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1.
BMC Pregnancy Childbirth ; 21(1): 96, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514342

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Retardo do Crescimento Fetal/etiologia , Macrossomia Fetal/etiologia , Gráficos de Crescimento , Neonatologia/normas , Adulto , Peso ao Nascer , Diabetes Mellitus Tipo 1/terapia , Feminino , Desenvolvimento Fetal , Retardo do Crescimento Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Modelos Logísticos , Masculino , Gravidez , Nascimento Prematuro , Reino Unido
2.
Diabetes Res Clin Pract ; 167: 108360, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32758619

RESUMO

AIMS: To describe all cases of gestational diabetes mellitus (GDM) managed at the Italian Hospital of San Daniele del Friuli from 2006 to 2018, after the establishment of a dedicated multidisciplinary team. METHODS: Data on mothers, pregnancies, and newborns have been recorded since the team establishment. The associations of maternal, pregnancy, and delivery characteristics with complications of pregnancy and delivery and adverse birth outcomes were assessed. RESULTS: 894 cases of GDM were observed, representing 6.8% of all deliveries. More than 20% of women were non-Italian, 5.3% had a previous macrosomic child, 12.5% previous diabetes or GDM, 27.3% family history of diabetes. On average, women had 4 visits at the clinic; mean glycated hemoglobin was 5.3%; starting body mass index (BMI) 26.2 and weight gain 10.3 kg. Cesarean sections were 21.8%. Pre-eclampsia was the most common pregnancy complication (4.7%). 6.0% of newborns were macrosomic and there were 3 fetal deaths. Only 26.3% of women had a post-partum oral glucose tolerance test. Initial BMI, weight gain, nationality, family history of diabetes or previous diabetes-related pregnancy complications were associated with pregnancy complications or adverse outcomes. CONCLUSIONS: We identified factors to be targeted for preventing GDM complications. Further efforts should be directed at post-partum.


Assuntos
Diabetes Gestacional/epidemiologia , Adulto , Índice de Massa Corporal , Cesárea , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Recém-Nascido , Itália/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez , Fatores de Risco , Ganho de Peso
3.
S Afr Med J ; 110(2): 154-158, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657688

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM), a disorder of glucose intolerance first encountered during pregnancy, has far-reaching implications for both mother and child. Insulin therapy remains the 'gold standard' of care, with oral hypoglycaemic agents (OHAs) increasingly being viewed as potential alternatives. OBJECTIVES: To compare maternal and neonatal outcomes in two cohorts of women with GDM exposed to either insulin monotherapy or OHAs. METHODS: A retrospective medical record review at Chris Hani Baragwanath Academic Hospital in South Africa was conducted for women with GDM diagnosed using the 100 g oral glucose tolerance test and/or random capillary blood glucose >11.1 mmol/L in 2010 - 2014. The findings were compared with a previous audit at the same clinic for the period 1992 - 2002. Variables of interest included maternal demographics, maternal comorbidities, glycaemic indices, treatments used during pregnancy, and obstetric and neonatal outcomes. RESULTS: A total of 192 women with GDM were identified for 2010 - 2014, and there were 348 women in the previous audit (1992 - 2002). Baseline characteristics and outcomes of women in the two cohorts were similar apart from earlier presentation (mean (standard deviation) gestational age (GA) 27 (7.5) weeks v. 28.3 (6.4) weeks; p=0.04), lower GA at delivery (36.3 (3.6) weeks v. 37 (1.6) weeks); p=0.008) and lower macrosomia rates (12.5% v. 4.9%; p=0.011) in the later cohort. When comparing the individual OHAs against insulin in the later cohort, both agents were comparable to insulin in terms of maternal and neonatal outcomes. CONCLUSIONS: This study contributes to the paucity of data on the safety of OHAs in GDM pregnancy in terms of maternal and neonatal outcomes. OHAs were shown to be an effective alternative to insulin for women with GDM in whom lifestyle measures fail, particularly in a resource-poor setting.


Assuntos
Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Resultado da Gravidez , Administração Oral , Adulto , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , África do Sul
4.
PLoS One ; 15(5): e0232634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469905

RESUMO

OBJECTIVE: During pregnancy, inhibin A is mainly derived from the placenta and regulates the implantation and differentiation of embryos. Our aim was to assess whether second trimester serum inhibin A was associated with an increased risk of adverse pregnancy outcomes. METHODS: We investigated the serum levels of Inhibin A during the second trimester in pregnancy, and analyzed associations between the Inhibin A and the risk of adverse pregnancy outcome. 12,124 pregnant women were enrolled in this study between January 2017 and July 2019 at the Obstetrics & Gynecology Hospital of Fudan University. Multivariate logistic regression analysis was conducted to estimate the relative risk between Inhibin A and adverse pregnancy outcome. RESULTS: Compared with the group without adverse pregnancy outcome, during the second trimester of pregnancy, age and Inhibin A were risk factors for pre-eclampsia, gestational diabetes mellitus and preterm delivery; Inhibin A was risk factors for low birth weight. Gravidity and Inhibin A were risk factors for macrosomia; while parity was a protective factor against pre-eclampsia, gestational hypertension and low birth weight. CONCLUSION: Elevated Inhibin A levels in pregnancy are significantly associated with pre-eclampsia, GDM, macrosomia, low birth weight and preterm delivery.


Assuntos
Inibinas/sangue , Complicações na Gravidez/epidemiologia , Segundo Trimestre da Gravidez/sangue , Adulto , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/sangue , Resultado da Gravidez , Nascimento Prematuro/sangue , Nascimento Prematuro/epidemiologia , Fatores de Risco
5.
PLoS One ; 15(5): e0233734, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469967

RESUMO

BACKGROUND: Several studies have suggested that record high unemployment during the Great Recession was associated with deleterious changes in diet and weight-related health. However, studies have yet to explore whether the Great Recession was also associated with obesity-related health in utero. METHODS: We investigated whether increasing county-level unemployment was associated with large-for-gestational age (LGA) births, using repeated cross-sectional data from California birth records between 2008 and 2011 (n = 1,715,052). LGA was defined as >90th percentile, using the Oken reference. We use the annual 1-year lagged value for county-level unemployment (2007-2010) and limit our analyses to singleton, term births. Linear probability models, with county and year fixed-effects were used to examine the unemployment-LGA association. All models control for county-level foreclosure rates, child gender, and maternal age, parity, education, and race/ethnicity. RESULTS: An increase in county-level unemployment was not statistically significantly associated with the prevalence of LGA (percentage point [PP]: 0.12; 95% CI: -0.02, 0.25). But, over the period of observation, for every one standard deviation increase in unemployment, LGA prevalence increased by 5% and p = 0.08. CONCLUSIONS: These results cautiously suggest some deleterious effects of the Great Recession on obesity-related health in utero.


Assuntos
Recessão Econômica/estatística & dados numéricos , Macrossomia Fetal/epidemiologia , Desemprego/estatística & dados numéricos , Adulto , California , Estudos Transversais , Dieta Ocidental , Feminino , Humanos , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Obesidade Materna/complicações , Gravidez , Adulto Jovem
6.
Arch Gynecol Obstet ; 302(1): 47-52, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32388777

RESUMO

BACKGROUND: Different screening procedures and diagnostic criteria are being followed in the same as well as in different countries with no single standard criteria established for diagnosis of GDM. So far, there are no studies in the Indian population comparing IADPSG with NICE criteria. OBJECTIVE: To compare International Association of Pregnancy and Study Groups (IADPSG) criteria with the National Institute for Health and Care Excellence (NICE) for diagnosis of gestational diabetes mellitus and its influence on maternal and perinatal outcomes. METHOD: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care institute in South India from March 2017 to October 2018. Six-hundred and eighty women with or without risk factors for GDM were recruited in the study and screened for GDM based on IADPSG and NICE criteria. Women with preexisting diabetes mellitus or with fasting plasma glucose ≥ 126 mg/dl were excluded. RESULTS: The overall prevalence of GDM in our study was 27.2% by either IADPSG/NICE criteria. In this study, 25.1% women and 11.6% women were diagnosed as GDM using IADPSG and NICE criteria, respectively. The level of agreement between the two diagnostic criteria was found to be poor in our study and was statistically significant (kappa = 0.429, p < 0.001). Women testing IADPSG-positive NICE-negative had a higher risk of GHTN, abortions, PROM, preterm delivery, caesarean section and congenital anomalies, meconium-stained liquor, and low Apgar scores at 1 min when compared to non GDM group. In addition, except for preterm delivery, women diagnosed as GDM by both IADPSG and NICE criteria had adverse outcomes such as preeclampsia, urinary tract infection, and polyhydramnios. Women diagnosed as GDM in IADPSG-negative NICE-positive had no significant adverse maternal or perinatal outcomes. CONCLUSIONS: IADPSG criteria appear to be more robust than NICE criteria for diagnosis of GDM. Women with substantial risk of maternal and perinatal outcomes are better identified by IADPSG criteria who would have been missed if NICE criteria was used.


Assuntos
Diabetes Gestacional/diagnóstico , Teste de Tolerância a Glucose/normas , Pré-Eclâmpsia/diagnóstico , Resultado da Gravidez , Adulto , Cesárea , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Índia/epidemiologia , Recém-Nascido , Masculino , Obstetrícia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez em Diabéticas , Prevalência , Estudos Prospectivos , Fatores de Risco , Sociedades Médicas , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 20(1): 133, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111183

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) in Fiji is a serious public health issue. However, there are no recent studies on GDM among pregnant women in Fiji. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM. METHODS: We used cross-sectional data of 255 pregnant women with GDM who gave birth to singleton infants at Colonial War Memorial Hospital (CWMH) in Suva city. Women underwent testing for GDM during antenatal clinic visits and were diagnosed using modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Multivariable logistic regression analysis was used to investigate factors associated with neonatal outcomes. RESULTS: Women with a previous baby weighing > 4 kg were 6.08 times more likely to experience neonatal macrosomia (Adjusted odds ratio (AOR) = 6.08; 95%CI: 2.46, 15.01). Compared to unmarried women, the odds of macrosomia among married women reduced by 71% (AOR = 0.29; 95%CI: 0.11, 0.77). Compared with delivery before 38 weeks of gestation, the infants of women who delivered between 38 and 41 weeks of gestation were 62 and 86% less likely to experience neonatal hypoglycaemia and Apgar score < 7 at 5 mins, respectively. The offspring of women who were overweight and obese had higher odds of neonatal hypoglycaemia. Late booking in gestation (≥28 weeks) was significantly associated with Apgar score < 7 at 5 min (AOR = 7.87; 95%CI: 1.11, 55.75). Maternal pre-eclampsia/pregnancy induced hypertension was another factor associated with low Apgar score in infants. CONCLUSIONS: The study found high rates of adverse neonatal outcomes among off springs of Fijian women with GDM and showed that interventions targeting pregnant women who are overweight, had a previous baby weighing > 4 kg, had pre-eclampsia, delivered before 38 weeks of gestation, and those who booked later than 13 weeks in gestation, are needed to improve pregnancy outcomes.


Assuntos
Índice de Apgar , Diabetes Gestacional/epidemiologia , Macrossomia Fetal/epidemiologia , Hipoglicemia/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Fiji/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Obesidade/epidemiologia , Sobrepeso , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Ganho de Peso , Adulto Jovem
8.
Lancet Psychiatry ; 7(5): 399-410, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32220288

RESUMO

BACKGROUND: Prenatal and perinatal insults are implicated in the aetiopathogenesis of psychotic disorders but the consistency and magnitude of their associations with psychosis have not been updated for nearly two decades. The aim of this systematic review and meta-analysis was to provide a comprehensive and up-to-date synthesis of the evidence on the association between prenatal or perinatal risk and protective factors and psychotic disorders. METHODS: In this systematic review and meta-analysis, we searched the Web of Science database for articles published up to July 20, 2019. We identified cohort and case-control studies examining the association (odds ratio [OR]) between prenatal and perinatal factors and any International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) non-organic psychotic disorder with a healthy comparison group. Other inclusion criteria were enough data available to do the analyses, and non-overlapping datasets. We excluded reviews, meta-analyses, abstracts or conference proceedings, and articles with overlapping datasets. Data were extracted according to EQUATOR and PRISMA guidelines. Extracted variables included first author, publication year, study type, sample size, type of psychotic diagnosis (non-affective psychoses or schizophrenia-spectrum disorders, affective psychoses) and diagnostic instrument (DSM or ICD and version), the risk or protective factor, and measure of association (primary outcome). We did random-effects pairwise meta-analyses, Q statistics, I2 index, sensitivity analyses, meta-regressions, and assessed study quality and publication bias. The study protocol was registered at PROSPERO, CRD42017079261. FINDINGS: 152 studies relating to 98 risk or protective factors were eligible for analysis. Significant risk factors were: maternal age younger than 20 years (OR 1·17) and 30-34 years (OR 1·05); paternal age younger than 20 years (OR 1·31) and older than 35 years (OR 1·28); any maternal (OR 4·60) or paternal (OR 2·73) psychopathology; maternal psychosis (OR 7·61) and affective disorder (OR 2·26); three or more pregnancies (OR 1·30); herpes simplex 2 (OR 1·35); maternal infections not otherwise specified (NOS; OR 1·27); suboptimal number of antenatal visits (OR 1·83); winter (OR 1·05) and winter to spring (OR 1·05) season of birth in the northern hemisphere; maternal stress NOS (OR 2·40); famine (OR 1·61); any famine or nutritional deficits in pregnancy (OR 1·40); maternal hypertension (OR 1·40); hypoxia (OR 1·63); ruptured (OR 1·86) and premature rupture (OR 2·29) of membranes; polyhydramnios (OR 3·05); definite obstetric complications NOS (OR 1·83); birthweights of less than 2000 g (OR 1·84), less than 2500 g (OR 1·53), or 2500-2999 g (OR 1·23); birth length less than 49 cm (OR 1·17); small for gestational age (OR 1·40); premature birth (OR 1·35), and congenital malformations (OR 2·35). Significant protective factors were maternal ages 20-24 years (OR 0·93) and 25-29 years (OR 0·92), nulliparity (OR 0·91), and birthweights 3500-3999 g (OR 0·90) or more than 4000 g (OR 0·86). The results were corrected for publication biases; sensitivity and meta-regression analyses confirmed the robustness of these findings for most factors. INTERPRETATION: Several prenatal and perinatal factors are associated with the later onset of psychosis. The updated knowledge emerging from this study could refine understanding of psychosis pathogenesis, enhance multivariable risk prediction, and inform preventive strategies. FUNDING: None.


Assuntos
Peso ao Nascer , Anormalidades Congênitas/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Transtornos Psicóticos/epidemiologia , Adulto , Fome Epidêmica , Feminino , Macrossomia Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Herpes Simples/epidemiologia , Herpesvirus Humano 2 , Humanos , Hipertensão/epidemiologia , Hipóxia/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Desnutrição/epidemiologia , Idade Materna , Transtornos do Humor/epidemiologia , Paridade , Idade Paterna , Poli-Hidrâmnios/epidemiologia , Gravidez , Complicações na Gravidez/psicologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Proteção , Fatores de Risco , Estações do Ano , Estresse Psicológico/epidemiologia , Adulto Jovem
9.
PLoS One ; 15(3): e0229496, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134959

RESUMO

OBJECTIVE: To assess the frequency and perinatal outcomes of gestational diabetes mellitus (GDM) defined by the criteria according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the National Institute for Health and Care Excellence (NICE) diagnostic criteria for GDM. DESIGN: A retrospective cohort study. SETTING: Six secondary and tertiary delivery hospitals in Finland in 2009. POPULATION: Pregnant women (N = 4,033) and their offspring. METHODS: We used data on comprehensive screening of pregnant women with a 2-h 75-g oral glucose tolerance test (OGTT), performed between gestational weeks 24 and 40. OGTT glucose concentrations were used to identify women who fulfilled IADPSG and NICE criteria. While cut-offs according to Finnish national criteria partly overlapped with both criteria, a subgroup of IADPSG- or NICE-positive GDM women remained undiagnosed by Finnish criteria and hence non-treated. They were analysed as subgroups and compared to controls who were negative with all cut-offs. MAIN OUTCOME MEASURES: GDM prevalence, birth weight SD score (BWSDS), large for gestational age (LGA) and caesarean section (CS) rates. RESULTS: Among the 4,033 women screened for GDM, 1,249 (31.0%) and 529 (13.1%) had GDM according to the IADPSG and NICE criteria, respectively. The LGA rate was similar in both groups. Regardless of the diagnostic criteria, women with GDM had a higher risk of induced delivery and CSs than controls. In IADPSG-positive non-treated women, offspring's BWSDS and CS rate were higher than in controls. CONCLUSIONS: GDM prevalence was 2.4-fold higher according to the IADPSG compared with the NICE criteria but the LGA rate did not differ. BWSDS and CS rate were increased already with mild untreated hyperglycaemia.


Assuntos
Cesárea/estatística & dados numéricos , Diabetes Gestacional/fisiopatologia , Macrossomia Fetal/diagnóstico , Programas de Rastreamento/métodos , Adulto , Glicemia/análise , Feminino , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Humanos , Gravidez , Resultado da Gravidez , Prevalência , Estudos Retrospectivos
10.
Ital J Pediatr ; 46(1): 8, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948472

RESUMO

BACKGROUND: In Italy live about 8.7% immigrants, which contribute to more than 15% of all deliveries taking place in Italy. We aimed to investigate whether newborns from high migratory pressure countries (HMPC) mothers have a different macrosomia and post-term pregnancy incidence compared to Italian newborns. METHODS: In this retrospective observational study, we analyzed data on 404.863 babies born between 2010 and 2017. Italian mothers delivered 309.658 (76.5%), HMPC mothers 88.179 (21.8%) and developed country (DC) mothers 7.026 (1.7%) babies. We analyzed the incidence of macrosomia and post term pregnancy. We estimated incidence rate (IR), unadjusted incidence rate ratio (IRR) and 95% confidence intervals (CIs) to evaluate the association between these perinatal parameters and the mother's region of birth. RESULTS: HMPC compared to Italian newborns showed a significantly higher incidence of birthweight > 4000 g (53.3‰ vs 39.1‰, p-value < 0.001; IRR 1.4, 95%CI = 1.36-1.45), birthweight ≥4500 g. (7.0‰ vs 3.8‰, p-value < 0.001; IRR 1.8, 95%CI = 1.67-2.0) and gestational age at birth > 41 weeks (19.9‰ vs 12.8‰, p-value < 0.001; IRR 1.55, 95%CI = 1.47-1.64). The macrosomia incidence between HPMC and Italian newborns was significantly increased at all gestational ages (Fig. 1), especially for mothers coming from Central Eastern Europe (121.79‰ vs 91.1‰, p-value< 0.001; IRR 1.34, 95%CI = 1.11-1.62). CONCLUSION: In Italy immigrant status represents a risk factor for macrosomia and post-term birth, which could be related to socio-economic status and unfavorable life conditions of immigrant mothers during pregnancy.


Assuntos
Emigrantes e Imigrantes , Macrossomia Fetal/epidemiologia , Mães , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Itália/epidemiologia , Gravidez , Gravidez Prolongada/epidemiologia , Estudos Retrospectivos , Fatores de Risco
11.
Acta Diabetol ; 57(6): 697-703, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31984438

RESUMO

AIMS: Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes. METHODS: A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM. RESULTS: Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m2 and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79-83, 84-87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p < 0.001) and the risk of second-trimester glucose > 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p < 0.001). FPG was significantly associated with LGA (8.2%, 9.3%, 10% and 11.7% in each quartile, p = 0.011) but not with other obstetrical outcomes. In a multivariate analysis including age, BMI, tobacco use, number of pregnancies and weight gained during pregnancy, first-trimester FPG was an independent predictor of LGA. CONCLUSIONS: First-trimester FPG is an early marker of GDM and LGA.


Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Jejum/sangue , Resultado da Gravidez , Primeiro Trimestre da Gravidez/sangue , Adulto , Glicemia/fisiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Diagnóstico Pré-Natal/métodos , Prevalência , Prognóstico , Estudos Retrospectivos
12.
Eur Child Adolesc Psychiatry ; 29(11): 1537-1545, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31894421

RESUMO

The prenatal environment can exert important effects on mental health. While much research has linked low birth weight to psychopathology, the intrauterine environment associated with high birth weight (macrosomia; > 4000 g) is also sub-optimal and may increase risk. Given the increasing prevalence of macrosomic births, understanding the mental health outcomes of infants born macrosomic can help refine theories of etiology, predict disorder, and target preventive interventions. Using data from the 2014 Ontario Child Health Study (OCHS), we examined the risk for psychiatric disorders in adolescents born macrosomic. Youth (N = 2151) aged 12-17 years completed the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Rates of common mental disorders assessed by the MINI-KID were compared between those born at normal birth weight (NBW; 2500-4000 g, n = 1817) and adolescents born macrosomic (> 4000 g, n = 334). These associations were then adjusted for participant age, sex, socioeconomic status (SES) of the family, parental mental health, and gestational diabetes mellitus. After adjustment for covariates, adolescents born macrosomic had higher odds of conduct disorder (CD; OR = 3.19, 95% CI: 1.37-7.43), oppositional defiant disorder (ODD; OR = 1.79, 95% CI: 1.11-2.91), and ADHD (OR = 1.77, 95% CI: 1.21-2.80). Moderation analyses revealed that males born macrosomic were more likely to have psychiatric problems than their female peers. Socioeconomic disadvantage also amplified the risk posed by macrosomia for ODD, ADHD, major depressive disorder, and generalized anxiety disorder. In this study, macrosomia was associated with an increased risk of clinically significant externalizing problems in adolescence, most notably among boys and those facing socioeconomic disadvantage.


Assuntos
Macrossomia Fetal/psicologia , Transtornos Mentais/etiologia , Adolescente , Criança , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Masculino , Gravidez , Fatores de Risco
13.
Aust N Z J Obstet Gynaecol ; 60(2): 204-211, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31353441

RESUMO

AIMS: Obesity-related complications have been identified across the entire childbearing journey. This study investigated changes in obesity prevalence and their impact on obstetric outcomes in a regional hospital in Victoria, Australia. METHODS: All women delivering during 1 January 2010 and 31 December 2016 were eligible to participate. Trends over time and outcomes were assessed on body mass indices (BMI). Incidences of complications were compared by BMI categories. The effect of obesity on hospital length of stay (LoS) was further assessed using the Generalised Estimating Equations approach. RESULTS: During the study period a total of 6661 women of whom 27.5% were overweight, and 16.1, 7.7, and 5.5% were respectively obese class I, class II, and class III, contributed to 8838 births. An increased trend over time in the prevalence of obesity (BMI > 35.0) (P = 0.041) and a decreased trend for vaginal deliveries for the whole sample (P = 0.003) were found. Multiple adverse outcomes were associated with increasing maternal BMI including increased risk of gestational diabetes, gestational hypertension, preeclampsia, emergency caesarean section, shoulder dystocia, macrosomia, and admission to special care. The multivariable analysis showed no associations between LoS and BMI. CONCLUSIONS: Over a short period of seven years, this study provides evidence of a significant trend toward more obesity and fewer vaginal births in a non-urban childbearing population, with increasing trends of poorer health outcomes. Assessing needs and risk factors tailored to this population is crucial to ensuring a model of care that safeguards a sustainable and effective regional maternity health service.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Tempo de Internação , Sobrepeso/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Vitória/epidemiologia
14.
J Gynecol Obstet Hum Reprod ; 49(1): 101628, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31499286

RESUMO

OBJECTIVES: The synergistic role of severe obesity and gestational diabetes mellitus (GDM) on pregnancy complications has been poorly studied. We aim to analyze the impact of GDM on pregnancy complications in women with class III obesity. MATERIAL AND METHODS: we performed a retrospective monocentric study including women with a pregestational BMI≥40kg/m2 with a singleton pregnancy from January 1996 to December 2014. We compared the risks of maternal, fetal and neonatal complications between patients with GDM and those without GDM. RESULTS: We included 354 patients, 121 (34.3%) had GDM and 63 needed insulin treatment (52.9% of the GDM women). Patients with GDM were older (30.4±5.1 vs 28.9±4.8 years,p=0.008) and had more frequently a history of GDM (24.8% vs 6.1%; p<0.0001). Patients with GDM were more often hospitalized (47.8% vs 29.8%, p=0.001) and were more likely to have premature birth (11.7% vs. 5.3%, p=0.031). Neonates from mothers with GDM were more frequently large for gestational age (31.6% vs 19.4%, p=0.011), and had a higher rate of transfers to neonatal intensive unit (9.2% vs 4.0%, p=0.047). There was no difference for preeclampsia, C-section, shoulder dystocia, neonatal hypoglycemia or postpartum complications. Outcomes were comparable in women with or without insulin therapy. CONCLUSION: The rate of GDM is particularly high in class III obese women. Morbidly obese women with GDM were more at risk for complications and needed more often insulin therapy. Our results suggest to pay a particular attention in this high-risk population.


Assuntos
Diabetes Gestacional , Obesidade Mórbida/complicações , Adulto , Fatores Etários , Índice de Massa Corporal , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipoglicemiantes/uso terapêutico , Recém-Nascido , Insulina/uso terapêutico , Obesidade Materna , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Estudos Retrospectivos
15.
Am J Obstet Gynecol ; 222(3): 265.e1-265.e19, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31574291

RESUMO

BACKGROUND: The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age has been poorly understood. OBJECTIVES: We aimed to estimate the impact of prepregnancy impaired fasting glucose defined by the World Health Organization cut point on the risk of preterm birth and large for gestational age and to investigate whether the World Health Organization cut point of impaired fasting glucose was appropriate for identifying women at risk of preterm birth and large for gestational age among the Chinese population. STUDY DESIGN: This was a retrospective cohort study of women from the National Free Preconception Health Examination Project with singleton birth from 121 counties/districts in 21 cities of Guangdong Province, China, from Jan. 1, 2013, to Dec. 31, 2017. Women were included if their prepregnancy fasting glucose was less than 7.0 mmol/L. The primary outcomes were preterm birth (gestational age <37 weeks), early preterm birth (gestational age <34 weeks), large for gestational age (birthweight by gestational age >90th percentile based on the international standards in the International Fetal and Newborn Growth Consortium for the 21st Century study), and severe large for gestational age (birthweight by gestational age >97th percentile). We calculated the adjusted risk ratio for impaired fasting glucose and a 1 standard deviation increase in fasting glucose. RESULTS: We included 640,469 women. Of these, 31,006 (4.84%) met the World Health Organization cut point for impaired fasting glucose, 32,640 (5.10%) had preterm birth and 7201 (1.12%) had early preterm birth, 45,532 (7.11%) had large for gestational age birth, and 16,231 (2.53%) had severe large for gestational age birth. Compared with women with normoglycaemia, women with prepregnancy impaired fasting glucose had a 7.0% higher risk of preterm birth (adjusted risk ratio, 1.07, 95% confidence interval, 1.02-1.12), 10.0% had a higher risk of large for gestational age (adjusted risk ratio, 1.10, 95% confidence interval, 1.06-1.14), and 17.0% had a higher risk of severe large for gestational age (adjusted risk ratio, 1.17, 95% confidence interval, 1.10-1.26). No significant association of prepregnancy impaired fasting glucose with early preterm birth was found. The association of prepregnancy impaired fasting glucose with preterm birth and large for gestational age were similar in subgroups of women with various baseline characteristics. Adjusted risk ratio for preterm birth per standard deviation fasting glucose (0.7 mmol/L) was 0.99 (95% confidence interval, 0.98-1.00), for early preterm birth an adjusted risk ratio of 0.99 (confidence interval, 0.97-1.02), for large for gestational age an adjusted risk ratio of 1.04 (confidence interval, 1.03-1.05), and for severe large for gestational age an adjusted risk ratio of 1.03 (confidence interval, 1.01-1.04). CONCLUSION: Our data suggest that maternal prepregnancy impaired fasting glucose increases the risk of preterm birth, large for gestational age, and severe large for gestational age. Data also suggest that the World Health Organization cut point of impaired fasting glucose is too restrictive, and lower levels of fasting glucose also increase the risk of large for gestational age and severe for severe gestational age in the Chinese population. Further investigation is warranted to determine whether and how counseling and interventions for women with prepregnancy impaired fasting glucose could reduce the risk of preterm birth and large for gestational age.


Assuntos
Peso ao Nascer , Glicemia/análise , Macrossomia Fetal/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , China/epidemiologia , Estudos de Coortes , Jejum , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Estudos Retrospectivos , Adulto Jovem
16.
J Matern Fetal Neonatal Med ; 33(1): 149-156, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886780

RESUMO

Objectives: Serial measurements of sonographic fetal abdominal circumference (AC) are useful for monitoring fetal growth during pregnancy and are essential for predicting macrosomia. The study was aiming to compare the AC profiles of infants born to mothers with or without hyperglycemia in Chinese population.Subjects and methods: The "GDM Prevalence Study (GPS)" was a large study conducted in 22 hospitals in three large cities in China, which included 34,085 NGT (normal glucose tolerant) women, 8272 GDM (gestational diabetes mellitus) women and 729 DM (diabetes mellitus) women. A total of 116,740 scans and 103,377 valid AC measurements were performed for the NGT, GDM and DM groups at different gestational age. AC profiles and fetal growth rates at different stages of pregnancy were compared between different groups.Results: The overall AC growth rate (ß) was higher in the macrosomia group than in the no macrosomia group in NGT (ß =10.250 versus 9.541, p < .001), GDM (ß = 10.572 versus 9.705, p < .001) and DM (ß = 11.363 versus 9.924, p < .001) pregnancies. Significant differences were observed between NGT-macrosomia, GDM-macrosomia and DM-macrosomia. Significant differences were also noted between NGT-no macrosomia, GDM-no macrosomia and DM-no macrosomia women. Participants in NGT-macrosomia group exhibited larger AC values than NGT-no macrosomia group beginning at 21 gestational weeks, and GDM-macrosomia group exhibited larger AC values than GDM-no macrosomia group beginning at 22 gestational weeks. AC growth rate was higher in NGT-macrosomia and GDM-macrosomia groups than in the corresponding no macrosomia groups between 22 and 30 gestational weeks.Conclusions: The overall AC growth rates are higher in macrosomia group compared to the no macrosomia group in NGT, GDM as well as DM participants. The significant difference of AC growth rates in NGT-macrosomia and GDM-macrosomia indicate the possible differential underlying mechanisms in developing macrosomia with or without hyperglycemia exposure. Our study demonstrate that larger fetal AC measurements around 21-22 weeks are associated with subsequent diagnosis of macrosomia, suggesting that macrosomia management should be initiated much earlier than we thought.


Assuntos
Abdome/anatomia & histologia , Macrossomia Fetal , Hiperglicemia , Mães , Abdome/patologia , Adulto , Pesos e Medidas Corporais , Estudos de Casos e Controles , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/complicações , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Mães/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Prevalência , Ultrassonografia Pré-Natal , Adulto Jovem
17.
J Matern Fetal Neonatal Med ; 33(1): 24-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29961396

RESUMO

Objective: Studies of maternal serum uric acid (UA) in pregnancy focus primarily on high levels of UA, however, both low and high UA levels can be markers of oxidative stress, a biological state potentially linked to fetal growth. We therefore aimed to test whether low and high maternal serum UA levels during pregnancy are associated with atypical fetal growth (unusually small or large) measured as birthweight (BW) for gestational age.Methods: The Pregnancy Outcomes and Community Health Study enrolled 3019 pregnant women between their 16th-27th week of pregnancy from 52 clinics in five Michigan communities (1998-2004). Maternal UA levels were measured in blood collected at enrollment among a subcohort of 1291 participants. Infant BW and gestational age were used to calculate gestational age-specific BW Z-score. Infants were grouped as small (SGA = BW < 10th percentile), appropriate (AGA = BW 10th-90th percentile), or large (LGA) = BW > 90th percentile) for their gestational age. Analyses considered multiple potential confounders. Linear spline or multiple linear regression models were applied to evaluate the relationship between maternal UA levels and BW Z-score overall and within SGA, AGA, and LGA groups. Model robustness was tested through bootstrap, sensitivity analysis, and cross-validation techniques.Results: The relation between maternal UA levels and BW Z-score varied by infant group. Among SGA infants, the relation was nonlinear (J-shape): both extremes of UA had lower BW Z-score with a breakpoint of 0.267 mmol/L UA (adjusted regression coefficient ß = 2.32, p = .01 for lower UA; adjusted ß = -37.38, p < .01 for higher UA). Among AGA infants, there was no significant association, and among LGA infants, the relation was linear (adjusted ß = 2.86, p = .03).Conclusions: Future research on maternal UA levels in pregnancy may benefit from considering both very low and high levels, and identifying in utero conditions associated with the two extremes.


Assuntos
Peso ao Nascer , Desenvolvimento Fetal/fisiologia , Gravidez/sangue , Ácido Úrico/sangue , Adulto , Estudos de Coortes , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido Pequeno para a Idade Gestacional/sangue , Testes para Triagem do Soro Materno , Mães/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
18.
Diabetes Care ; 43(1): 74-81, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31690637

RESUMO

OBJECTIVE: Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia. RESEARCH DESIGN AND METHODS: Data collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines (1992-2015). EGWG means having exceeded the upper limit of the Institute of Medicine-recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants. RESULTS: Of 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; P < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; P < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1-1.7; P < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1-1.5; P < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4-11.0; P < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2-1.7; P < 0.0001). CONCLUSIONS: The absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Ganho de Peso na Gestação/fisiologia , Sobrepeso/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Adulto , Glicemia/metabolismo , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Insulina/uso terapêutico , Sobrepeso/complicações , Sobrepeso/epidemiologia , Sobrepeso/terapia , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Prognóstico , Estudos Prospectivos , Ganho de Peso/fisiologia
19.
Acta Obstet Gynecol Scand ; 99(4): 518-524, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31738455

RESUMO

INTRODUCTION: Cerebral palsy (CP) is a lifelong disorder with a high rate of comorbidities and complications. We hypothesized that women with CP are at increased risk of adverse pregnancy outcome. MATERIAL AND METHODS: In this nationwide population-based cohort study 1997-2011, we examined the outcome of 770 births in women with CP vs 1 247 408 births in women without a CP diagnosis using the Swedish Medical Birth Register. We used unconditional logistic regression, adjusting for maternal age, smoking, parity, year of birth and epilepsy, to calculate adjusted odds ratios for adverse pregnancy outcome. Main adverse outcome was preterm birth. Secondary outcomes were cesarean section, induction of labor, low 5-min Apgar score, small for gestational age, large for gestational age, and stillbirth. RESULTS: After adjusting for potential confounders, maternal CP was associated with increased risk of preterm birth (12.9% vs 4.9%; adjusted odds ratio [aOR] 2.8, 95% CI 2.3-3.5), cesarean delivery (aOR 1.9, 95% CI 1.6-2.2), induced delivery (aOR 1.4, 95% CI 1.1-1.6), low 5-min Apgar score (aOR 1.8, 95% CI 1.1-2.9) and small of gestational age birth (aOR 1.6, 95% CI 1.2-2.3). We found no increased risk of large for gestational age or stillbirth. CONCLUSIONS: Women with CP are at increased risk of preterm birth and other adverse pregnancy outcomes, suggesting that they deserve extra surveillance during antenatal care. Further studies, with information on type of CP and gross motor function, are warranted to better understand the association between CP and pregnancy outcome.


Assuntos
Paralisia Cerebral/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Índice de Apgar , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Induzido/estatística & dados numéricos , Razão de Chances , Gravidez , Sistema de Registros , Natimorto/epidemiologia , Suécia/epidemiologia , Adulto Jovem
20.
BJOG ; 127(4): 490-499, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31778255

RESUMO

OBJECTIVE: To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs. DESIGN: Prospective observational cohort study. SETTING: Single tertiary multidisciplinary antenatal clinic in Malaysia. POPULATION: A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT. METHODS: Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records. MAIN OUTCOME MEASURES: Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile. RESULTS: Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m2 and 61% had a pre-gravid BMI of ≤ 25 kg/m2 , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile. CONCLUSION: Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy. TWEETABLE ABSTRACT: Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance.


Assuntos
Peso ao Nascer , Macrossomia Fetal/sangue , Hiperlipidemias/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Hiperlipidemias/complicações , Recém-Nascido , Malásia/epidemiologia , Masculino , Obesidade/epidemiologia , Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Triglicerídeos/sangue
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