Ambient PM gross ß-activity and glucose levels during pregnancy.

BACKGROUND: Exposure to ionizing radiation has been associated with insulin resistance and type 2 diabetes. In light of recent work showing an association between ambient particulate matter (PM) gross ß-activity and gestational diabetes mellitus (GDM) among pregnant women, we examined pregnancy glucose levels in relation to PM gross ß-activity to better understand this pathway. METHODS: Our study included 103 participants receiving prenatal care at Beth Israel Deaconess Medical Center in Boston, MA. PM gross ß-activity was obtained from US Environmental Protection Agency's RadNet program monitors, and blood glucose levels were obtained from the non-fasting glucose challenge test performed clinically as the first step of the 2-step GDM screening test. For each exposure window we examined (i.e., moving average same-day, one-week, first-trimester, and second-trimester PM gross ß-activity), we fitted generalized additive models and adjusted for clinical characteristics, socio-demographic factors, temporal variables, and PM with an aerodynamic diameter ≤ 2.5 µm (PM2.5). Subgroup analyses by maternal age and by body mass index were also conducted. RESULTS: An interquartile range increase in average PM gross ß-activity during the second trimester of pregnancy was associated with an increase of 17.5 (95% CI: 0.8, 34.3) mg/dL in glucose concentration. Associations were stronger among younger and overweight/obese participants. Our findings also suggest that the highest compared to the lowest quartile of one-week exposure was associated with 17.0 (95% CI: - 4.0, 38.0) mg/dL higher glucose levels. No associations of glucose were observed with PM gross ß-activity during same-day and first-trimester exposure windows. PM2.5 was not associated with glucose levels during any exposure window in our data. CONCLUSIONS: Exposure to higher levels of ambient PM gross ß-activity was associated with higher blood glucose levels in pregnant patients, with implications for how this novel environmental factor could impact pregnancy health.

Improving Patient Knowledge of Aneuploidy Testing Using an Educational Video: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of an educational video explaining aneuploidy testing. METHODS: This was a randomized controlled trial of women with singleton pregnancies having aneuploidy testing at less than 14 weeks of gestation from September 2016 to March 2017 at our prenatal ultrasound center. We developed an educational video on aneuploidy testing. Participants, stratified by age younger than or 35 years or older at estimated delivery date, were randomized to either view or not view the video before their ultrasonogram. Participants 35 years or older also met with a genetic counselor at the ultrasound appointment. All participants completed a survey assessing knowledge of genetic testing (score of 0-15) at baseline and after the appointment. The primary outcome was change in knowledge score after the intervention. A sample size of 23 per group (n=92) was planned for a total of 46 women younger than 35 years of age and 46 women aged 35 years or older. Data are presented as median (interquartile range). RESULTS: Of 104 eligible women who were approached, 92 were randomized. Forty women aged younger than 35 years and 41 women aged 35 years or older completed the study. Baseline characteristics were similar across groups. In women younger than 35 years, the video group had a significant improvement in knowledge score (+2.0 [1.0-5.0]) compared with the control group (0 [-1.0 to 1.0]; P=.01) and reported better understanding of the information compared with the control group (P<.001) with no change in patient satisfaction (P=.25). In women 35 years or older, change in knowledge score was similar for the video and control groups (P=.98) with no difference in self-reported understanding (P=.49) or patient satisfaction (P=.30). CONCLUSION: A patient-centered educational video explaining aneuploidy testing options improved knowledge and self-reported understanding of the information in women younger than 35 years with no change in patient satisfaction. No difference was seen for women 35 years or older, likely as a result of genetic counseling provided to these women.

Continuous Glucose Monitoring, Glycemic Variability, and Excessive Fetal Growth in Pregnancies Complicated by Type 1 Diabetes.

BACKGROUND: To examine trimester-specific associations among glycemic variability, fetal growth, and birthweight in pregnancies with type 1 diabetes mellitus (Type 1 DM). METHODS: In this retrospective cohort study of 41 pregnant women with Type 1 DM, we used continuous glucose monitoring (CGM) data to calculate glycemic variability (coefficient of variation of glucose) over a 7-day interval in each trimester. Clinical data, including fetal biometry, birthweight, and perinatal complications, were extracted from medical records. RESULTS: Women maintained good glycemic control during pregnancy, with mean HbA1c in the first, second, and third trimester 6.5%, 6.1%, and 6.4%, respectively. Sixty-three percent of infants were large for gestational age (LGA). Estimated fetal weight percentile (EFW%ile) and abdominal circumference percentile (AC%ile) increased during pregnancy, consistent with accelerated prenatal growth. Correlations between trimester-specific glycemic variability and EFW, AC, and birthweight were not statistically significant. After maternal age adjustment, glycemic variability was not associated with birthweight for any trimester (adj. ß for first trimester: -38.46, 95% CI: -98.58 to 21.66; adj. ß for second trimester: -12.20, 95% CI: -51.47 to 27.06; adj. ß for third trimester: -26.26, 95% CI: -79.52 to 27.00). CONCLUSIONS: The occurrence of LGA remains very high in contemporary U.S. women with Type 1 DM, despite the use of CGM and overall good glycemic control. Neither HbA1c nor glycemic variability predicted fetal overgrowth or birthweight. Since LGA is a key driver of maternal and newborn complications in pregnancies with Type 1 DM, our data emphasize the importance of investigating both glucose-dependent and glucose-independent underlying mechanisms.

Prenatal diagnosis of acro-dermatoungual-lacrimal-tooth syndrome, a dominantly inherited ectrodactyly.

As part of an assessment for preeclampsia, a prenatal sonogram performed on a pregnant woman at 33 weeks 4 days' gestation showed ectrodactyly in all 4 fetal extremities. The woman's husband had a history of hand abnormalities but was unaware that his condition was genetic. His examination was notable for ectrodactyly, small, peg-shaped teeth, microretrognathia, nail dysplasia, and a history of lacrimal duct blockage in infancy, consistent with a diagnosis of acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome. Acro-dermato-ungual-lacrimal-tooth syndrome is inherited as an autosomal dominant condition. Many of the inherited ectrodactyly syndromes are now known to be due to mutations in the p63 gene. This case, in which a prenatal sonographic diagnosis of ADULT syndrome was made, illustrates the importance of following up on a history of paternal hand anomalies.