Body mass index at 11-13 weeks' gestation and pregnancy complications.

OBJECTIVE: To examine the association between body mass index (BMI) at 11-13 weeks' gestation and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. METHODS: This was a prospective screening study for adverse obstetric outcomes in women with singleton pregnancies attending for their first routine hospital visit at 11(+0)-13(+6) weeks of gestation. The maternal weight and height were measured and the BMI was calculated. Regression analysis was performed to examine the association between BMI and each of the adverse pregnancy outcomes. RESULTS: We examined 41,577 pregnancies with a live fetus at 11-13 weeks. There was a significant contribution from maternal BMI, in addition to maternal characteristics and obstetric history, in the prediction of subsequent miscarriage, stillbirth, preeclampsia, gestational hypertension, gestational diabetes mellitus, delivery of small and large for gestational age neonates, and both elective and emergency cesarean section, but not spontaneous preterm delivery. The risk for each pregnancy complication increased exponentially with BMI, except for delivery of small for gestational age neonates which decreased with BMI. CONCLUSIONS: Maternal BMI at 11-13 weeks can be combined with other maternal characteristics and obstetric history to estimate patient-specific risks for many pregnancy complications.

Maternal serum visfatin at 11-13 weeks of gestation in gestational diabetes mellitus.

BACKGROUND: Visfatin and adiponectin are produced by adipose tissue and have opposite effects on insulin resistance. Circulating concentrations of these biomarkers are altered in type 2 diabetes mellitus. We sought to examine the potential value of maternal serum visfatin and adiponectin concentrations in early pregnancy as potential biomarkers in the prediction of gestational diabetes mellitus (GDM). METHODS: This work was a case-control study of 100 women who developed GDM and 300 nondiabetic controls. Maternal serum visfatin and adiponectin were measured between 11 and 13 weeks of gestation. Regression analysis in the nondiabetic group was performed to examine the maternal characteristics affecting the serum concentrations of visfatin and adiponectin. Likelihood ratios for GDM were calculated for visfatin and adiponectin, and performance of screening was assessed by using ROC curve analysis. RESULTS: In the GDM group compared with the nondiabetic group, the median maternal serum visfatin concentration was increased (1.34 multiples of the median [MoM], interquartile range [IQR] 0.70-2.87, vs 1.00 MoM, IQR: 0.53-1.92; P = 0.004) and serum adiponectin was decreased (0.66 MoM, IQR 0.50-0.92, vs 1.01, IQR 0.70-1.29; P < 0.0001). In screening for GDM by a combination of maternal factors and serum adiponectin and visfatin, the estimated detection rate was 68.0% (95% CI 58.3-76.3%), at a false-positive rate of 10%. CONCLUSIONS: At 11-13 weeks in pregnancies that develop GDM, the serum concentration of adiponectin is decreased and visfatin is increased, and these biomarkers can be combined with maternal factors to provide effective early screening for GDM.

Maternal serum adiponectin at 11-13 weeks of gestation in pregnancies delivering small for gestation neonates.

OBJECTIVE: To investigate whether maternal serum levels of adiponectin in the first trimester are altered in pregnancies that subsequently deliver small for gestational age (SGA) neonates. METHODS: Maternal serum adiponectin and pregnancy-associated plasma protein A (PAPP-A) were measured at 11-13 weeks' gestation in 50 singleton normotensive pregnancies that delivered SGA neonates and 300 non-SGA controls. The median adiponectin and PAPP-A levels in the SGA and non-SGA groups, expressed as multiple of the unaffected median (MoM), were compared. RESULTS: The distribution of serum adiponectin was made gaussian by square root (sqrt) transformation. Regression analysis in the non-SGA group demonstrated that for sqrt adiponectin a significant independent contribution was provided by maternal age, weight, smoking status, African and South-Asian racial origin. Each value in the SGA and non-SGA group was then converted into a multiple of the non-SGA median (MoM) after adjustment for maternal characteristics. In the SGA group, compared to the non-SGA controls, median maternal serum PAPP-A was decreased (0.79, interquartile range [IQR] 0.54-1.06 MoM vs. 1.00, IQR 0.71-1.39 MoM) but adiponectin MoM was not significantly different (0.89, IQR 0.65-1.31 MoM vs. 1.02, IQR 0.70-1.29 MoM). CONCLUSION: Maternal serum adiponectin is not a useful biochemical marker for early prediction of SGA.