM. Methods Blood levels of pGCD59 were measured in samples from 693 obese women (body mass index > 29) undergoing a 75-g, 2-hour oral glucose tolerance test (OGTT) at <20 weeks’ gestation in the Vitamin D and Lifestyle Intervention study: the main analyses included 486 subjects who had normal glucose tolerance throughout the pregnancy, 207 who met criteria for GDM at <20 weeks, and 77 diagnosed with GDM at pregnancy weeks 24 through 28. Reference tests were 75-g, 2-hour OGTT adjudicated based on International Association of Diabetes and Pregnancy Study Group criteria. The index test was a pGCD59 ELISA. Results Mean pGCD59 levels were significantly higher (P < 0.001) in women with GDM < 20 (3.9 ± 1.1 standard peptide units [SPU]) than in those without (2.7 ± 0.7 SPU). pGCD59 accurately identified GDM in early pregnancy with an area under the curve receiver operating characteristic curves of 0.86 (95% confidence interval [CI], 0.83-0.90). One-unit increase in maternal pGCD59 level was associated with 36% increased odds of delivering an LGA infant (odds ratio for LGA vs non-LGA infant: 1.4; 95% CI, 1.1-1.8; P = 0.016). Conclusion Our results indicate that pGCD59 is a simple and accurate biomarker for detection of GDM in early pregnancy and risk assessment of LGA.

scholarly journals Obstetric and Neonatal Outcomes of Pregnancies with Mild Gestational Hyperglycemia Diagnosed at Gestational Diabetes Mellitus Screening

2018 ◽  
pp. 1 ◽  
Author(s):  
Sedat Akgol ◽  
Mehmet Sukru Budak
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Challenge Test ◽  
Large For Gestational Age ◽  
Oral Glucose ◽  
Mild Gestational Hyperglycemia ◽  
Glucose Challenge ◽  
Gestational Hyperglycemia

<p><strong>Objective:</strong> The aim of this study was to evaluate obstetric and neonatal outcomes of pregnancies with mild gestational hyperglycemia diagnosed at gestational diabetes mellitus screening.</p><p><strong>Study design:</strong> Between September 2016 and August 2017, the pregnant women diagnosed as normal glycaemia or mild gestational hyperglycemia according to the results of gestational diabetes mellitus screening with 50 g oral glucose challenge test, and 100 g oral glucose tolerance test were compared [Normal glycaemia: Blood glucose value &lt;140 mg/dL 1 hour after 50 g oral glucose challenge test].</p><p><strong>Results:</strong> The following results were obtained in the normal glycaemia and mild gestational hyperglycemia groups respectively: Mean gestational age at birth, 38.9±1.6 and 39±1.9 weeks; preterm, term, post-term birth rates, 6%, 86.2% 7.8% and 6.8%, 86.4% and 6.8%; cesarean delivery rate, 30.9% and 34.9%; birth weight 3227.9±394.9 and 3241.05±418.5 g; small for gestational age, 4.4% and 2.3%; large for gestational age 4.6% and 7%; without any significant difference between the groups. Five minute APGAR scores were significantly lower in the mild gestational hyperglycemia group compared to the normal glycaemia group.</p><p><strong>Conclusion:</strong> There was no significant increase in adverse pregnancy outcomes such as preterm birth, post-term birth, increased caesarean delivery rate, small for gestational age and large for gestational age, except for a significant decrease in 5 minute APGAR scores in the mild gestational hyperglycemia group compared to the normal glycaemia group in our study.</p>

scholarly journals Distinct Metabolic Profile in Early Pregnancy of Overweight and Obese Women Developing Gestational Diabetes

2019 ◽  
Vol 150 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Kati Mokkala ◽  
Tero Vahlberg ◽  
Outi Pellonperä ◽  
Noora Houttu ◽  
Ella Koivuniemi ◽  
...  
Keyword(s):  
Amino Acids ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Metabolic Profile ◽  
Medical Condition ◽  
Oral Glucose ◽  
Low Grade ◽  
Obese Women ◽  
Characteristic Analysis

ABSTRACT Background Reliable biomarkers for gestational diabetes mellitus (GDM) would be beneficial in the early prevention of adverse metabolic outcomes during pregnancy and beyond. Objectives The objective of this study was to investigate whether the early pregnancy serum metabolic profile differs in women developing GDM from those remaining healthy. Furthermore, we evaluated the potential of these metabolites to act as predictive markers for GDM. Methods This was a prospective study investigating overweight and obese [prepregnancy BMI (in kg/m2) ≥25 and &gt;30, respectively] pregnant women (prepregnancy median BMI: 28.5; IQR: 26.4–31.5; n = 357). Fasting serum samples were analyzed with a targeted NMR approach in early pregnancy (median: 14.3 weeks of gestation). GDM was diagnosed on the basis of a 2-h, 75-g oral-glucose-tolerance test at a median of 25.7 weeks of gestation. Results In early pregnancy, 78 lipid metabolites differed in women who later developed GDM (n = 82) compared with those who remained healthy (n = 275) (ANCOVA, adjusted for confounding factors and corrected for multiple comparisons; false discovery rate &lt;0.05). Higher concentrations of several-sized VLDL particles and medium- and small-sized HDL particles, and lower concentrations of very large-sized HDL particles, were detected in women developing GDM. Furthermore, concentrations of amino acids including 2 branched-chain amino acids, isoleucine and leucine, and GlycA, a marker for low-grade inflammation, were higher in women who developed GDM. Receiver operating characteristic analysis revealed that the most predictive marker for GDM was a higher concentration of small-sized HDL particles (AUC: 0.71; 95% CI: 0.67, 0.77; P &lt; 0.001). Conclusions We identified a distinct early pregnancy metabolomic profile especially attributable to small HDL particles in women developing GDM. The aberrant metabolic profile could represent a novel way to allow early identification of this most common medical condition affecting pregnant women. This trial was registered at clinicaltrials.gov as NCT01922791.

scholarly journals Early Screening for Gestational Diabetes Using IADPSG Criteria May Be a Useful Predictor for Congenital Anomalies: Preliminary Data from a High-Risk Population

2020 ◽  
Vol 9 (11) ◽  
pp. 3553
Author(s):  
Agnieszka Zawiejska ◽  
Katarzyna Wróblewska-Seniuk ◽  
Paweł Gutaj ◽  
Urszula Mantaj ◽  
Anna Gomulska ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Gestational Diabetes ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Congenital Malformations ◽  
Fasting Blood Glucose ◽  
High Risk Population ◽  
Oral Glucose ◽  
Iadpsg Criteria ◽  
In Pregnancy

Background: Our aim was to investigate whether the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) glycemic thresholds used for detecting hyperglycemia in pregnancy can be predictive for malformations in women with hyperglycemia detected in early pregnancy. Methods: a single-center, retrospective observational trial of 125 mother-infant pairs from singleton pregnancies with hyperglycemia according to the IADPSG criteria diagnosed at the gestational age below 16 weeks. Glucose values obtained from 75-g OGTT (oral glucose tolerance test) were investigated as predictors for congenital malformations in newborns. Results: Characteristics of the cohort: maternal age: 31.5 ± 5.2, pre-pregnancy body mass index (BMI) ≥ 30 kg/m2: 42.0%, gestational age at diagnosis (weeks): 12.0 ± 4.0, and newborns with congenital malformations: 8.8%. Fasting blood glycemia (FBG) and HbA1c (Haemoglobin A1c) at baseline significantly predicted the outcome (expB: 1.06 (1.02–1.1), p = 0.007 and expB: 2.05 (1.24–3.38), p = 0.005, respectively). Both the fasting blood glucose (FBG) value of 5.1 mmol/dL (diagnostic for gestational diabetes mellitus (GDM)) and 5.5 mmol/dL (upper limit for normoglycemia in the general population) significantly increased the likelihood ratio (LR) for fetal malformations: 1.3 (1.1; 1.4) and 1.5 (1.0; 2.4), respectively. Conclusions: (1) Fasting glycemia diagnostic for GDM measured in early pregnancy is associated with a significantly elevated risk for congenital malformations. (2) Our data suggest that women at elevated risks of GDM/diabetes in pregnancy (DiP) should have their fasting blood glucose assessed before becoming pregnant, and the optimization of glycemic control should be considered if the FBG exceeds 5.1 mmol/dL.

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

2011 ◽  
Vol 8 (2) ◽  
pp. 136-139 ◽  
Author(s):  
Esra E. Onal ◽  
Ibrahim M. Hirfanoglu ◽  
Serdar Beken ◽  
Nilgun Altuntas ◽  
Canan Turkyilmaz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Neonatal Outcomes ◽  
Large For Gestational Age

Comparison of the effectivity of two internationally recommended screening methods for the recognition of gestational diabetes

2013 ◽  
Vol 154 (20) ◽  
pp. 776-783
Author(s):  
Mónika Salamon ◽  
Zsuzsanna Soós ◽  
Roland Oláh ◽  
Máté Hazai ◽  
László Sóvágó ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
International Association ◽  
World Health ◽  
Large For Gestational Age ◽  
Screening Methods ◽  
Oral Glucose ◽  
Adverse Pregnancy

Introduction: Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gramm oral glucose tolerance test (2nd rercommendation), which differs from the evaluation used in the afore mentioned screening system. Aims: The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. Methods: By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and postterminal birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. Results: With the exception of the prevalence of large for gestational age infants – which was higher among women screened by the new evaluation – no substantial difference in the efficacy of the two investigated methods was found. Conclusion: The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases. Orv. Hetil., 2013, 154, 776–783.

scholarly journals Neonatal Outcomes of Large-for-Gestational Age Infants with or without Gestational Diabetes Mellitus

2018 ◽  
Vol 16 (2) ◽  
pp. 25-30
Author(s):  
Taslima Begum ◽  
Gulshan Ara Begum ◽  
Mahmood A Chowdhury ◽  
Wazir Ahmed ◽  
Md Badrudddoza
Keyword(s):  
Blood Glucose ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Respiratory Distress ◽  
Hospital Stay ◽  
Gestational Age ◽  
Neonatal Outcomes ◽  
Large For Gestational Age ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Background: Infants are considered Large for Gestational Age (LGA)if their birth weight is greater than the 90th percentile for gestational age. Birth weight is influenced by a number of factors with maternal diabetes being one of the most common risk factor affecting birth weight. They have an increased risk for adverse perinatal outcomes. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.Methods: This is a prospective study of all live-born LGA infants of 37 weeks of gestation with a birth weight of 4000g admitted at Neonatal ward of Chattagram Maa Shishu-O-General Hospital (CMSOGH) between 1st August 2013 to 31st July 2014. Type of sampling was purposive convenient sampling. A total of 51 neonatal patients were included. Data was collected in case record form. Data collected for the mothers included age, parity, gestational age and mode of delivery. Data for the infants include sex, birth weight, birth length and laboratory test. Outcomes were compared between infants of diabetic mothers (Group A) and infants of non- diabetic mothers (Group B). Then data was analyzed by SPSS 17.0 program and presented by tabular method, diagram and chart.Results: Among fifty one study subjects, thirty were Infants of Diabetic Mothers (IDMs) while twenty one were non- IDMs. 19 (63.3%) of the IDMs were male while 11 (36.7%) were female. Among the 21 non-IDMs 10 (47.6%) were male and 11 (52.4%) were female. Male to female ratio was 1.4:1. 5 (16.7%) of the IDMs were delivered vaginally while 25 (83.3%) were delivered by Caesarian Section (CS) where as 8 (38.1%) of the non- IDMs were delivered vaginally while 13 (61.9%) were delivered by CS. Respiratory distress was the most common morbidity affecting 70% of the IDMs and 66.7% of the non-IDMs. TTN accounted for the majority of the respiratory distress cases, occurring in 17 of the IDMs and 12 of the non-IDMs. Regarding analysis of other clinical features, convulsion (63.3%) was present more in IDMs than in non-IDMs (52.4%) cyanosis was found more in IDMs (60%) than non-IDMs (38.1%). Hypoglycemia was found more in IDMs than in non-IDMs. Mean glucose values were 41.06±19.91mg/dl for IDMs and 53.06±28.96mg/dl for the non-IDMs (p=0.001). Hyperbilirubinemia was more frequently observed in IDMs than in non- IDMs. About 17 (56.6%) of the IDMs and 7(33.3%) of the non-IDMs developed jaundice during the period of hospital stay. Polycythemia was not observed in both the groups but PCV was higher in IDMs (53.96±6.36) compared to non-IDMs (50.50±8.76). Hypocalcemia was not peculiar to a specific group. Five of the IDMs had congenital anomaly, of which three of them had cardiac anomaly. One of the non-IDM was suffering from ventricular septal defect. Birth asphyxia was observed more in non-IDMs (71.4%) than in IDMs (53.3%).One of the IDMs and two of the non-IDMs sustained a brachial plexus injury following vaginal delivery. On an average, IDMs had a longer duration of hospital stay. Outcome was more fatal in IDMs. About six (20%) of IDMs died compared to two (9.5%) of the non-IDMs. That was found statistically significant (p=<0.05).Conclusion: LGA babies with diabetic mother had more adverse outcome in terms of mortality and blood glucose level. More concentration is needed to control blood glucose of mother during pregnancy. Also extra care for the babies is needed to avoid fatal neonatal outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 25-30

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