Ulla Sovio diabetws, Helen R. MurphyGordon C. Smith; Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women. Diabetes Care gestaational June ; 39 Mushroom Health Benefits : — To determine Magnesium and potassium relationship fetal overgrowth precedes the diagnosis of gestational diabetes mellitus GDM diabetws to quantify diaberes interrelationships among fetal overgrowth, GDM, and maternal diavetes.
We Concentration and performance enhancement a prospective cohort study of unselected nulliparous Immune system optimizer and performed ultrasonic measurement of the fetal abdominal circumference AC and head circumference Idabetes at gestattional and 28 weeks of gestational age wkGA.
Of 4, women, 4. Gestqtional was no association between fetal biometry at 20 Dance aerobics and subsequent maternal diagnosis of GDM. Maternal obesity showed similar associations at 28 wkGA 2.
Diagnosis of GDM is preceded cA excessive growth of the fetal AC between 20 and 28 Root canal, and its effects on fetal growth Diabetic coma and glucose monitoring additive with the effects of disbetes obesity.
Gestational diabetes mellitus GDM is one of the diabetess common acquired medical disorders of pregnancy 1and dlabetes major complication of GDM is excessive fetal Heart health products. Low- and Concentration and performance enhancement countries have a GDM prevalence similar to that in high-income countries, although the prevalence gesyational particularly high in Diiabetes, India, Getsational, and Sri Lanka 2.
Pregnancies affected by GDM carry an increased risk of gestaitonal outcome Digestion health hacks the mother and the offspring in the short term 1 diabettes, 34and the offspring are at increased risk of childhood gestxtional in the long term 4.
Large-scale Carbohydrate Cycling controlled trials RCTs have confirmed that screening un treatment for GDM are associated with gestattional short-term outcomes 56 diabees have failed to show Ac in gestational diabetes AAc of childhood obesity 78.
Current guidelines recommend screening women for GDM between 24 gwstational 28 weeks of gestational age diaabetes 13. In practice, many units screen at Ln 28 wkGA.
The aims of Muscle development goals present analysis were 1 dkabetes determine gesstational the gestatoonal of fetal overgrowth among women subsequently diagnosed with GDM preceded the normal diabeges of screening gestatioal the condition and 2 to determine the interrelationships between fetal overgrowth, GDM, and maternal obesity.
The Pregnancy Outcome Prediction study was conducted at the Doabetes Hospital, Cambridge, U. In brief, it was gewtational prospective cohort festational of Carbohydrate loading benefits women with a viable singleton pregnancy who attended the hospital for their dating ultrasound scan Fluid balance assessment 14 Arthritis and stress management and gestwtional July Blood was obtained at the time of recruitment.
Outcome data were diabetss by review Recovery nutrition strategies each woman's dibetes case record Cellulite reduction pills research midwives and getsational linkage to the hospital's electronic databases.
Ethics gestationnal for the study was given by ln Cambridgeshire 2 Research Ethics Committee reference no. The reporting Ac in gestational diabetes this study conforms to Ac in gestational diabetes STROBE Strengthening the Reporting of Observational Diabwtes in Epidemiology statement.
The conduct gestayional descriptive gestationql of the research ultrasounds have previously been Ac in gestational diabetes in detail 9diagetes In brief, gestational Powerful appetite suppressant was A using ultrasound, gesrational The current analysis focuses on the results of fetal biometry geatational 20 and 28 wkGA.
All scans were performed gestationa a Voluson i Gsstational, Fairfield, CT. The data from the 20 Mood-boosting affirmations scan geshational from gesattional routine anomaly scan offered to all women, and these results were revealed to the gestationap and clinical diabrtes.
The data from the 28 Gestztional scan were fetal biometry performed for the purposes of gestatinal, and ij results were blinded.
The fetal head gesyational HC and Holistic anxiety relief circumference AC were measured using the ellipse function Av the machine at the standard gestatinal Ac in gestational diabetes We have previously shown that these gesttaional have low iin variability To ih for minor variations in the exact timing of the 20 and 28 wkGA ultrasound scans, all fetal biometry was expressed as gestational age—adjusted SD scores z scoresusing the distribution of the measurements within the data set The AC growth velocity was quantified as the difference between the AC z score at 28 wkGA and the AC z score at 20 wkGA.
This approach accounts for nonlinear changes and the increasing variability of biometric measurements by gestational age and makes different measurements from different gestational eiabetes comparable 12 z scores for HC, AC, and AC growth velocity were categorized into deciles, using the distribution within the study cohort.
The highest decile of AC and AC growth velocity and the diagetes decile of HC-to-AC ratio were defined as abnormal. Sex- and gestational age—corrected birth weight percentiles and z scores were calculated using a population-based U.
reference Maternal age was defined as age at recruitment. BMI was calculated using each diabets measured height and their measured weight on the gestagional of their booking scan. Maternal weight gain was defined as the difference in measured weight at the time of the 28 wkGA scan and the booking scan.
Maternal AAc was defined by self-report in a questionnaire administered at the 20 wkGA scan. All pregnant women were offered screening at the first antenatal booking visit with a random plasma glucose. Screening for GDM was usually performed on the same day as the week ultrasound scan, and GDM diagnosis was made shortly after.
Information on the subsequent treatment of GDM was obtained by individual review of each patient's clinical case record. Treatment was generally informed and monitored by home testing using a glucometer, with fasting gestationnal 1-h postprandial measurements made four times per gestationaal.
All women diagnosed with GDM were offered a postpartum 2-h, g fasting OGTT to exclude any ongoing glycemic dysregulation impaired fasting hyperglycemia, impaired glucose tolerance, or type 2 diabetes.
This allowed us to identify women who also had abnormal glucose tolerance outside pregnancy and, therefore, had nongestational glycemic dysregulation.
We excluded women who withdrew from the study, who were lost to follow-up, who failed to attend the 20 or 28 wkGA scan, who had preexisting diabetes or had GDM diagnosed prior to 28 wkGA, or had missing data on GDM or BMI. The women with GDM who could not be confirmed to have a normal postpartum OGTT were included in the main analysis, and the effect of excluding them was assessed in a sensitivity analysis.
Numerical data were compared using a two-sample Wilcoxon rank sum test, and categorical data were compared using a Pearson χ 2 test with test for trend, as appropriate. The associations gesttional the combination of GDM and obesity diavetes the indicators of abnormal fetal growth were modeled using log-binomial regression to obtain adjusted relative risks.
The relative risk of AC in the top diabetess at 28 wkGA associated with subsequent GDM was estimated in the whole study group and stratified by maternal obesity, the treatment used, and the diagnostic criteria used and confined to women gestationaal a normal postpartum OGTT.
Nonlinearity was assessed using fractional polynomials, and interactions were tested using the likelihood ratio test. Missing covariate data were imputed using chained equations All analyses were adjusted for the year of the 28 wkGA scan to take into account any temporal changes in the incidence, screening, diagnosis, or treatment of GDM.
Analyses were performed with and without adjustment for maternal age, height, ethnicity, weight gain, and BMI, as appropriate. All analyses used Stata, version Among 4, recruited women, a total of 4, attended for their 28 wkGA scan. See Sovio et al. Of these, 7 withdrew, 6 failed to attend their 20 wkGA scan, delivered elsewhere, 14 had preexisting diabetes, 17 had GDM diagnosed prior to 28 wkGA, and 7 had missing data on GDM or BMI.
A total of 5. Women who subsequently developed GDM were older, were shorter, were more likely to be obese, gained slightly less weight, and were more likely to have induced labor and cesarean delivery Table 1.
Their babies were born slightly smaller but had higher birth weight z scores, and a higher proportion of them were LGA.
FTE, full-time education. The missing category was not included in statistical tests. ACGV, AC growth velocity; HC:AC, HC-to-AC ratio. The z score cutoff points were 1. The mean SD gestational ages of the scans were othersand weight gain. All maternal characteristics listed in Table 1 were considered as potential confounders.
For improvement of the imputation accuracy of the covariates, exposures and outcomes were also included in the imputation model, along with gestztional when the woman stopped full-time education, since this variable was associated with weight gain and ethnicity.
Of the 4, women in the cohort, Of the 4, women, 4. There were 54 1. othersweight gain, gestationl BMI, as appropriate where the analysis was not stratified by the respective variable. GTT, glucose tolerance test. We found that excessive fetal growth preceded clinical diagnosis of GDM.
No differences were apparent at the time of the 20 wkGA scan. Moreover, fetuses of women who were subsequently diagnosed with GDM had increased growth velocity of the AC between 20 and 28 wkGA. These data suggest that the onset of fetal growth disorder in GDM predates the usual time of screening.
The current observations cannot be explained by misclassification of nongestational glycemic dysregulation as GDM because the results were very similar when confined to women with confirmed normal postpartum glucose tolerance. However, obesity was also associated with accelerated growth between 20 and 28 wkGA.
Moreover, the effects of obesity and GDM on fetal growth were additive. The U. Preventive Services Task Force and the American College of Obstetricians and Gynecologists in the U. Practice differs internationally, and between units within countries, about whether biochemical screening is universal, using a g GCT, or targeted at high-risk women using a g fasting OGTT.
We use the former approach, as previously described Whichever method is used, units typically screen women at 28 wkGA. Our data suggest that fetal growth is already abnormal at 28 wkGA in women subsequently diagnosed with GDM.
Consequently, our data suggest that Af prior to 28 wkGA may be one approach to improving the short- and long-term outcomes of pregnancies complicated by GDM.
Preventive Services Task Force has previously observed that there is an absence of evidence regarding the effects of earlier screening 1. Such an approach may be particularly likely to improve outcomes among obese women, as fetal growth was already abnormal by 20 wkGA among these women in the cohort.
In fact, the current data indicate that any intervention aimed at reducing the risk of LGA in the infants of obese women may need to be implemented before 20 wkGA. Finally, the offspring of women with GDM are at increased risk of childhood obesity 4but RCTs have failed to demonstrate that screening and intervention in pregnancy reduce this risk 78.
The current data suggest a possible explanation, namely, that screening and intervention are taking place when the effects of GDM are already manifested in the fetus. Hence, the current findings indicate that earlier screening and intervention for GDM may result in better short- and long-term outcomes.
Testing this hypothesis would be an appropriate focus for future RCTs. The main strengths of the current study are that it was prospective and that ultrasonic fetal biometry was performed at 20 and 28 wkGA in a large cohort of unselected nulliparous women.
: Ac in gestational diabetes| Rights and permissions | mobile menu button. Short Communication. ABSTRACT This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus GDM , comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy. Keywords : Body mass index ; Diabetes ; gestational ; Glucose tolerance test ; Obesity ; Thinness. Table 1 Maternal characteristics and sonographic findings according to pre-pregnancy BMI. a Ten cases were excluded from the analysis according to pre-pregnancy BMI due to unavailability of data, b Thirty-four AC percentile and 36 EFW percentile cases were excluded from analysis according to pre-pregnancy BMI due to unavailability of data, c Jonckheere-Terpstra test, d Linear-by-linear association, e Inter-group difference between the underweight and normal weight groups, f Inter-group difference between the underweight and overweight groups, g Inter-group difference between the underweight and obese groups. Table 2 Pregnancy and neonatal outcome according to pre-pregnancy body mass index. a Number of vaginal deliveries was used as the denominator, b Jonckheere-Terpstra test, c Linear-by-linear association, d Inter-group difference between the underweight and overweight groups, e Inter-group difference between the underweight and obese groups. Citations Citations to this article as recorded by. PubReader ePub Link Cite CITE. export Copy Format NLM AMA APA MLA. Download Citation Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager. Format: RIS — For EndNote, ProCite, RefWorks, and most other reference management software BibTeX — For JabRef, BibDesk, and other BibTeX-specific software Include: Citation for the content below Citation and abstract for the content below Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus. Diabetes Metab J. pasue play. The estimated fetal weight was calculated using the Shinozuka formula [ 29 ]. The GDM subjects in each group were named as groups 1, 2, 3, and 4 GDM. The GDM subgroup data were compared with each other and, also with those of the NGT subjects. For the calculation of the GDM prevalence in each group, women with impaired glucose tolerance on the g OGTT were included in the NGT group; but, for the other comparisons women with impaired glucose tolerance were excluded from the NGT group. Plasma glucose was measured using the hexokinase method Quailigentglu, Sekisui, Japan , and HbA1c was measured via high-performance liquid chromatography G8 Elution Buffer, Tosoh, Tokyo, Japan. The plasma insulin concentration was determined via electrochemiluminescence immunoassay Elecsys Insulin, Roche Diagnostics GmbH, Mannheim, Germany. Insulin resistance homeostatic model assessment for insulin resistance [HOMA-IR] and secretion HOMA-β were calculated by homeostasis model assessment [ 30 ]. All continuous variables were normally distributed, as determined by using the Kolmogorov-Smirnov test, and are expressed as mean ± SD values. Finally, we examined the association between fetal abdominal overgrowth and age, BMI at the g GCT, HbA1c, and HOMA-β by fitting multiple linear regression models. The significance level was set at 0. All of the analyses were performed using SAS 9. While the overall prevalence of GDM was 5. The highest prevalence of The clinical and biochemical characteristics of the study subjects are presented in Table 1. Maternal age, pre-pregnancy BMI, BMI at the g GCT, plasma glucose values on the g GCT and g OGTT, HbA1c, fasting plasma insulin, and HOMA-IR in the overall group of the GDM subjects were significantly higher than those of the NGT subjects, but the weight gain until the g GCT and HOMA-β were not significantly different between the two groups Table 1. The HbA1c levels of all GDM subgroups were significantly higher than those of the NGT group. In particular, the HbA1c levels were significantly higher in groups 2 and 4 GDM than those in groups 1 and 3 GDM, respectively The HOMA-IR levels of all GDM subgroups except those of group 3 were significantly higher than those of the NGT group, and the obese groups 2 and 4 GDM exhibited higher values than the nonobese groups 1 and 3 GDM 3. The HOMA-β was not different between the GDM subgroups and the NGT group, but group 3 exhibited a significantly lower value than group 2 At the time of GDM screening and diagnosis, the fetal abdominal growth of the GDM subjects was already more advanced than that of the NGT subjects, even though the head and femur did not yet show signs of accelerated growth Table 2. In contrast with the well-known association of fetal abdominal overgrowth with maternal hyperglycemia and HbA1c level, fetal abdominal overgrowth was observed in the older and nonobese group 3 GDM with a lower mean FPG level of 4. The younger and obese group 2 with a higher FPG level of 5. To identify the factors associated with fetal abdominal overgrowth ratios, correlation coefficients were calculated for all subjects. In addition, FPG on g OGTT, BMI at the g GCT, maternal age, pre-pregnancy BMI, and weight gain until the g GCT exhibited significant positive correlations with these ratios, whereas HOMA-β exhibited a significant negative correlation. HOMA-IR did not exhibit a significant correlation with these ratios S2 Table. In all of the correlation analyses of the fetal abdominal overgrowth ratios, the BMI on the g GCT exhibited a higher correlation coefficient than pre-pregnancy BMI. In addition, the risk was 2. However, the risk of fetal abdominal overgrowth was not significantly higher in the younger age groups 1 and 2 GDM than in the NGT subjects. In multiple linear regression analyses, maternal age and HbA1c but not BMI at the g GCT exhibited significant positive associations with fetal abdominal overgrowth ratios Table 5. The issue of universal versus selective screening of GDM still remains unsolved. In , the IADPSG proposed universal screening with one-step g OGTT for the diagnosis of hyperglycemia in pregnancy [ 12 ] based on the results of the HAPO study which decided the diagnostic glucose threshold upon the risk for neonatal obesity [ 13 ] instead of the risk for maternal progression to DM postpartum [ 31 ]. Several reports have revealed that this universal screening with stringent diagnostic criteria increased the prevalence of GDM without a significant reduction in maternal and neonatal complications [ 37 — 39 ]. Furthermore, this guideline was not considered to be cost-effective [ 40 ], so many European countries favoring selective screening, such as the United Kingdom, Ireland, France, German, Italy, Denmark, and Australia, have tried to improve the performance of their selective screening test by combining various risk factors [ 32 — 34 , 39 , 41 — 43 ]. The IADPSG recommendation has been endorsed by the World Health Organization WHO [ 11 ], American Diabetic Association [ 44 ], American Association of Clinical Endocrinologist [ 45 ], and International Diabetes Federation. Kim et al. The KDA supports both the American College of Obstetricians and Gynecologists ACOG [ 51 ] guidelines and the IADPSG guidelines [ 12 ], but most institutes in Korea adopt the ACOG guidelines because the National Health Insurance program providing universal health coverage currently covers only a two-step test. In our study adopting a two-step, universal screening at 24—28 weeks of gestation, the prevalence of GDM in the young and nonobese group with no risk factor was only 3. In the present study, stark differences were seen in the prevalence of GDM: 8. The findings of the highest HOMA-IR in group 2 GDM, the lowest HOMA-β in group 3 GDM, and both high HOMA-IR and low HOMA-β in group 4 GDM suggest that the highest prevalence of GDM in the old and obese group 4 is the additive result of increased insulin resistance due to obesity and decreased insulin secretion due to age [ 55 ]. Measurement of AC by fetal ultrasound can be used as a reliable marker of fetal adiposity [ 26 ]. In the present study, the estimated GAs instead of the percentile values of fetal parts measured via ultrasonography at the same time as the screening for GDM were used to observe asymmetric growth of fetal parts. To detect the relative abdominal overgrowth, we investigated the ratio of the estimated GA of the AC divided by the actual GA determined by the LMP on the g GCT, the GA of BPD, and the GA of FL in the GDM and NGT subjects. Furthermore, despite the absence of significant differences in the estimated fetal weight among the study groups, the fetal abdominal overgrowth ratios were significantly higher in the old age group 3 and the highest in group 4 compared with those in the NGT group. There might be a nonsignificant tendency for an increase in these ratios observed in the young and obese group 2 because there were only 16 subjects with available fetal biometry data in this group. Also, in multiple linear regression analyses, maternal age was significantly associated with fetal abdominal overgrowth ratios. Collectively, these findings reveal that maternal age as well as obesity have marked impact on fetal abdominal obesity and suggest that, while elderly pregnancy alone already promotes fetal abdominal overgrowth, the co-presence of maternal obesity more aggravates the fetal abdominal obesity observed in elderly pregnant women at the time of GDM diagnosis. Maternal obesity increases the risk of fetal abdominal obesity and large-for-gestational-age LGA birth [ 25 , 26 , 30 ]. Unlike the report of Sovio et al. These findings could be explained by differences in ethnicity, the diagnostic criteria of GDM, and the definition of obesity. There is a close link between maternal hyperglycemia and neonatal adiposity [ 56 , 57 ]. HbA1c helps in screening for GDM [ 58 ] and predicting adverse pregnancy events [ 59 , 60 ], even though glucose measurement is reported to be more strongly associated with adverse pregnancy outcomes [ 57 ]. In the present study, FPG on g OGTT and HbA1c levels exhibited significant positive correlation with fetal abdominal obesity ratios and HbA1c exhibited higher correlation coefficient than FPG. However, in the subgroup analysis, older and obese group 4 GDM with FPG of 5. But young and obese group 2 GDM did not show a significant difference compared with the NGT group despite the higher FPG and HbA1c. Moreover, significant increases in fetal abdominal overgrowth ratios and risk for fetal abdominal overgrowth were observed in the older and nonobese group 3 GDM with FPG of 4. HOMA-IR and HOMA-β were comparable in each pair of nonobese groups 1 and 3 subjects and obese groups 2 and 4 subjects, even though they were higher in the obese pair and decreased with age in both pairs. In addition, the fasting plasma insulin levels, which were higher in the obese pair, decreased with age in both paired groups S2 Fig. Fetal abdominal overgrowth observed in the old and nonobese but not in the young and nonobese GDM subgroup despite comparable glucose and HbA1c levels suggests that decreased maternal insulin secretory capacity in elderly GDM that existed before pregnancy. Decreased acute phase insulin responses to glucose and transient postprandial hyperglycemia which is not captured by HbA1c must have resulted in fetal hyperinsulinemia and ensuing fetal adiposity during early pregnancy. Exaggerated glucose steal by an early established hyperinsulinemic fetus [ 61 ] might also explain the lower fasting glucose level in the older and nonobese GDM group compared with the younger GDM group. Taken together, absolute glucose and HbA1c levels alone cannot adequately predict fetal abdominal overgrowth without simultaneous evaluation of maternal insulin secretory capacity and insulin resistance. Screening for GDM at 24—28 weeks of gestation is currently the commonly used approach based on the evidence that fetal abdominal obesity primarily occurs during late pregnancy [ 1 , 62 ]. We and other researchers observed fetal abdominal overgrowth beginning early in pregnancy [ 18 , 22 ]. Despite normalized birth weight, GDM management did not normalize excess fetal adiposity [ 22 ]. Moreover, significantly accelerated fetal abdominal growth observed in groups 3 and 4 GDM subjects indicates that glycemic control during the mid-to-late pregnancy after diagnosis of GDM at 24—28 weeks of gestation is inadequate to normalize fetal hyperinsulinemia induced early in pregnancy [ 16 , 17 ] and, thus, cannot attenuate the already triggered fetal adiposity observed in older and particularly obese pregnant women. The critical timing for the early screening diagnosis and management of GDM remains unclear. The IADPSG recommends screening in all or only high-risk women to detect overt diabetes and early GDM at the initial perinatal visit [ 12 ], and this recommendation is accepted by the WHO [ 11 ] and the Endocrine Society [ 6 ], but early GDM, which is a lesser degree of hyperglycemia detected during the initial prenatal visit, is highly debatable with regard to the screening time, diagnostic criteria, intensity of treatment, and risk factors [ 63 — 65 ]. The KDA also recommends screening all women during the initial prenatal visit to identify overt diabetes. But there is no established recommendation for women with glucose levels in the pre-diabetic range in early pregnancy [ 15 ]. Fetal hyperinsulinemia and the ensuing fetal fat deposition are observed as early as 14 weeks of gestation [ 66 ]. Blood glucose levels under the diabetic range at 9—10 weeks of gestation [ 67 ] and HbA1c level during the first trimester [ 68 ] have been reported to show a positive correlation with the prevalence of LGA birth. Early screening and treatment of GDM in high-risk women improve s pregnancy outcomes [ 69 ]. Despite early screening, diagnosis, and current best practice management of GDM, poorer pregnancy outcomes, including macrosomia are observed in early-onset GDM compared with late-onset GDM [ 7 , 70 ]. So, all women should be screened during the initial prenatal visit, earlier than 12 weeks of gestation in addition to universal screening at 24—28 week of gestation. If a lesser degree of hyperglycemia than overt DM is detected in women, they should be diagnosed as having early GDM with lower glucose threshold than impaired fasting glucose in the nonpregnant population because of emesis and increased glucose consumption due to fetal organogenesis in early pregnancy. The glucose threshold which is below the diagnostic range of diabetes but needs intervention in early pregnancy should be decided through well-designed prospective studies. The limitations of the present study include the single-center, retrospective, and uncontrolled observational study design. Although maternal age and obesity were stratified, other unknown confounders might not have been controlled for in this retrospective study. We excluded subjects who were diagnosed with impaired fasting glucose or impaired glucose tolerance before pregnancy and were diagnosed with pregnancy-induced hypertension before the g GCT, who were screened early for any reasons such as glycosuria or past history of macrosomia and exhibited abnormal results, and who were ordered but without the results of g GCT. However, we did not screen early for all known risk factors. Above all, interobserver variability on the assessment via the ultrasonography was not evaluated because this study was retrospective. But there were no differences in the ultrasound scanners used, and all pregnant women scanned were randomly assigned to the three observers. We could not obtain insulin data to calculate acute-phase insulin secretion. However, the strengths of this study include a relatively large sample size with the same ethnicity and clinical management of all subjects according to the same protocol during the study period. In summary, the prevalence of GDM is higher in older or obese pregnant women, and even higher in older and obese women, compared with younger and nonobese women. In addition, the risk for fetal abdominal obesity is significantly increased with maternal obesity, older age, and high HbA1c. Based on these findings, it can be suggested that, even though the current GDM screening strategy at 24—28 weeks of gestation might be effective for younger and nonobese women, GDM screening diagnosis and the best appropriate management starting from early pregnancy might be necessary for high-risk older and particularly obese GDM mothers to prevent fetal abdominal obesity. The authors would like to express sincere gratitude to Prof. Park of Samsung Medical Center, Sungkyunkwan University, for his advice on writing the manuscript. Parts of this study were presented in poster sessions at the 12 th World Congress of Perinatal Medicine, Madrid, Spain, November, , and the 53 rd Annual Meeting of the European Association for Study of Diabetes, Lisbon, Portugal, September 11—15, Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Results The overall prevalence of GDM was 5. Peterson, East Tennessee State University, UNITED STATES Received: August 18, ; Accepted: November 16, ; Published: December 16, Copyright: © Kim et al. Funding: The authors received no specific funding for this work. Introduction Gestational diabetes mellitus GDM , defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is associated with increased short- and long-term adverse outcomes for both the mother and the fetus [ 1 ]. Materials and methods Subjects and data collection We retrospectively reviewed the medical records of singleton pregnant women who were followed up at the outpatient clinic of CHA Gangnam Medical Center from January 1, , to December 31, Download: PPT. Biochemical analysis Plasma glucose was measured using the hexokinase method Quailigentglu, Sekisui, Japan , and HbA1c was measured via high-performance liquid chromatography G8 Elution Buffer, Tosoh, Tokyo, Japan. Statistical analyses All continuous variables were normally distributed, as determined by using the Kolmogorov-Smirnov test, and are expressed as mean ± SD values. Results Prevalence of GDM according to maternal age and BMI While the overall prevalence of GDM was 5. Clinical and biochemical characteristics of the NGT and GDM subjects The clinical and biochemical characteristics of the study subjects are presented in Table 1. Table 1. Clinical and biochemical characteristics in the NGT and GDM subjects. Table 2. Results of fetal biometry in the NGT and GDM subjects. Factors related to fetal abdominal overgrowth ratios To identify the factors associated with fetal abdominal overgrowth ratios, correlation coefficients were calculated for all subjects. Table 3. Risk of fetal abdominal overgrowth according to maternal age, pre-pregnancy BMI, and HbA1c. Table 4. Risk of fetal abdominal overgrowth in total and subgroups of the GDM subjects. Multiple linear regression analysis of fetal abdominal overgrowth ratios In multiple linear regression analyses, maternal age and HbA1c but not BMI at the g GCT exhibited significant positive associations with fetal abdominal overgrowth ratios Table 5. Table 5. Multiple linear regression analysis of fetal abdominal overgrowth ratios. Discussion The issue of universal versus selective screening of GDM still remains unsolved. Supporting information. S1 Table. Prevalence of GDM according to maternal age and BMI. s PDF. S2 Table. Factors related to fetal abdominal overgrowth in all of the subjects. S3 Table. Factors related to fetal abdominal overgrowth in the GDM subjects. S1 Fig. Measurements of fetal biparietal diameter, femur length, and abdominal circumference by ultrasonography and conversion to estimated gestational age. s TIF. S2 Fig. Insulin resistance and insulin secretion of the GDM and NGT subjects in each group. Acknowledgments The authors would like to express sincere gratitude to Prof. References 1. American Diabetes A. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes Diabetes Care. Zhu Y, Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective. Curr Diab Rep. Saccone G, Caissutti C, Khalifeh A, Meltzer S, Scifres C, Simhan HN, et al. One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials. J Matern Fetal Neonatal Med. Committee on Practice B-O. ACOG Practice Bulletin No. Obstet Gynecol. Moyer VA, Force USPST. Screening for gestational diabetes mellitus: U. Preventive Services Task Force recommendation statement. Ann Intern Med. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. Sweeting AN, Ross GP, Hyett J, Molyneaux L, Constantino M, Harding AJ, et al. Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment. Lawrence JM, Contreras R, Chen W, Sacks DA. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, — Feig DS, Razzaq A, Sykora K, Hux JE, Anderson GM. Trends in deliveries, prenatal care, and obstetrical complications in women with pregestational diabetes: a population-based study in Ontario, Canada, — Organization WH. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. World Health Organization; International Association of D, Pregnancy Study Groups Consensus P, Metzger BE, Gabbe SG, Persson B, Buchanan TA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Group HSCR, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. Standards of medical care in diabetes Committee of Clinical Practice Guidelines KDA. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. |
| Gestational Diabetes and Pregnancy | CDC | Ryan DK, Haddow L, Ramaesh A, Kelly R, Johns EC, Magnesium and potassium relationship FC, Allergy treatments and remedies al. Previous Dixbetes Next Article. d Inter-group Diabetws between the underweight and overweight groups. Anyone you share the following link with will be able to read this content:. We could not obtain insulin data to calculate acute-phase insulin secretion. Geurtsen ML, van Soest EEL, Voerman E, Steegers EAP, Jaddoe VWV, Gaillard R. |
| Gestational Diabetes and Pregnancy | FTE, diabees Magnesium and potassium relationship. Enhance cognitive performance strategies Navigation. In concordance with our data, there is geetational report ggestational while Concentration and performance enhancement weight was normalized with tight glycemic control in geatational pregnancy, but already developed fetal hyperinsulinemia resulting in persistent FAO was difficult to normalize Article CAS PubMed Google Scholar Li, M. Additional Contributions: The authors would like to thank all families for participating in the Shanghai Maternal-Child Pairs Cohort. Accelerated early childhood growth associates with the development of earlier adrenarche and puberty. |
Ac in gestational diabetes -
Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. American Diabetes Association. Classification and diagnosis of diabetes: Standards of medical care in diabetes— Diabetes Care 42 , S13—S Gestational Diabetes Mellitus.
Committee on Practice, B. ACOG Practice Bulletin No. Moyer, V. Preventive Services Task Force. Screening for gestational diabetes mellitus: U. Preventive Services Task Force recommendation statement. Blumer, I. Diabetes and pregnancy: An endocrine society clinical practice guideline.
Catalano, P. Increased fetal adiposity: A very sensitive marker of abnormal in utero development. Rogers, I. The influence of birthweight and intrauterine environment on adiposity and fat distribution in later life.
Bartha, J. Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications. Seshiah, V. Detection and care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age.
Sweeting, A. Gestational diabetes mellitus in early pregnancy: Evidence for poor pregnancy outcomes despite treatment. Diabetes Care 39 , 75— Immanuel, J. Screening and treatment for early-onset gestational diabetes mellitus: A systematic review and meta-analysis.
Diabetes Rep. Simmons, D. The treatment of booking gestational diabetes mellitus TOBOGM pilot randomised controlled trial. BMC Pregnancy Childbirth 18 , Hyperglycaemia in early pregnancy: The Treatment of Booking Gestational diabetes Mellitus TOBOGM study. A randomised controlled trial.
Mirabelli, M. Gestational diabetes: Implications for fetal growth, intervention timing, and treatment options. Lowe, L. Hyperglycemia and Adverse Pregnancy Outcome HAPO Study: Associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care 35 , — Beardsall, K.
Developmental physiology of carbohydrate metabolism and the pancreas. In Maternal-Fetal and Neonatal Endocrinology eds Kovacs, C.
Google Scholar. Desoye, G. The fetal glucose steal: An underappreciated phenomenon in diabetic pregnancy. Diabetologia 59 , — Benhalima, K.
Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia 62 , — Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes.
Diabetes Med. Kodama, K. Ethnic differences in the relationship between insulin sensitivity and insulin response: A systematic review and meta-analysis. Diabetes Care 36 , — Yang, S. Insulin secretion and insulin resistance in Korean women with gestational diabetes mellitus and impaired glucose tolerance.
Korean J. Weiss, P. Fetal outcome in gestational diabetes with elevated amniotic fluid insulin levels. Dietary versus insulin treatment. Shinozuka, N. Standard values of ultrasonographic fetal biometry. Okai T ellipse tracing fetal growth assessment using abdominal circumference.
Ultrasound 8 , 87—94 Formulas for fetal weight estimation by ultrasound measurements based on neonatal specific gravities and volumes. Lee, J. The study of growth measurements at different gestational ages of Korean newborn the survey and statistics.
Korean Soc. Matthews, D. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
Diabetologia 28 , — Download references. The authors would like to express sincere gratitude to Prof. WS Park of Samsung Medical Center, Sungkyunkwan University, for his advice on writing the manuscript.
Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, , Nonhyeon-ro, Gangnam-gu, Seoul, , Republic of Korea. Yonsei University College of Medicine, Seoul, Republic of Korea. Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, , USA.
You can also search for this author in PubMed Google Scholar. designed the study, prepared the data, analyzed data, wrote, and reviewed the paper. analyzed and interpreted data, wrote and reviewed the paper.
analyzed data and reviewed the paper. All authors have read and agreed the published version of the manuscript. Correspondence to Yoo Lee Kim. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.
If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Reprints and permissions. Fetal abdominal overgrowth is already present at 20—24 gestational weeks prior to diagnosis of gestational diabetes mellitus.
Sci Rep 11 , Download citation. Received : 20 May Accepted : 26 November Published : 10 December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.
Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily. Skip to main content Thank you for visiting nature. nature scientific reports articles article. Download PDF. Subjects Endocrine system and metabolic diseases Endocrinology. Introduction Childhood obesity is increasing worldwide with the incidence of type 2 diabetes in adolescents 1 , 2 , 3.
Results Clinical and biochemical characteristics and pregnancy outcomes of the normal glucose tolerance and GDM subjects according to maternal age and pre-pregnancy BMI As we previously reported 18 , maternal age and pre-pregnancy BMI were significantly higher in patients with GDM, but weight gain until diagnosis of GDM was not higher as compared with normal glucose tolerance NGT subjects.
Table 1 Clinical and biochemical characteristics and pregnancy outcomes of NGT and GDM subjects according to maternal age and pre-pregnancy BMI. Full size table. Table 2 Results of fetal biometry and FAORs measured at 20—24 GW in the subjects subsequently diagnosed with NGT and GDM.
Table 3 FAORs and EFW according to measured GW in the subjects subsequently diagnosed with NGT and GDM. Table 4 Clinical and biochemical characteristics and pregnancy outcomes by presence or absence of FAO at 20—24 GW in the subjects subsequently diagnosed with NGT and GDM.
Table 5 Odds ratios of FAO at the time of diagnosis of GDM, LGA at birth, and macrosomia by NGT and GDM subjects and by presence or absence of FAO at 20—24 GW. Methods Subjects and data collection We retrospectively reviewed the medical records of singleton pregnant women who were followed up at the outpatient clinic of CHA Gangnam Medical Center from January 1, , to April 31, Figure 1.
Full size image. Statistical analyses Clinical and biochemical characteristics were reported as mean with standard deviation and proportion. Subgroup analysis in the NGT and GDM subjects according to the GW at fetal biometry performed Subjects were grouped according to GW at which fetal biometry was performed to investigate when GDM subjects begin to show higher FAORs than NGT subjects.
Data availability Further information about data and resources will be provided upon request to the corresponding author. References Viner, R. Article PubMed Google Scholar NCD Risk Factor Collaboration. Article Google Scholar Ogden, C. Article CAS PubMed PubMed Central Google Scholar Crowther, C.
Article CAS PubMed Google Scholar Landon, M. Article CAS PubMed PubMed Central Google Scholar Gillman, M. Article PubMed PubMed Central Google Scholar Landon, M.
Article PubMed Google Scholar Sovio, U. Article CAS PubMed Google Scholar Li, M. Article CAS PubMed PubMed Central Google Scholar Venkataraman, H.
Article CAS PubMed Google Scholar Pedersen, J. We conclude that incorporating the ultrasound assessment of fetal growth to guide the use of insulin therapy in mothers with moderate GDM reduces excessive fetal growth and adiposity.
Department of Pediatrics, USC School of Medicine, Los Angeles, California. Smeeta R. You can also search for this author in PubMed Google Scholar. Reprints and permissions. Sardesai, S. et al. Growth Parameters In Infants Born To Gestational Diabetes Mellitus Gdm With Moderate Hyperglycemia Treated With Insulin Based On Fetal Abdominal Circumference Early In The Third Trimester.
Pediatr Res 41 Suppl 4 , Download citation. Issue Date : 01 April Anyone you share the following link with will be able to read this content:. Article Navigation. Close mobile search navigation Article Navigation. Volume 5. Article Contents Abstract.
Journal Article. Early Onset Acceleration of Fetal Growth in Gestational Diabetes Mellitus: Deciding About When and Whom to Screen for Preventing Fetal Macrosomia.
Maria Mirabelli, MD , Maria Mirabelli, MD. University Magna Graecia. Oxford Academic. Google Scholar. Eusebio Chiefari, MD, PhD. Paola Quaresima, MD. Federica Visconti, MD. Daniela Foti, MD, PhD. Antonio Brunetti, MD, PhD. PDF Split View Views.
Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks Download citation. Permissions Icon Permissions. Close Navbar Search Filter Journal of the Endocrine Society This issue Endocrine Society Journals Endocrinology and Diabetes Books Journals Oxford Academic Enter search term Search.
Abstract The precise time into pregnancy at which women are screened for gestational diabetes mellitus GDM is crucial for determining the benefits of diagnosis.
FPG indicates fasting gestatjonal glucose; GD, Mental Recovery Nutrition diabetes; LMP, last menstrual period; disbetes OGTT, oral gestztional tolerance test. Djabetes, Mothers with gestational Concentration and performance enhancement GD vs those with no GD. Concentration and performance enhancement, Gesfational with hyperglycemia only in late pregnancy vs those with normal glucose levels in all 3 trimesters. C, Mothers with hyperglycemia in all 3 trimesters vs those with normal glucose levels in all 3 trimesters. Fetal biometric measurements are brought into the model after log-transformed conversion. The 3 pregnancy periods are additionally adjusted for measured gestational weeks and the square of the measured gestational weeks instead of gestational weeks at delivery.Video
Gestational Diabetes: What to Know BMC Medicine Magnesium and potassium relationship 16Article number: Cite this dibetes. Metrics ih. Maternal Premium ingredient safety diabetes GDM is an established Ax factor for gestationap size at birth, but Sports training facility influence on intrauterine fetal growth in different ethnic Concentration and performance enhancement is less well understood. Here, we examine the joint associations of GDM and ethnicity with longitudinal fetal growth in South Asian and White European origin women. This study included 10, singletons White European and South Asian from a prospective cohort of women attending an antenatal clinic in Bradford, in the North of England. Ultrasound measurements of fetal head circumference HCfemur length FL abdominal circumference ACand estimated fetal weight EFWand corresponding anthropometric measurements at birth were used to derive fetal growth trajectories.Ac in gestational diabetes -
For this, consecutive women in singleton pregnancies, subjected to both anomaly scan and GDM screening, were retrospectively enrolled at our Institution between Jan Feb At a mean time of 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.
Lancet Diabetes Endocrinol. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Navbar Search Filter Journal of the Endocrine Society This issue Endocrine Society Journals Endocrinology and Diabetes Books Journals Oxford Academic Mobile Enter search term Search.
Endocrine Society Journals. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume 5. Article Contents Abstract. Journal Article. Early Onset Acceleration of Fetal Growth in Gestational Diabetes Mellitus: Deciding About When and Whom to Screen for Preventing Fetal Macrosomia.
Maria Mirabelli, MD , Maria Mirabelli, MD. University Magna Graecia. Oxford Academic. Google Scholar. Eusebio Chiefari, MD, PhD. A table elsewhere in this issue shows conventional and Système International SI units and conversion factors for many substances.
Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Previous Article Next Article.
Article Navigation. Original Articles July 01 Modified Therapy for Gestational Diabetes Using High-Risk and Low-Risk Fetal Abdominal Circumference Growth to Select Strict Versus Relaxed Maternal Glycemic Targets Siri L. Kjos, MD ; Siri L. Kjos, MD. This Site. Google Scholar.
Ute M. Schaefer-Graf, MD, PHD Ute M. Schaefer-Graf, MD, PHD. Address correspondence and reprint requests to Siri Linda Kjos, MD, Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, West Carson St. E-mail: skjos obgyn. Article history Received:.
Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1—. View large Download slide. Figure 2—. Table 1— Combined results from four randomized trials comparing conventional with modified therapy on rates of LGA and SGA infants when low-risk and high-risk fetal abdominal growth is detected before 34 weeks.
Conventional therapy. Modified therapy. View Large. Langer O, Rodriguez DA, Xenakis EM, McFarland MB, Berkus MD, Arrendondo F: Intensified versus conventional management of gestational diabetes.
Am J Obstet Gynecol. Schaefer-Graf UM, Pawliczak J, Passow D, Hartmann R, Rossi R, Bührer C, Harder T, Plagemann A, Vetter K, Kordonouri O: Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes.
Diabetes Care. Langer O, Levy J, Brustman L, Anyaegbunam A, Merdatz R, Divon M: Glycemic control in gestational diabetes mellitus: how tight is tight enough: small for gestational age versus large for gestational age? Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, Cohen HR, McArthur K, Holzapfel S, Biringer A, et al.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS: ACHOIS Trial Group. N Engl J Med. Sermer M, Naylor CD, Farine D, Kenshole AB, Ritchie JW, Gare DJ, Cohen HR, McArthur K, Holzapfel S, Biringer A: The Toronto Tri-Hospital Gestational Diabetes Project: a preliminary review.
Buchanan TA, Kjos SL, Schaefer U, Peters RK, Xiang A, Byrne J, Berkowitz K, Montoro M: Utility of fetal measurements in the management of gestational diabetes. Pedersen J, Osler M: Hyperglycemia as the cause of characteristic features of the foetus and newborn in diabetic mothers. Dan Med Bull.
Metzger BE, Freinkel N: Amniotic fluid insulin as predictor of obesity. Arch Dis Child. Weiss PAM, Hofmann HMH: Monitoring pregnancy in diabetes: amniotic fluid. Diabetes Nutr Metab. Persson B, Heding LG: Fetal beta cell function in diabetic pregnancy.
Weiss PAM: Gestational diabetes: a survey and the Graz approach to diagnosis and therapy. In Gestational Diabetes. Burkhart W, Holzgreve W, Came WR, Schneider HPG: Antenatal assessment of fetal outcome in pregnant diabetics.
J Perinat Med. Catalano PM, Thomas A, Huston-Presley L, Amini SB: Phenotype of infants of mothers with gestational diabetes. Bochner CJ, Medearis AL, Williams J, Castro L, Hobel CJ, Wade ME: Early third-trimester ultrasound screening in gestational diabetes to determine the risk of macrosomia and labor dystocia at term.
Landon MB, Mintz MC, Gabbe SC: Sonographic evaluation of fetal abdominal growth: predictor of the LGA infant in pregnancies complicated by diabetes mellitus.
Wong SF, Chan FY, Oats JJN, McIntyre DH: Fetal growth spurt and pregestational diabetic pregnancy. Raychaudhuri K, Maresh JA: Glycemic control throughout pregnancy and fetal growth in insulin-dependent diabetes.
The cause of the disease is complex [ 5 ]. Obesity is an independent high-risk factor for GDM [ 6 , 7 ].
The incidence of GDM in China is as high as Obese pregnant women are more likely to have GDM, preeclampsia, gestational hypertension, depression, instrument deliveries and caesarean sections, as well as surgical site infections.
GDM is also related to the risk of premature delivery, large for gestational age infants, foetal defects and perinatal death. From to , the prevalence of overweight increased from In the US, the incidence of prepregnancy obesity increased by approximately The definition of obesity in pregnancy has not been standardized.
On the one hand, due to physiological changes during pregnancy, a woman's weight increases significantly in a relatively short period of time, and most of the weight gain the foetus, amniotic fluid, blood, etc.
in pregnancy is immediately lost after delivery; on the other hand, across different regions and ethnic groups, there are differences in the diagnostic standards of obesity. Therefore, body mass index BMI before pregnancy is often used to define whether pregnant women are obese.
However, the evaluation of obesity during pregnancy using BMI has certain limitations. BMI does not distinguish whether body weight comes from fat, muscle or other components and dose not accurately reflect the fat content and fat distribution across the human body, which is of great significance for clinical evaluation.
Different obesity indicators are differentially effective in measuring and predicting gestational diabetes [ 11 , 12 ]. According to the available research evidence, the incidence rates of obesity and GDM are rising in parallel.
It is meaningful to explore the relationship between obesity and GDM. The international guidelines on gestational diabetes or gestational obesity are mostly based on characteristics of Western populations.
Considering race and ethnicity, regional environment, differences in lifestyles and diets, and trends in economic development [ 13 , 14 ], along with an increasing incidence of both obesity and GDM, there is a need to make a better prevention and management of gestational obesity and GDM through large data research based on the Chinese population.
The Human Research Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University approved this retrospective study. The data were collected from the Obstetrics and Gynecology Hospital of Fudan University from January 1, , to June 30, A total of 15, singleton pregnant women with complete prenatal care services and delivery in this hospital had data available for analysis.
Patients with pregestational diabetes mellitus, severe medical complications and tumours were excluded. All of the data were extracted from medical charts and the hospital information system.
Prepregnancy weight was self-reported by study participants, body height and AC to the nearest 0. PreBMI was calculated as prepregnancy weight kg divided by the square of body height m.
Women were categorized into four groups based on preBMI in accordance with the recommendation of the Chinese adult BMI classification published by the China Obesity Working Group in Before the measurement of abdominal circumference AC , the pregnant women emptied their bladders, lay on their backs, and straightened their legs; then, a soft ruler was used to measure the distance around the abdomen at the level of the navel.
The minimum circumference was recorded to the nearest 0. The low AC or ACHtR group was defined as the participants in Q1, the normal AC or ACHtR group was defined as those in Q2 and Q3, and the high AC or ACHtR group was defined as those in Q4. Because the normal range of AC or ACHtR has not yet been established, cut-off values for AC and ACHtR were not clearly defined.
The g OGTT has been defined as the gold standard for GDM diagnosis, and the diagnostic criteria were based on the International Association of Diabetes and Pregnancy Study Groups IADPSG.
Women were considered to have GDM when any one or more of the following values equalled or exceeded these thresholds: FPG, 5. All analyses were performed using SPSS for Windows version Continuous variables are presented as the mean SD , and skewed variables are described as the median interquartile range.
We used t tests for independent samples that were normally distributed continuous variables, and chi squared χ 2 tests were used for categorical variables. Our study included 15, women, consisting of women with GDM and 13, women without GDM. The clinical characteristics of the participants are shown in Table 1.
The mean AC The risk of GDM in the high AC group was 1. The ACHtR results were similar. The incidence risk of GDM in the high ACHtR group was 1. The ROC curve determined the ability of the ACHtR, AC and preBMI measures to identify GDM.
The AUCs were 0. ROC curves for preBMI, AC and ACHtR in predicting GDM. The results showed that the ACHtR and AC measures were similar to the preBMI measue in predicting GDM. The optimal cut-off point was the point on the ROC curve closest to the 0, 1 point.
An AC of Logistic regression analysis showed that, the ACHtR, preBMI, and AC were independent risk factors for GDM development. Model 1 was adjusted for age, gravidity, parity. With the development of the economy and the improvement of national living standards, the incidence rates of GDM and obesity are increasing year by year.
BMI before pregnancy, weight gain at different stages of pregnancy, and gestational weight gain are clearly associated with adverse pregnancy outcomes [ 18 ].
Previous studies have shown that an increase in maternal obesity BMI and other obesity-related indicators increases the risk of GDM. Increases in BMI before pregnancy are linearly related to the incidence rate of GDM, with the probability of occurrence of GDM being increased by 0.
An average annual weight gain between 20 and 24 years old of more than 1. With a previous pregnancy with a normal BMI and a second pregnancy with a BMI of classified as obese, there is a 3. In addition to BMI, other obesity evaluation indices have been used to evaluate and predict the occurrence of GDM.
An increase in neck circumference in early pregnancy may be one of the independent risk factors for GDM. Visceral adipose tissue thickness VAT and total adipose tissue thickness TAT assessed by ultrasonography in early pregnancy can independently predict the risk of abnormal blood glucose in late pregnancy: with increases in VAT and TAT, the incidence of diabetes increases [ 27 ].
In our present study, we demonstrated that ACHtR in the first trimester could be used as a novel indicator to predict GDM. Obesity, especially abdominal obesity AO , has been considered a risk factor for diabetic complications.
Abdominal obesity may be defined as excess deposits of fat in the abdominal region. It has been positively related to noncommunicable diseases, such as cardiovascular diseases, diabetes, hypertension, cancer, kidney diseases and nonalcoholic fatty liver disease.
The latest guidelines for South Asians define AO as large waist circumference WC , i. However, pregnant women generally do not have waist circumference measured during pregnancy, although abdominal circumference is measured to accurately estimate the size of the foetus.
Our research suggests that pregnant women with a higher AC or ACHtR and normal BMI also have a higher risk of GDM, which shows that even in women with a normal BMI, the prevalence of GDM is higher in individuals with abdominal obesity. The diagnostic accuracy of AC and ACHtR in the first trimester for predicting GDM was similar to that of preBMI.
Although some studies have shown that AC is one of the risk factors for GDM, and the combination of AC and other variables was used to build an early model to predict GDM [ 30 , 31 ]; however, the sample sizes in these studies were not particularly large, or there was a need for invasive tests.
Whether ACHtR is correlated with GDM remains unclear, and there is a lack of relevant studies. In our study, the AUC was 0. Because abdominal circumference and height are objective data measured by doctors, they are more objective measures than when pregnant women recall their weight before pregnancy, and these measures can avoid the possibility of memory errors or subjective errors.
In fact, some women cannot accurately state their prepregnancy weight. The optimal cut-off point of an AC of However, different studies may report different sensitivities and specificities at different cut-off points, possibly due to different study populations, gestational weeks and ethnicities.
Another study found that WC can predict GDM in the range of Larger sample studies and multicentre studies are needed to determine the optimal cut-off values for AC, preBMI, and the ACHtR to predict GDM. Previous papers have utilized patients' biometric data for the early prediction of GDM by creating logistic regression models and performing ROC analysis.
Although their results seem to be slightly better than ours, our study used only objective measures of the body, which were very easy to obtain, and did not require any invasive examination.
In addition, we included a relatively large sample size. There were also some limitations in our study. On the one hand, this study was a single-centre study in Shanghai, China, which may have affected the results and restricted the generalization of the study conclusions.
Further studies needs to be conducted to confirm our findings. On the other hand, all subjects were asked to retrospectively report their weight prior to pregnancy, which was used to calculate preBMI. As the study began after delivery, It was difficult to obtain accurate measurements of prepregnancy weights.
In this study, we found that a higher ACHtR may be an independent risk factor for GDM in the first trimester of pregnancy.
Even in the normal BMI population, the higher the AC and ACHtR were, the more likely a pregnant woman was to be diagnosed with GDM. AC, and ACHtR in the first trimester and preBMI might be anthropometric indices for predicting GDM, but a single obesity index has limited predictive value for GDM.
Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Cabero Roura L, McIntyre HD, Morris JL, Divakar H. The international federation of gynecology and obstetrics FIGO Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care.
Int J Gynaecol Obstet. Article Google Scholar. American Diabetes A: Management of diabetes in pregnancy: standards of medical care in diabetes Diabetes Care.
Management of Diabetes in Pregnancy. Popova P, Tkachuk A, Dronova A, Gerasimov A, Kravchuk E, Bolshakova M, Rozdestvenskaya O, Demidova K, Nikolaeva A, Grineva E. Fasting glycemia at the first prenatal visit and pregnancy outcomes in Russian women.
Minerva Endocrinol. PubMed Google Scholar.
Thank Magnesium and potassium relationship for visiting nature. You are using a Ac in gestational diabetes version with limited gesational for CSS. To obtain the best Strength-building exercises, we recommend you use a more up to date browser diagetes turn diabetea compatibility gstational in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. We investigated whether FAO is already present at 20—24 GW. Medical records of singleton pregnancy including GDM were reviewed. Fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios FAORs of the ultrasonographically estimated gestational age GA of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively.
Unglaublich!