scholarly journals Combined Effect of Maternal Vitamin D Deficiency and Gestational Diabetes Mellitus on Trajectories of Ultrasound-Measured Fetal Growth: A Birth Cohort Study in Beijing, China

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Zheng Liu ◽  
Hui Liu ◽  
Xiangrong Xu ◽  
Shusheng Luo ◽  
Jue Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Birth Cohort ◽  
Fetal Growth ◽  
Reference Population ◽  
Abdominal Circumference ◽  
Birth Cohort Study ◽  
Increased Risk ◽  
Beijing China

Objective. Few studies have examined whether maternal 25(OH)D deficiency and gestational diabetes mellitus (GDM) jointly affect fetal growth. We aimed to examine the separate and combined effects of maternal 25(OH)D deficiency and GDM on trajectories of fetal growth. Methods. We established a birth cohort (2016-2017) with 10,913 singleton pregnancies in Tongzhou Maternal and Child Health Hospital of Beijing, China. Maternal 25(OH)D deficiency (serum 25OHD concentration<20.0 ng/mL) was detected, and GDM was diagnosed at 24~28 gestational weeks. Fetal growth was assessed by longitudinal ultrasound measurements of estimated fetal weight (EFW) and abdominal circumference (AC) from 28 gestational weeks to delivery, both of which were standardized as gestational-age-adjusted Z-score. A k-means algorithm was used to cluster the longitudinal measurements (trajectories) of fetal growth. Logistic regression models were used for estimating exposure-outcome associations and additive interactions. Results. We identified two distinct trajectories of fetal growth, and the faster one resembling the 90th centile curve in the reference population was classified as excessive fetal growth. Maternal 25(OH)D deficiency and GDM were independently associated with an increased risk of excessive fetal growth. The combination of maternal 25(OH)D deficiency and GDM was associated with an increased risk of excessive fetal growth assessed by EFW Z-score (odds ratio (OR): 1.36; 95% confidence interval (CI): 1.15~1.62) and AC Z-score (OR (95% CI): 1.32 (1.11~1.56)), but the relative excess risks attributable to interaction were nonsignificant (P>0.05). Conclusion. Maternal 25(OH)D deficiency and GDM may jointly increase the risk of excessive fetal growth. Interventions for pregnancies with GDM may be more beneficial for those with 25(OH)D deficiency than those without regarding risk of excessive fetal growth, if confirmed in a large sample.

scholarly journals Use of Prophylactic Iron Salts Supplementation During Gestation and Development of Gestational Diabetes Mellitus in Women From 2015 Pelotas (Brazil) Birth Cohort Study

2021 ◽  
Author(s):  
Vanessa Iribarrem Avena Miranda ◽  
Tatiane da Silva Dal Pizzol ◽  
Marysabel Pinto Telis Silveira ◽  
Sotero Serrate Mengue ◽  
Mariângela Freitas Silveira ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Birth Cohort ◽  
Iron Supplementation ◽  
Deficiency Anemia ◽  
Birth Cohort Study ◽  
Iron Salts ◽  
Increased Risk

Abstract Background This study aims to evaluate the association between the use of iron salts during the first two trimesters in non-anemic women and the development of gestational diabetes mellitus (GDM). Methods The study used maternal data from 2015 Pelotas Birth Cohort. All non-anemic women at 24th week (N = 2463) were eligible for this study. GDM was self-reported by women. Crude and adjusted logistic regression were performed considering level of significance = 0.05. Results Among the women studied, 69.7% were exposed to prophylactic iron supplementation in the two first trimesters of gestation. The prevalence of GDM among those exposed was 8.7% (95%CI 7.4–10.1) and among those who were not exposed was 9.3% (CI95% 7.4–11.6). Iron supplementation was not associated with increased risk of GDM in crude (OR = 0.9; 95%CI 0,7–1,3) and adjusted analysis (OR = 1.1; 95% CI 0,8–1,6). Conclusions The results suggested that routine iron use in non-anemic pregnant women does not increase the risk of developing gestational diabetes. This evidence supports the existing national and international guidelines, whose recommendation is prophylactic iron supplementation for all pregnant women as soon as they initiate antenatal care in order to prevent iron deficiency anemia.

Association between maternal antimony exposure and risk of gestational diabetes mellitus: A birth cohort study

Chemosphere ◽  
2020 ◽  
Vol 246 ◽  
pp. 125732 ◽  
Author(s):  
Qianqian Zhang ◽  
Xiaona Li ◽  
Xin Liu ◽  
Moran Dong ◽  
Jianpeng Xiao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Birth Cohort ◽  
Birth Cohort Study

scholarly journals Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22–24 Weeks: A Retrospective Cohort Study of Medical Records

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3645
Author(s):  
Danyao Jin ◽  
Janet Wilson Rich-Edwards ◽  
Chunyi Chen ◽  
Yue Huang ◽  
Yinping Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Medical Records ◽  
Generalized Estimating Equations ◽  
Abdominal Circumference ◽  
Fetal Head ◽  
Femur Length ◽  
Fetal Size

Early intervention of gestational diabetes mellitus (GDM) is effective in reducing pregnancy disorders. Fetal growth, measured by routine ultrasound scan a few weeks earlier before GDM diagnosis, might be useful to identify women at high risk of GDM. In the study, generalized estimating equations were applied to examine the associations between ultrasonic indicators of abnormal fetal growth at 22–24 weeks and the risk of subsequent GDM diagnosis. Of 44,179 deliveries, 8324 (18.8%) were diagnosed with GDM between 24 and 28 weeks. At 22–24 weeks, fetal head circumference (HC) < 10th, fetal femur length (FL) < 10th, and estimated fetal weight (EFW) < 10th percentile were associated with 13% to 17% increased risks of maternal GDM diagnosis. Small fetal size appeared to be especially predictive of GDM among women who were parous. Fetal growth in the highest decile of abdominal circumference (AC), HC, FL and EFW was not associated with risk of subsequent GDM. The observed mean difference in fetal size across gestation by GDM was small; there was less than 1 mm difference for AC, HC, and FL, and less than 5 g for EFW before 24 weeks. Despite similar mean fetal growth among women who were and were not later diagnosed with GDM, mothers with fetuses in the lowest decile of HC, FL and EFW at 22–24 weeks tended to have higher risk of GDM.

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

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&lt;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.

scholarly journals Myoinositol plus α-lactalbumin supplementation, insulin resistance and birth outcomes in women with gestational diabetes mellitus: a randomized, controlled study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rosario D’Anna ◽  
Francesco Corrado ◽  
Saverio Loddo ◽  
Giuseppe Gullo ◽  
Loretta Giunta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Folic Acid ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Clinical Outcomes ◽  
Fetal Growth ◽  
Treated Group ◽  
Abdominal Circumference ◽  
Reduce Insulin Resistance

AbstractTo verify whether myo-inositol plus α-lactalbumin may reduce insulin resistance and excessive fetal growth in women with gestational diabetes mellitus. In a 12-month period, 120 women with a diagnosis of gestational diabetes mellitus were consecutively enrolled with an allocation of 1:1 in each group and randomly treated with myo-inositol plus α-lactalbumin plus folic acid (treated group) or folic acid (control group) for 2 months. Primary outcome was the variation of insulin resistance through the study evaluated by HOMA-IR. Secondary outcome was the evaluation, through the study, of fetal growth by ultrasound measurements of abdominal circumference centiles and estimated fat thickness. Some clinical outcomes were also considered. After 2 months, in the treated group, a significant reduction in insulin resistance (HOMA values 3.1 ± 1.4 vs 6.1 ± 3.4, p = 0.0002) and fetal growth was shown (Abdominal circumference centiles 54.9 ± 23.5 vs 67.5 ± 22.6, P = 0.006). Among clinical outcomes, a significant decrease in the rate of women who needed insulin (6.7% vs 20.3%, p = 0.03) and of pre-term birth (0 vs 15.2%, p = 0.007) was evidenced. A combination of myo-inositol and α-lactalbumin may reduce insulin resistance and excessive fetal growth.Clinical trial registration: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT 03763669, first posted date 04/12/2018; last posted date December 06/12/2018.

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