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1.
Rev Saude Publica ; 53: 100, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31800911

RESUMO

OBJECTIVE: To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS: A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000-3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS: 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS: Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.


Assuntos
Macrossomia Fetal/etiologia , Ganho de Peso na Gestação/fisiologia , /complicações , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Colômbia , Estudos Transversais , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 833-839, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874473

RESUMO

Objective: To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods: A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results: (1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions: Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.


Assuntos
Diabetes Gestacional/epidemiologia , Macrossomia Fetal/epidemiologia , Obesidade/complicações , Peso ao Nascer , Índice de Massa Corporal , China/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Idade Gestacional , Humanos , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Ganho de Peso
3.
Int J Gynaecol Obstet ; 147(3): 404-412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479156

RESUMO

OBJECTIVE: To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). METHODS: A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. RESULTS: Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2 . Despite poor initial HbA1c for pre-gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre-gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV-infected pregnancies (9.4%) than non-HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide-exposed group than the insulin-alone group (12.2% vs 0%, P=0.025). CONCLUSION: Obesity is a significant predictor for macrosomia and was high in all groups. In a low-/middle-income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.


Assuntos
Diabetes Gestacional/epidemiologia , Infecções por HIV/epidemiologia , Gravidez em Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Recém-Nascido Prematuro , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
4.
BMC Pregnancy Childbirth ; 19(1): 219, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262264

RESUMO

BACKGROUND: Despite an increased number of infants born with macrosomia globally, low birth weight infants have currently attracted more attention. Macrosomia is a growing problem in most developing countries and it directly or indirectly contributes to morbidity, mortality, and disability worldwide. The main objective of this study was to assess the level of macrosomia and its associated factors in the private clinics of Mekelle city, Tigray region, Ethiopia, 2017. METHODS: An institution based cross-sectional study with a total of 309 pregnant mothers was conducted. We collected data from the pregnant mothers as well as from their medical records using structured questionnaire and checklist respectively. We entered and analyzed the data using statistical package for social science (SPSS)-21 by applying binary logistic regression to identify the factors associated with macrosomia. Finally, we used texts and tables to summarize the results of the study. RESULTS: The prevalence of macrosomia was 19.1% (95% confidence interval (CI) = 14.9, 23), and the mean ± standard deviations of birth weights were 3440 ± 543 g. Macrosomia was significantly associated with: weight gain during pregnancy ≥16 kg (adjusted odds ratio (AOR) = 11, 95% CI: 3, 37), pre-pregnancy overweight (AOR = 5, 95% CI = 2, 13), pre-pregnancy obesity (AOR = 15, 95% CI = 5, 50), maternal age (AOR =2.6, 95% CI = 1.2, 5.8) and giving birth to macrosomic baby in the last pregnancy (AOR = 2.7, 95% CI = 1.1, 7). CONCLUSION: We found that prevalence of macrosomia was high, and significantly associated with pre-pregnancy body mass index (BMI), pregnancy weight gain, maternal age and giving birth to a macrosomic baby in the last pregnancy. Hence, we recommend that emphasis should be given to maternal counseling for weight management before and during pregnancy.


Assuntos
Macrossomia Fetal/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Complicações na Gravidez/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Etiópia/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Nascimento Vivo , Modelos Logísticos , Idade Materna , Razão de Chances , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Instalações Privadas/estatística & dados numéricos , Fatores de Risco
5.
Diabetes Res Clin Pract ; 154: 82-89, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271809

RESUMO

AIMS: Obesity increases risk of gestational diabetes mellitus (GDM) and GDM increases risk of macrosomia but their inter-relations for increased risk of macrosomia remain uncertain. We aimed to examine associations between prepregnancy overweight and macrosomia, and synergistic effects between prepregnancy overweight and GDM on macrosomia. METHODS: From 2010 to 2012, 19,622 women in urban Tianjin, China, underwent a 50-g 1-h glucose challenge test (GCT) at 24-28 gestational weeks and followed by a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT value was ≥ 7.8 mmol/L. GDM was defined according to International Association of Diabetes and Pregnancy Study Group's criteria. Overweight was defined as body mass index ≥ 24.0 kg/m2. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between prepregnancy overweight and GDM was used to test synergistic effects. RESULTS: In the cohort, 1791 (9.1%) and 1726 (8.8%) of the women delivered a macrosomic infant or a large-for-gestational-age (LGA) infant, respectively. Prepregnancy overweight was associated with increased risk of macrosomia and LGA with adjusted ORs being 2.29 (95%CI: 2.07-2.54) and 2.27 (2.05-2.52), respectively. Copresence of prepregnancy overweight and GDM greatly enhanced the adjusted ORs of overweight alone (ORs for macrosomia and LGA: 2.17, 1.94-2.42 & 2.21,1.98-2.47) and GDM alone (ORs for macrosomia and LGA: 2.01,1.48-2.72 & 2.14, 1.60-2.87) for macrosomia and LGA to 5.29 (4.07-6.87) for macrosomia and 4.72 (3.66-6.10) for LGA, with significant additive interactions. CONCLUSIONS: Prepregnancy overweight increased the risks of macrosomia and LGA independently and synergistically with GDM.


Assuntos
Peso ao Nascer , Diabetes Gestacional/fisiopatologia , Macrossomia Fetal/etiologia , Sobrepeso/complicações , Complicações na Gravidez/etiologia , Adulto , China/epidemiologia , Feminino , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Estudos Prospectivos , Fatores de Risco
6.
Int J Gynaecol Obstet ; 146(3): 326-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31242319

RESUMO

OBJECTIVE: To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS: Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS: A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION: Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.


Assuntos
Diabetes Gestacional/fisiopatologia , Frutosamina/metabolismo , Hemoglobina A Glicada/metabolismo , Doenças do Recém-Nascido/etiologia , Albumina Sérica/metabolismo , Adulto , Biomarcadores/metabolismo , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Estudos Prospectivos , Curva ROC
7.
Nutrients ; 11(4)2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31010102

RESUMO

Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.


Assuntos
Peso ao Nascer , Comportamento Alimentar , Desenvolvimento Fetal , Obesidade/prevenção & controle , Fenômenos Fisiológicos da Nutrição Pré-Natal , Temperança , Ganho de Peso , Adulto , Índice de Massa Corporal , Ingestão de Alimentos , Feminino , Macrossomia Fetal/etiologia , Macrossomia Fetal/prevenção & controle , Idade Gestacional , Humanos , Hiperfagia/complicações , Hiperfagia/prevenção & controle , Inquéritos Nutricionais , Obesidade/complicações , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/prevenção & controle , Gravidez , Complicações na Gravidez/etiologia , Trimestres da Gravidez , Gestantes , Autocontrole , Adulto Jovem
8.
Diabetes Care ; 42(5): 718-726, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010942

RESUMO

Pregnancy has been equated to a "stress test" in which placental hormones and growth factors expose a mother's predisposition toward metabolic disease, unleashing her previously occult insulin resistance (IR), mild ß-cell dysfunction, and glucose and lipid surplus due to the formidable forces of pregnancy-induced IR. Although pregnancy-induced IR is intended to assure adequate nutrition to the fetus and placenta, in mothers with obesity, metabolic syndrome, or those who develop gestational diabetes mellitus, this overnutrition to the fetus carries a lifetime risk for increased metabolic disease. Norbert Freinkel, nearly 40 years ago, coined this excess intrauterine nutrient exposure and subsequent offspring developmental risk "fuel-mediated teratogenesis," not limited to only excess maternal glucose. Our attempts to better elucidate the causes and mechanisms behind this double-edged IR of pregnancy, to metabolically characterize the intrauterine environment that results in changes in newborn body composition and later childhood obesity risk, and to examine potential therapeutic approaches that might target maternal metabolism are the focus of this article. Rapidly advancing technologies in genomics, proteomics, and metabolomics offer us innovative approaches to interrogate these metabolic processes in the mother, her microbiome, the placenta, and her offspring that contribute to a phenotype at risk for future metabolic disease. If we are successful in our efforts, the researcher, endocrinologist, obstetrician, and health care provider fortunate enough to care for pregnant women have the unique opportunity to positively impact health outcomes not only in the short term but in the long run, not just in one life but in two-and possibly, for the next generation.


Assuntos
Diabetes Gestacional/metabolismo , Macrossomia Fetal/etiologia , Obesidade/metabolismo , Complicações na Gravidez/metabolismo , Distinções e Prêmios , Peso ao Nascer/fisiologia , Diabetes Gestacional/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Resistência à Insulina/fisiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/metabolismo , Obesidade/complicações , Gravidez
9.
BMC Pregnancy Childbirth ; 19(1): 126, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975086

RESUMO

BACKGROUND: Maternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m2 was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes. METHODS: Data containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain. RESULTS: Obese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes. CONCLUSIONS: Obese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate.


Assuntos
Ganho de Peso na Gestação , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez/epidemiologia , Adulto , Teorema de Bayes , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Saúde do Lactente , Recém-Nascido , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Fatores de Risco , Estados Unidos/epidemiologia
10.
J Pregnancy ; 2019: 3849596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941218

RESUMO

In 1990, Institute of Medicine (IOM) recommended gestational weight gain (GWG) ranges for women in the United States primarily to improve infant birth weight. Changes in key aspects of reproductive health of women of child bearing age, a rising prevalence of obesity, and noncommunicable diseases prompted the revision of IOM guidelines in 2009. However, there is no such recommendation available for Asian women. This systematic review assesses the utility of IOM-2009 guidelines among Indian and other Asian pregnant women in terms of maternal and fetal outcomes. 624 citations were identified using PubMed and Google Scholar, out of which 13 were included. Prospective/retrospective studies of healthy Asian women with a singleton pregnancy which specifically examined fetal-maternal outcomes relative to IOM-2009 guidelines were included. Results. Majority of pregnant Indian women achieved less GWG than the recommendations whereas a mixed trend was noticed among the other Asian pregnant women. The most common fetal-maternal complications among the excessive GWG women were found to be macrosomia, large for gestational age and caesarean section followed by gestational diabetes and hypertension, whereas low birth weight, small for gestational age and preterm birth, was found to be associated with low GWG women. The findings highlight the need for appropriate GWG limits across the different body mass index levels specifically for Indians and other Asian population. However, there are not enough publications regarding the utility of IOM-2009 guidelines among the Indian and other Asian women. Thus, higher-quality researches are warranted in future to further validate the findings of the present review.


Assuntos
Ganho de Peso na Gestação , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Cesárea , Bases de Dados Bibliográficas , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Feminino , Macrossomia Fetal/etiologia , Macrossomia Fetal/prevenção & controle , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Adulto Jovem
11.
PLoS One ; 14(3): e0211788, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30865630

RESUMO

BACKGROUND: Pregestational diabetes is associated with fetal macrosomia, and umbilical perfusion of the fetal liver has a role in regulating fetal growth. We therefore hypothesized that pregestational diabetes alters fetal liver blood flow depending on degree of glycemic control. METHODS: In a prospective study, 49 women with pregestational diabetes underwent monthly ultrasound examinations during 24-36 gestational weeks. Blood flow was determined in the umbilical vein, ductus venosus and portal vein, and blood velocity was measured in the left portal vein, the latter reflecting the watershed between splanchnic and umbilical flow. The measurements were compared with reference values by z-score statistics, and the effect of HbA1c assessed. RESULTS: The umbilical venous flow to the liver (z-score 0.36, p = 0.002), total venous liver flow (z-score 0.51, p<0.001) and left portal vein blood velocity (z-score 0.64, p<0.001), were higher in the study group. Normalized portal venous flow was lower (z-score -0.42, p = 0.002), and normalized total venous liver flow tended to be lower after 30 gestational weeks (z-score -0.54, p = 0.047) in the diabetic pregnancies compared with reference values from a low-risk population. The left portal vein blood velocity was positively, and the portal fraction of total venous liver flow negatively correlated with first trimester HbA1C. CONCLUSIONS: In spite of increased umbilical blood distribution to the fetal liver, graded according to glycemic control, the total venous liver flow did not match third trimester fetal growth in pregnancies with pregestational diabetes, thus contributing towards increased perinatal risks and possibly altered liver function with long-term metabolic consequences.


Assuntos
Feto/irrigação sanguínea , Feto/diagnóstico por imagem , Fígado/irrigação sanguínea , Fígado/embriologia , Gravidez em Diabéticas/diagnóstico por imagem , Gravidez em Diabéticas/fisiopatologia , Adulto , Velocidade do Fluxo Sanguíneo , Feminino , Desenvolvimento Fetal , Macrossomia Fetal/diagnóstico por imagem , Macrossomia Fetal/etiologia , Humanos , Recém-Nascido , Fígado/diagnóstico por imagem , Circulação Hepática/fisiologia , Estudos Longitudinais , Masculino , Veia Porta/diagnóstico por imagem , Veia Porta/embriologia , Veia Porta/fisiopatologia , Gravidez , Estudos Prospectivos , Fluxo Sanguíneo Regional , Ultrassonografia Pré-Natal , Veias Umbilicais/diagnóstico por imagem , Veias Umbilicais/embriologia , Veias Umbilicais/fisiopatologia , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 19(1): 105, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922244

RESUMO

BACKGROUND: Maternal body mass index is linked to short- and long-term unfavorable health outcomes both for child and mother. We conducted a systematic review and meta-analysis of population-based cohort studies to evaluate maternal BMI and the risk of harmful neonatal outcomes in China. METHODS: Six databases identified 2454 articles; 46 met the inclusion criteria for this study. The dichotomous data on maternal BMI and harmful neonatal outcomes were extracted. Pooled statistics (odds ratios, ORs) were derived from Stata/SE, ver. 12.0. Sensitivity analyses assessed the robustness of the results. Meta-regression and subgroup meta-analyses explored heterogeneity. RESULTS: The meta-analysis revealed that compared with normal BMI, high maternal BMI is associated with fetal overgrowth, defined as macrosomia ≥4000 g (OR 1.91, 95% CI 1.75-2.09); birth weight ≥ 90% for gestational age (OR 1.88, 95% CI 1.64-2.15); and increased risk of premature birth (OR 1.38, 95% CI 1.25-2.52) and neonatal asphyxia (OR 1.74, 95% CI 1.39-2.17). Maternal underweight increased the risk of low birth weight (OR 1.61, 95% CI 1.33-1.93) and small for gestational age (OR 1.75, 95% CI 1.51-2.02). CONCLUSIONS: Raised as well as low pre-pregnancy BMI is associated with adverse neonatal outcomes. Management of weight during pregnancy might help reduce their adverse neonatal outcomes in future intervention studies or programmes.


Assuntos
Índice de Massa Corporal , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez/epidemiologia , Adulto , Peso ao Nascer , China/epidemiologia , Feminino , Macrossomia Fetal/etiologia , Ganho de Peso na Gestação , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Obesidade/complicações , Gravidez , Complicações na Gravidez/etiologia , Fatores de Risco
13.
J Perinat Med ; 47(4): 402-408, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-30817307

RESUMO

Background Maternal obesity, excessive gestational weight gain and fetal macrosomia may affect the health of the mother and the newborn, and are associated with cesarean delivery. Pregnant women with a migration background have a higher risk of obesity but nevertheless a lower frequency of cesarean deliveries than women from the majority population. This study assesses which of these factors most influence the risk of a cesarean delivery and whether their prevalence can explain the lower cesarean rates in migrant women. Methods A total of 2256 migrant women and 2241 non-immigrant women subsequently delivering in three hospitals of Berlin/Germany participated. Multivariate logistic regression analysis was conducted to assess the effects of obesity, excessive gestational weight gain and macrosomia on cesarean delivery. Standardized coefficients (STB) were used to rank the predictors. Results Obesity was more frequent in immigrant than among non-immigrant women. The mean gestational weight gain was independent of migration status. The frequency of macrosomia increased with maternal weight. Obesity and excessive gestational weight gain were the most important predictors of cesarean besides older age; fetal macrosomia played a much smaller role. Despite similar distributions of the three risk factors, the frequency of cesarean deliveries was lower in migrant than in non-immigrant women. Conclusion The presence of obesity and/or excessive gestational weight gain is associated with an increased risk of a cesarean delivery; fetal macrosomia does not increase the risk when obesity and weight gain are considered. The distribution of these risk factors is similar in migrant and non-immigrant women, so they cannot explain the lower frequency of cesarean deliveries in migrant women.


Assuntos
Cesárea/estatística & dados numéricos , Macrossomia Fetal/epidemiologia , Ganho de Peso na Gestação , Obesidade/complicações , Migrantes/estatística & dados numéricos , Adulto , Feminino , Macrossomia Fetal/etiologia , Alemanha/epidemiologia , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
14.
Rev Bras Ginecol Obstet ; 41(2): 104-115, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30786308

RESUMO

Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared with human insulin in the treatment of pregnant women with diabetes through a systematic review with meta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE and Google Scholar. We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies. We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Gestacional/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Aborto Espontâneo/etiologia , Peso ao Nascer , Feminino , Macrossomia Fetal/etiologia , Idade Gestacional , Humanos , Hipoglicemia/induzido quimicamente , Insulina/análogos & derivados , Insulina Aspart/uso terapêutico , Insulina Glargina/uso terapêutico , Insulina Lispro/uso terapêutico , Estudos Observacionais como Assunto , Gravidez , Cuidado Pré-Natal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
15.
Diabetes Care ; 42(5): 810-815, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30765428

RESUMO

OBJECTIVE: Continuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24-h day. Our aim was to examine the role of temporal glucose variation on the development of large for gestational age (LGA) infants in women with treated gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We performed a prospective observational study of 162 pregnant women with GDM in specialist multidisciplinary antenatal diabetes clinics. Participants undertook 7-day masked CGM at 30-32 weeks' gestation. Standard summary indices and glycemic variability measures of CGM were calculated. Functional data analysis was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity, and parity. RESULTS: Mean glucose was significantly higher in women who delivered an LGA infant (6.2 vs. 5.8 mmol/L, P = 0.025, or 111.6 mg/dL vs. 104.4 mg/dL). There were no significant differences in percentage time in, above, or below the target glucose range or in glucose variability measures (all P > 0.05). Functional data analysis revealed that the higher mean glucose was driven by a significantly higher glucose for 6 h overnight (0030-0630 h) in mothers of LGA infants (6.0 ± 1.0 mmol/L vs. 5.5 ± 0.8 mmol/L, P = 0.005, and 108.0 ± 18.0 mg/dL vs. 99.0 ± 14.4 mg/dL). CONCLUSIONS: Mothers of LGA infants run significantly higher glucose overnight compared with mothers without LGA infants. Detecting and addressing nocturnal glucose control may help to further reduce rates of LGA in women with GDM.


Assuntos
Glicemia/metabolismo , Ritmo Circadiano/fisiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/terapia , Macrossomia Fetal/etiologia , Adolescente , Adulto , Peso ao Nascer/fisiologia , Automonitorização da Glicemia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/sangue , Macrossomia Fetal/epidemiologia , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
16.
PLoS One ; 14(2): e0211278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30716114

RESUMO

OBJECTIVE: To examine the association between maternal BMI>50kg/m2 during pregnancy and maternal and perinatal outcomes. MATERIALS AND METHODS: An international cohort study was conducted using data from separate national studies in the UK and Australia. Outcomes of pregnant women with BMI>50 were compared to those of pregnant women with BMI<50. Multivariable logistic regression estimated the association between BMI>50 and perinatal and maternal outcomes. RESULTS: 932 pregnant women with BMI>50 were compared with 1232 pregnant women with BMI<50. Pregnant women with BMI>50 were slightly older, more likely to be multiparous, and have pre-existing comorbidities. There were no maternal deaths, however, extremely obese women had a nine-fold increase in the odds of thrombotic events compared to those with a BMI<50 (uOR: 9.39 (95%CI:1.15-76.43)). After adjustment, a BMI>50 during pregnancy had significantly raised odds of preeclampsia/eclampsia (aOR:4.88(95%CI: 3.11-7.65)), caesarean delivery (aOR: 2.77 (95%CI: 2.31-3.32)), induction of labour (aOR: 2.45(95% CI:2.00-2.99)) post caesarean wound infection (aOR:7.25(95%CI: 3.28-16.07)), macrosomia (aOR: 8.05(95%CI: 4.70-13.78)) compared a BMI<50. Twelve of the infants born to women in the extremely obese cohort died in the early neonatal period or were stillborn. CONCLUSIONS: Pregnant women with BMI>50 have a high risk of inferior maternal and perinatal outcomes.


Assuntos
Índice de Massa Corporal , Resultado da Gravidez , Adulto , Cesárea/estatística & dados numéricos , Estudos de Coortes , Eclampsia/epidemiologia , Eclampsia/etiologia , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Trabalho de Parto Induzido , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Razão de Chances , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Fatores de Risco , Natimorto/epidemiologia
17.
Diabet Med ; 36(2): 158-166, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30698863

RESUMO

AIMS: To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy. RESEARCH DESIGN AND METHODS: Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre-pregnancy was compared with initiation of CSII during pregnancy. RESULTS: MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0-23.0) years vs 11.0 (5.5-17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre-pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365-4100) g vs 3360 (3365-4100) g; P<0.001] and higher large-for-gestational-age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54-3.51); P<0.001 and 1.89 (95% CI 1.02-3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre-pregnancy use, similar glucose control and outcome was achieved. CONCLUSIONS: There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Macrossomia Fetal/etiologia , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Gravidez em Diabéticas/tratamento farmacológico , Adulto , Peso ao Nascer , Diabetes Mellitus Tipo 1/complicações , Feminino , Ganho de Peso na Gestação/fisiologia , Hemoglobina A Glicada/metabolismo , Humanos , Recém-Nascido , Injeções Subcutâneas , Sistemas de Infusão de Insulina , Idade Materna , Cuidado Pré-Concepcional , Gravidez , Trimestres da Gravidez , Estudos Retrospectivos
18.
J Matern Fetal Neonatal Med ; 32(22): 3859-3863, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29852791

RESUMO

Objective: We aimed to develop new predictive models for excluding macrosomia using only maternal physical parameters, without sonographic examination. Methods: The present study retrospectively analyzed the medical records of pregnant women who delivered singleton infants at term at one obstetric hospital in an urban area in Japan from May 2005 to April 2017. We performed logistic regression analysis to predict macrosomia and created an integer risk scoring system based on the significant predictors. We also developed an alternative predictive regression model using machine learning with the random forest algorithm. Results: There were 203 cases of macrosomia among 15,263 eligible women. Although our scoring system had low specificity and positive predictive value, the negative predictive value for screening macrosomia was very high (0.996-1.000). The other model, using machine learning with the random forest algorithm to predict macrosomia, showed a negative predictive value of 0.99, which was similar to the results of our scoring system. Conclusions: Our integer scoring system is an easy and useful method for excluding macrosomia among pregnant women without sonographic examination.


Assuntos
Macrossomia Fetal/diagnóstico , Macrossomia Fetal/etiologia , Modelos Estatísticos , Mães , Adulto , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Mães/estatística & dados numéricos , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal
19.
Diabetologia ; 62(2): 249-258, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30421138

RESUMO

AIMS/HYPOTHESIS: This study aimed to examine the association of maternal diabetes, being large for gestational age (LGA) and breast-feeding with being overweight or obese in pre-school-aged children. METHODS: Data on height and weight at the time of their pre-school (age 4-6 years) immunisation visit between January 2009 and August 2017, as well as breast-feeding status in the first 5 months of life, for 81,226 children born between January 2005 and August 2013 were linked with maternal hospitalisation and outpatient records and birth registry data. Children were grouped into six categories based on maternal diabetes status during pregnancy (no diabetes, gestational diabetes or pre-existing diabetes) and birthweight (appropriate for gestational age [AGA] or LGA). WHO criteria were used to identify children who were overweight or obese. RESULTS: There were 69,506 children in the no diabetes/AGA group (control), 5926 in the no diabetes/LGA group, 4563 in the gestational diabetes/AGA group, 573 in the gestational diabetes/LGA group, 480 in the pre-existing diabetes/AGA group and 178 in the pre-existing diabetes/LGA group. The rate of being overweight/obese at pre-school age ranged from 20.5% in the control group to 42.9% in the gestational diabetes/LGA group. The adjusted attributable risk per cent for LGA alone (39.4%) was significantly higher than that for maternal gestational diabetes (16.0%) or pre-existing diabetes alone (15.1%); the risk for the combinations of gestational diabetes/LGA and pre-existing diabetes/LGA were 50.1% and 39.1%, respectively. Further stratification of the pre-existing diabetes groups found the prevalence of being overweight/obese was 21.2% in the type 1/AGA group, 31.4% in the type 1/LGA group (similar to those in the no diabetes groups), 26.7% in the type 2/AGA group and 42.5% in the type 2/LGA group. Breast-feeding was associated with a lower likelihood of being overweight/obese in childhood in all groups except gestational diabetes/LGA and pre-existing diabetes/LGA (both type 1 and type 2). CONCLUSION/INTERPRETATION: LGA is a stronger marker for risk of being overweight/obese in early childhood, compared with maternal diabetes during pregnancy. Rates of being overweight/obese in childhood were highest in LGA children born to mothers with gestational diabetes or pre-existing type 2 diabetes. Breast-feeding was associated with a lower risk of being overweight/obese in childhood in the majority of children; however, this association was not maintained in LGA children of mothers with diabetes.


Assuntos
Aleitamento Materno , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional/metabolismo , Macrossomia Fetal/etiologia , Sobrepeso/etiologia , Obesidade Pediátrica/etiologia , Índice de Massa Corporal , Criança , Pré-Escolar , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Sobrepeso/metabolismo , Obesidade Pediátrica/metabolismo , Gravidez , Gravidez em Diabéticas/metabolismo , Fatores de Risco
20.
Diabet Med ; 36(2): 167-176, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29932243

RESUMO

AIM: Excessive gestational weight gain increases risk of gestational diabetes mellitus (GDM) but it remains unclear whether weight control after GDM diagnosis improves outcomes. We assessed whether: (1) total gestational weight gain during pregnancy (0-36 weeks); (2) early gestational weight gain (0-28 weeks, before GDM diagnosis); or (3) late gestational weight gain (28-36 weeks, after diagnosis) are associated with maternal-fetal outcomes. METHODS: Some 546 women with GDM who delivered viable singleton infants at a single UK obstetric centre (October 2014 to March 2017) were included in this retrospective observational study. RESULTS: Higher total gestational weight gain was associated with Caesarean section [n = 376; odds ratio (OR) 1.05; confidence intervals (CI) 1.02-1.08, P < 0.001] and large for gestational age (OR 1.08; CI 1.03-1.12, P < 0.001). Higher late gestational weight gain (28-36 weeks; n = 144) was associated with large for gestational age (OR 1.17; CI 1.01-1.37, P < 0.05), instrumental deliveries (OR 1.26; CI 1.03-1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37; CI 1.92-6.82, P < 0.001), and higher post-partum 2-h oral glucose tolerance test concentrations (beta coefficient 0.12; CI 0.01-0.22, P < 0.05). Women who avoided substantial weight gain after GDM diagnosis had 0.7 mmol/l lower postnatal 2-h glucose and needed half the amount of insulin/day at 36 weeks compared with women with substantial weight gain after diagnosis. There were no significant associations between early gestational weight gain (0-28 weeks) and pregnancy outcomes. CONCLUSIONS: These findings suggest that controlling gestational weight gain should be a priority following GDM diagnosis to optimize pregnancy outcomes and improve maternal postnatal glucose homeostasis. The period after diagnosis of GDM (often 28 weeks gestation) is not too late to offer lifestyle advice or intervention to improve weight management and pregnancy outcomes.


Assuntos
Diabetes Gestacional/fisiopatologia , Ganho de Peso na Gestação/fisiologia , Adulto , Índice de Massa Corporal , Parto Obstétrico/estatística & dados numéricos , Diabetes Gestacional/tratamento farmacológico , Feminino , Macrossomia Fetal/etiologia , Humanos , Hipoglicemiantes/uso terapêutico , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Insulina/uso terapêutico , Masculino , Idade Materna , Metformina/uso terapêutico , Gravidez , Resultado da Gravidez , Trimestres da Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
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