Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

Abstract Background Offspring of women with type 1 diabetes are at increased risk of accelerated fetal growth which is associated with perinatal morbidity. Growth standards are used to identify large- or small- for gestational age (LGA, SGA) infants. Our aim was to examine which growth standards identify infants at risk of perinatal complications during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles calculated. Unadjusted logistic regression identified the associations between different growth standards and perinatal outcomes including preterm delivery, Caesarean delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. All standards were associated with some but not all perinatal outcomes studied. Infants born >97.7 th centile were at highest risk of complications. Conclusions WHO standards underestimated birthweight centile. GROW and INTERGROWTH standards identified similar numbers of infants as LGA and SGA with GROW showing stronger associations with neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants with suspected birthweight >97.7th centile according to any standard may require extra surveillance. Definitions of LGA and SGA should be re-evaluated in diabetic pregnancy.

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

10.21203/rs.3.rs-27918/v3 ◽

2020 ◽

Author(s):

Claire L Meek ◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura Caroline Kusinski ◽

Esther Lopez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Who Standards ◽

Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born >97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. Conclusions GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.Trial registration: This trial is registered with ClinicalTrials.gov. number NCT01788527.

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

10.21203/rs.3.rs-27918/v4 ◽

2021 ◽

Author(s):

Claire L Meek ◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura Caroline Kusinski ◽

Esther Lopez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Who Standards ◽

Nicu Admission

Abstract BackgroundOffspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).MethodsThis was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres (ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. ResultsAccelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born >97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. Conclusions GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

10.21203/rs.3.rs-27918/v1 ◽

2020 ◽

Author(s):

Claire L Meek ◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura Caroline Kusinski ◽

Esther Lopez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Who Standards ◽

Nicu Admission

Abstract BackgroundOffspring of women with type 1 diabetes are at increased risk of accelerated fetal growth which is associated with perinatal morbidity. Growth standards are used to identify large- or small- for gestational age (LGA, SGA) infants. Our aim was to examine which growth standards identify infants at risk of perinatal complications during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).MethodsThis was a pre-specified analysis of CONCEPTT involving 225 pregnant women from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles calculated. Unadjusted logistic regression identified the associations between different growth standards and perinatal outcomes including preterm delivery, Caesarean delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. ResultsAccelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. All standards were associated with some but not all perinatal outcomes studied. Infants born >97.7th centile using GROW or INTERGROWTH standards were at highest risk of complications. Conclusions WHO standards underestimated birthweight centile. GROW and INTERGROWTH standards identified similar numbers of infants as LGA and SGA with GROW showing stronger associations with neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants with suspected birthweight >97.7th centile using GROW or INTERGROWTH standards may require extra surveillance. Definitions of LGA and SGA should be re-evaluated in diabetic pregnancy. Trial registration: This trial is registered with ClinicalTrials.gov. number NCT01788527.

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03554-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claire L. Meek ◽

◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura C. Kusinski ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Link Type ◽

Who Standards ◽

Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres (ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes. Conclusions GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes. Trial registration This trial is registered with ClinicalTrials.gov. number NCT01788527. Trial registered 11/2/2013.

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199-LB: Low Prevalence of Small-for-Gestational-Age in Women with Type 1 Diabetes and Chronic Hypertension

Diabetes ◽

10.2337/db19-199-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 199-LB

Author(s):

SARIT HELMAN ◽

TAMARRA JAMES-TODD ◽

FLORENCE M. BROWN

Keyword(s):

Type 1 Diabetes ◽

Gestational Age ◽

Small For Gestational Age ◽

Chronic Hypertension ◽

Low Prevalence

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OC07.04: Stillbirth risk and small‐for‐gestational‐age rate in subgroups according to maternal size: comparison of GROW, WHO and IG21 fetal growth standards

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.22245 ◽

2020 ◽

Vol 56 (S1) ◽

pp. 19-19

Author(s):

A. Francis ◽

O. Hugh ◽

J. Gardosi

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Growth Standards ◽

Maternal Size

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The Risks of Adverse Neonatal Outcome Among Preterm Small for Gestational Age Infants According to Neonatal Versus Fetal Growth Standards

PEDIATRICS ◽

10.1542/peds.111.6.1273 ◽

2003 ◽

Vol 111 (6) ◽

pp. 1273-1277 ◽

Cited By ~ 87

Author(s):

W. Zaw ◽

R. Gagnon ◽

O. da Silva

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Outcome ◽

Growth Standards ◽

Adverse Neonatal Outcome

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Prediction of Late-Onset Small for Gestational Age and Fetal Growth Restriction by Fetal Biometry at 35 Weeks and Impact of Ultrasound–Delivery Interval: Comparison of Six Fetal Growth Standards

Journal of Clinical Medicine ◽

10.3390/jcm10132984 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2984

Author(s):

Ricardo Savirón-Cornudella ◽

Luis Mariano Esteban ◽

Rocío Aznar-Gimeno ◽

Peña Dieste-Pérez ◽

Faustino R. Pérez-López ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Detection Rate ◽

Late Onset ◽

University Hospital ◽

Detection Rates ◽

Growth Standards ◽

Fetal Biometry ◽

Increased Risk

Small-for-gestational-age (SGA) infants have been associated with increased risk of adverse perinatal outcomes (APOs). In this work, we assess the predictive ability of the ultrasound-estimated percentile weight (EPW) at 35 weeks of gestational age to predict late-onset SGA and APOs, according to six growth standards, and whether the ultrasound–delivery interval influences the detection rate. To this purpose, we analyze a retrospective cohort study of 9585 singleton pregnancies. EPWs at 35 weeks were calculated to the customized Miguel Servet University Hospital (MSUH) and Figueras standards and the non-customized MSUH, Fetal Medicine Foundation (FMF), INTERGROWTH-21st, and WHO standards. As results of our analysis, for a 10% false positive rate, the detection rates for SGA ranged between 48.9% with the customized Figueras standard (AUC 0.82) and 60.8% with the non-customized FMF standard (AUC 0.87). Detection rates to predict SGA by ultrasound–delivery interval (1–6 weeks) show higher detection rates as intervals decrease. APOs detection rates ranged from 27.0% with FMF to 7.9% with the Figueras standard. In conclusion, the ability of EPW to predict SGA at 35 weeks is good for all standards, and slightly better for non-customized standards. The APO detection rate is significantly greater for non-customized standards.

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Consecutive measurements show association of IGF-1 with fetal growth in type 1 diabetic pregnancy

Medical Research Archives ◽

10.18103/mra.v9i6.2429 ◽

2021 ◽

Vol 9 (6) ◽

Author(s):

Greta Dubietyte ◽

Karsten Kaiser ◽

Michael Nielsen ◽

Finn Lauszus

Keyword(s):

Blood Pressure ◽

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Growth Restriction ◽

The Other ◽

Z Score ◽

Different Levels ◽

In Pregnancy

Background: Abnormal fetal growth can lead to adverse outcomes in pregnancy as well in later postnatal life and is more prevalent in diabetic pregnancies. These are usually associated with large for gestational age neonates, an issue that has already been broadly examined. On the other side, diabetes in pregnancy can also relate to intrauterine growth restriction and small for gestational age neonates. During pregnancy, maternal IGF-1 is secreted excessively and additionally produced by placenta, which regulates transport of nutrients to the fetus acting through an IGF-receptor and accordingly affects its growth. As type 1 diabetes carries a higher risk of adverse events associated with fetal growth there is a natural focus on possible links between IGF-1 and fetal growth. Aim: The present study investigated the time-course relationship between the maternal serum IGF-1 and the birthweight as an obstetrical outcome in type 1 diabetic pregnancies with various levels of background risk. Methods: 130 pregnant women with type 1 diabetes were consecutively recruited for measurement of growth factors, genes affecting coagulation, evaluated for diabetes status, and perinatal outcome. The birthweight z-score was computed and grouped into tertiles for analysis of association with repeated measurements of IGF-1. Diurnal blood pressure was measured by monitor. Retinopathy grade was evaluated by two specialists independently, blinded of the clinical data. Blood samples for IGF-1 during pregnancy were drawn from week 6 and every 4th week until week 30, then every 2 nd week. Genomic DNA was extracted from peripheral blood. Results: The median of the lowest tertile of birthweight z-score was 0.4 (-1 - +1.3) and included more women with micro/macroalbuminuria than the middle and upper tertile; however, ¾ had normoalbuminuria and no further sign of surplus vasculopathy compared to the other tertile groups. The lowest birthweights were associated with a lower rise in IGF-1 from week 22 to 32. Neither glycemic control, genetics, grade of retinopathy, renal function nor vascular resistance indices in diurnal blood pressure were different between the tertile groups. Conclusion: Our main finding is that lower IGF-1 levels are associated with subsequent lower birthweight in diabetic pregnancy and is displayed markedly at the end of 2nd trimester. We hypothesize that the relative low birthweight, despite being within the limits of appropriate for gestational age may display inappropriate growth if not outright growth-restriction. We were able to discern different levels of growth at a critical point in pregnancy where ultrasound may pick up different levels of growth patterns and optimized care can be commenced.

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