Gestational Diabetes Mellitus and Macrosomia: A Literature Review

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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Gestational Diabetes Mellitus and Infant Adiposity at Birth: A Systematic Review and Meta-Analysis of Therapeutic Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10040835 ◽

2021 ◽

Vol 10 (4) ◽

pp. 835

Author(s):

Manoja P. Herath ◽

Jeffrey M. Beckett ◽

Andrew P. Hills ◽

Nuala M. Byrne ◽

Kiran D. K. Ahuja

Keyword(s):

Diabetes Mellitus ◽

Adipose Tissue ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fat Mass ◽

Metabolic Disorders ◽

Later Life ◽

Therapeutic Interventions ◽

Increased Risk ◽

The Impact

Exposure to untreated gestational diabetes mellitus (GDM) in utero increases the risk of obesity and type 2 diabetes in adulthood, and increased adiposity in GDM-exposed infants is suggested as a plausible mediator of this increased risk of later-life metabolic disorders. Evidence is equivocal regarding the impact of good glycaemic control in GDM mothers on infant adiposity at birth. We systematically reviewed studies reporting fat mass (FM), percent fat mass (%FM) and skinfold thicknesses (SFT) at birth in infants of mothers with GDM controlled with therapeutic interventions (IGDMtr). While treating GDM lowered FM in newborns compared to no treatment, there was no difference in FM and SFT according to the type of treatment (insulin, metformin, glyburide). IGDMtr had higher overall adiposity (mean difference, 95% confidence interval) measured with FM (68.46 g, 29.91 to 107.01) and %FM (1.98%, 0.54 to 3.42) but similar subcutaneous adiposity measured with SFT, compared to infants exposed to normal glucose tolerance (INGT). This suggests that IGDMtr may be characterised by excess fat accrual in internal adipose tissue. Given that intra-abdominal adiposity is a major risk factor for metabolic disorders, future studies should distinguish adipose tissue distribution of IGDMtr and INGT.

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Evaluation of post-delivery discharge plan on postpartum screening of mothers with gestational diabetes mellitus for type ii diabetes mellitus – a clinical audit

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.417 ◽

2021 ◽

Vol 46 ◽

pp. S690

Author(s):

E.M.S.S. Ehagama ◽

S.R. Rambukwella ◽

W. Abeykoon ◽

R. Jayatissa

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Type Ii Diabetes ◽

Clinical Audit ◽

Type Ii Diabetes Mellitus ◽

Type Ii ◽

Postpartum Screening ◽

Discharge Plan

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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 Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2020.1767572 ◽

2020 ◽

pp. 1-6

Author(s):

Roman Starikov ◽

Phinnara Has ◽

Robert Wu ◽

D. Michael Nelson ◽

Mai He

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Small For Gestational Age ◽

Adverse Outcomes ◽

Type I ◽

Type Ii ◽

Increased Risk

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Impact of the Implementation of New WHO Diagnostic Criteria for Gestational Diabetes Mellitus on Prevalence and Perinatal Outcomes: A Population-Based Study

Journal of Pregnancy ◽

10.1155/2016/2670912 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Katja Erjavec ◽

Tamara Poljičanin ◽

Ratko Matijević

Keyword(s):

Diabetes Mellitus ◽

Caesarean Section ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Diagnostic Criteria ◽

Apgar Score ◽

Perinatal Outcomes ◽

Labor Induction ◽

Increased Risk ◽

The Impact

Objectives. To determine the impact of the implementation of new WHO diagnostic criteria for gestational diabetes mellitus (GDM) on prevalence, predictors, and perinatal outcomes in Croatian population.Methods. A cross-sectional study was performed using data from medical birth certificates collected in 2010 and 2014. Data collected include age, height, and weight before and at the end of pregnancy, while perinatal outcome was assessed by onset of labor, mode of delivery, and Apgar score.Results. A total of 81.748 deliveries and 83.198 newborns were analysed. Prevalence of GDM increased from 2.2% in 2010 to 4.7% in 2014. GDM was a significant predictor of low Apgar score (OR 1.656), labor induction (OR 2.068), and caesarean section (OR 1.567) in 2010, while in 2014 GD was predictive for labor induction (OR 1.715) and caesarean section (OR 1.458) only. Age was predictive for labor induction only in 2014 and for caesarean section in both years, while BMI before pregnancy was predictive for all observed perinatal outcomes in both years.Conclusions. Despite implementation of new guidelines, GDM remains burdened with increased risk of labor induction and caesarean section, but no longer with low Apgar score, while BMI remains an important predictor for all three perinatal outcomes.

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Antibiotic Use in Pregnancy, Abnormal Fetal Growth, and Development of Gestational Diabetes Mellitus

American Journal of Perinatology ◽

10.1055/s-0038-1669948 ◽

2018 ◽

Vol 36 (03) ◽

pp. 243-251 ◽

Cited By ~ 1

Author(s):

Janet Catov ◽

Tiffany Deihl ◽

Maisa Feghali ◽

Christina Scifres ◽

John Mission

Keyword(s):

Diabetes Mellitus ◽

Birth Weight ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Academic Medical Center ◽

Antibiotic Use ◽

Large For Gestational Age ◽

The Impact ◽

In Pregnancy

Objective Antibiotics are commonly used in pregnancy. Prior studies have indicated that antibiotic use in pregnancy may affect birth weight, whereas data in nonpregnant individuals suggest that antibiotic exposure may increase diabetes risk. We evaluated the impact of antibiotic prescriptions during pregnancy on the prevalence of small for gestational age (SGA) and large for gestational age (LGA) birth weight and gestational diabetes mellitus (GDM). Study Design This retrospective cohort study of 12,551 women who delivered at a large academic medical center between 2012 and 2014 assessed the number and type of antibiotic prescriptions prior to GDM testing using the electronic medical record. SGA and LGA birth weight and GDM rates were compared among women who were or were not prescribed antibiotics. Results Overall, 3,991 (31.8%) of 12,551 patients received at least one antibiotic prescription. After covariate adjustment, no differences existed in risk of SGA (adjusted odds ratio [aOR]: 1; 95% confidence interval [CI]: 0.88–1.15; p = 0.94), LGA (aOR: 1; 95% CI: 0.86–1.17; p = 0.97), or GDM (aOR: 0.90; 95% CI: 0.72–1.13; p = 0.36) between women who were or were not prescribed antibiotics. Conclusion Antibiotic use does not affect the risk of SGA or LGA birth weight or GDM in pregnant women. These results provide reassurance regarding the use of antibiotics when clinically indicated in pregnancy.

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Gestational Diabetes Mellitus: Physical Exercise and Health Outcomes

Biological Research For Nursing ◽

10.1177/1099800408323728 ◽

2008 ◽

Vol 10 (2) ◽

pp. 145-155 ◽

Cited By ~ 13

Author(s):

Carol A. Snapp ◽

Sue K. Donaldson

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Physical Exercise ◽

Gestational Diabetes Mellitus ◽

Infant Health ◽

Exercise Group ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Increased Risk ◽

Maternal Exercise

Purpose: Gestational diabetes mellitus (GDM) is a serious complication of pregnancy associated with increased risk of adverse outcomes for both mother and infant. This study assesses the association of maternal exercise during GDM pregnancy and selected maternal and infant adverse GDM-related outcomes. The analysis uses information derived from the 1988 National Maternal Infant Health Survey (NMIHS) data. Methods: Women in the 1988 NMIHS database were identified and grouped as to having experienced a non-GDM (n = 2,952,482) or GDM (n = 105,600) pregnancy. Non-GDM and GDM groups were compared as to demographic and personal-attribute variables. The second part of this study focused on the women with GDM pregnancy, specifically a subset (n = 75,160) who met inclusion/exclusion criteria for the study of exercise during pregnancy. Each was categorized to either the exercise group or the nonexercise group. Results: The non-GDM and GDM groups of pregnant women were not different as to the variables studied, except that older age and increased body mass index (BMI) were associated with GDM pregnancy. For the study of exercise during GDM pregnancy, the only variable that was associated with the exercise group was size of the infant. Participants in the exercise group were less likely than those in the nonexercise group to have delivered a large for gestational age (LGA) infant (F [1, 4314] = 9.82, p = .0017). Implications: The results of this study suggest that moderate maternal leisure time physical exercise during GDM pregnancy may reduce the risk of delivery of an LGA infant.

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Early gestational diabetes mellitus (GDM) is associated with worse pregnancy outcomes compared with GDM diagnosed at 24–28 weeks gestation despite early treatment

QJM ◽

10.1093/qjmed/hcaa167 ◽

2020 ◽

Author(s):

M Mustafa ◽

D Bogdanet ◽

A Khattak ◽

L A Carmody ◽

B Kirwan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnancy Outcomes ◽

Neonatal Intensive Care ◽

Adverse Pregnancy Outcome ◽

Post Partum ◽

Large For Gestational Age ◽

Iadpsg Criteria ◽

Adverse Pregnancy

Summary Background Gestational diabetes mellitus (GDM) is associated+ with adverse pregnancy outcomes compared with women with normal glucose tolerance in pregnancy. The WHO recommends screening at 24–28 weeks gestation for GDM. Women who are diagnosed before 24–28 weeks gestation have a longer intervention period which may impact positively on pregnancy outcomes. Aim This study aimed to examine pregnancy outcomes of women with GDM diagnosed <24 weeks gestation compared with those diagnosed at 24–28 weeks in a large Irish cohort. Methods A retrospective cohort study of 1471 pregnancies in women with GDM diagnosed using IADPSG criteria between September 2012 and April 2016 was conducted. At GDM diagnosis, women were classified as early GDM <24 weeks or standard GDM 24–28 weeks gestation. Results Women with early GDM had a significantly greater risk of pregnancy-induced hypertension (12.4% vs. 5.3%; P < 0.05), post-partum haemorrhage (8.7% vs. 2.4%; P < 0.05) and post-partum glucose abnormalities (32% vs. 15.6%; P < 0.05). Their offspring had a greater risk of pre-maturity (10.9% vs. 6.6%; P < 0.05), stillbirth (1.4% vs. 0.5%; P < 0.05), large for gestational age (19.1% vs. 13.4% P < 0.05) and need neonatal intensive care (30.7% vs. 22.1%; P < 0.05) compared with offspring of women with standard GDM. Rates of C-section and pre-maturity were still higher in the early GDM group when the two groups where compared based on their post-natal OGTT. Conclusion Early GDM women and their offspring are at greater risk of an adverse pregnancy outcome compared with those diagnosed at 24–28 weeks. In view of the abnormal post-natal glucose findings, early GDM may reflect a more advanced state in diabetes pathogenesis.

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Gestational Diabetes Mellitus is associated with increased risk of Non-Alcoholic Fatty Liver Disease: A population-based cohort study

Endocrine Abstracts ◽

10.1530/endoabs.56.gp92 ◽

2018 ◽

Author(s):

Aikaterini Lavrentaki ◽

Anuradhaa Subramanian ◽

G Neil Thomas ◽

George Valsamakis ◽

Konstantinos Toulis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Liver Disease ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Fatty Liver Disease ◽

Population Based ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Alcoholic Fatty Liver Disease

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Gestational Diabetes Mellitus Treatment Schemes Modify Maternal Plasma Cholesterol Levels Dependent to Women´s Weight: Possible Impact on Feto-Placental Vascular Function

Nutrients ◽

10.3390/nu12020506 ◽

2020 ◽

Vol 12 (2) ◽

pp. 506 ◽

Cited By ~ 1

Author(s):

Susana Contreras-Duarte ◽

Lorena Carvajal ◽

María Jesús Garchitorena ◽

Mario Subiabre ◽

Bárbara Fuenzalida ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Vascular Function ◽

Plasma Cholesterol ◽

Umbilical Vein ◽

Maternal Plasma ◽

Maternal Weight ◽

Cholesterol Levels ◽

The Impact

Gestational diabetes mellitus (GDM) associates with fetal endothelial dysfunction (ED), which occurs independently of adequate glycemic control. Scarce information exists about the impact of different GDM therapeutic schemes on maternal dyslipidemia and obesity and their contribution to the development of fetal-ED. The aim of this study was to evaluate the effect of GDM-treatments on lipid levels in nonobese (N) and obese (O) pregnant women and the effect of maternal cholesterol levels in GDM-associated ED in the umbilical vein (UV). O-GDM women treated with diet showed decreased total cholesterol (TC) and low-density lipoproteins (LDL) levels with respect to N-GDM ones. Moreover, O-GDM women treated with diet in addition to insulin showed higher TC and LDL levels than N-GDM women. The maximum relaxation to calcitonin gene-related peptide of the UV rings was lower in the N-GDM group compared to the N one, and increased maternal levels of TC were associated with even lower dilation in the N-GDM group. We conclude that GDM-treatments modulate the TC and LDL levels depending on maternal weight. Additionally, increased TC levels worsen the GDM-associated ED of UV rings. This study suggests that it could be relevant to consider a specific GDM-treatment according to weight in order to prevent fetal-ED, as well as to consider the possible effects of maternal lipids during pregnancy.

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