Abstract
BackgroundThe infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age. Antenatal dietary and lifestyle interventions have been shown to be ineffective at reducing this risk. Our aim was to examine the effects of metformin in addition to a diet and lifestyle intervention on fetal growth and adiposity among women with a BMI above the healthy range.MethodsWomen who had a body mass index ≥25 kg/m2 in early pregnancy, and a singleton gestation, were enrolled in the GRoW trial from three public maternity hospitals in metropolitan Adelaide. Women were invited to have a research ultrasounds at 28 and 36 weeks’ gestation at which ultrasound measures of fetal biometry and adiposity were obtained. Fetal biometry z-scores and trajectories were calculated. Measurements and calculations were compared between treatment groups. This secondary analysis was pre-specified.ResultsUltrasound data from 511 women were included in this analysis. The difference in femur length at 36 weeks’ gestation was (0.07 cm, 95% CI 0.01–0.14 cm, p = 0.019) and this was was statistically significant, however the magnitude of effect was small. Differences between treatment groups for all other fetal biometry measures, z-scores, estimated fetal weight, and adiposity measures at 28 and 36 weeks’ gestation were similar.ConclusionsThe addition of metformin to dietary and lifestyle advice in pregnancy for overweight and obese women has no clinically relevant effect on ultrasound measures of fetal biometry or adiposity.Trial registrationAustralian and New Zealand Clinical Trials Registry (ACTRN12612001277831).
Highlights
The infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age
Infants born to women who are overweight or obese are at increased risk of being born macrosomic or large for gestational age (LGA) [1, 8,9,10], of birth trauma including shoulder dystocia [10, 11], low Apgar scores, requiring resuscitation at birth [1, 8, 10], hypoglycaemia [12, 13] and requiring neonatal intensive care admission [1, 8, 12]
We have previously reported that adjuvant antenatal metformin therapy is not associated with any differences in birth weight or risk of infants being born large for gestational age [23]
Summary
The infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age. Women commencing pregnancy overweight or obese, defined as a body mass index (BMI) of ≥ 25 kg/m2 and ≥ 30 kg/m2, respectively,have an increased risk of adverse pregnancy and birth outcomes. Infants born to women who are overweight or obese are at increased risk of being born macrosomic or large for gestational age (LGA) [1, 8,9,10], of birth trauma including shoulder dystocia [10, 11], low Apgar scores, requiring resuscitation at birth [1, 8, 10], hypoglycaemia [12, 13] and requiring neonatal intensive care admission [1, 8, 12]. Such interventions have not reduced infant birthweight or risk of an infant born LGA [18]
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