Abstract
Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at 24–28 gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery. We investigated whether FAO is already present at 20–24 GW. Medical records of 7820 singleton pregnancy including 384 GDM were reviewed. Fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. FAO was defined as FAOR ≥ 90th percentile. FAORs measured at 20–24 GW in older and/or obese but not in young and non-obese GDM subjects were significantly higher than those in NGT subjects. Relative to NGT subjects without FAO at 20–24 GW, odds ratios for exhibiting FAO at GDM diagnosis and large for gestational age in GDM with FAO at 20–24 GW were 10.15 and 5.57, and their primary cesarean delivery rate was significantly higher than those in GDM without FAO (44% vs. 29%). Earlier diagnosis and active interventions of GDM well before 20–24 GW might be necessary to prevent FAO in the older and/or obese women.
Highlights
Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at [24,25,26,27,28] gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery
We investigated whether FAO is already present at [20,21,22,23,24] GW in GDM mother in order to determine the appropriate time for early diagnosis and treatment of GDM to prevent FAO
As compared with normal glucose tolerance (NGT) subjects, all GDM subgroups had a higher prevalence of large for gestational age (LGA) at birth and macrosomia, but young and non-obese group 1 GDM did not (Table 1, published in Ref.15)[18]
Summary
Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at [24,25,26,27,28] gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery. No reduction in childhood obesity or metabolic dysfunction in the offspring of treated GDM subjects has been reported, even though only female offspring showed significantly lower fasting glucose[6,7]. This controversial situation raises the question whether the onset of fetal overgrowth among women subsequently diagnosed with GDM might occur well before the diagnosis of GDM at ≤ 28 gestational weeks (GW). AC and EFW percentile in medium and low risk group were significantly higher than those in NGT group but there was no significant difference in birth weight p ercentile[16]
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