Abstract
BackgroundMaternal gestational diabetes (GDM) is an established risk factor for large size at birth, but its influence on intrauterine fetal growth in different ethnic populations is less well understood. Here, we examine the joint associations of GDM and ethnicity with longitudinal fetal growth in South Asian and White European origin women.MethodsThis study included 10,705 singletons (4747 White European and 5958 South Asian) from a prospective cohort of women attending an antenatal clinic in Bradford, in the North of England. All women completed a 75-g oral glucose tolerance test at 26–28 weeks’ gestation. Ultrasound measurements of fetal head circumference (HC), femur length (FL) abdominal circumference (AC), and estimated fetal weight (EFW), and corresponding anthropometric measurements at birth were used to derive fetal growth trajectories. Associations of GDM and ethnicity with these trajectories were assessed using multilevel fractional polynomial models.ResultsEight hundred thirty-two pregnancies (7.8%) were affected by GDM: 10.4% of South Asians and 4.4% of White Europeans. GDM was associated with a smaller fetal size in early pregnancy [differences (95% CI) in mean HC at 12 weeks and mean AC and EFW at 16 weeks comparing fetuses exposed to GDM to fetuses unexposed (reference) = − 1.8 mm (− 2.6; − 1.0), − 1.7 mm (− 2.5; − 0.9), and − 6 g (− 10; − 2)] and a greater fetal size from 24 weeks’ gestation through to term [differences (95% CI) in mean HC, AC, and EFW comparing fetuses exposed to GDM to those unexposed = 0.9 mm (0.3; 1.4), 0.9 mm (0.2; 1.7), and 7 g (0; 13) at 24 weeks]. Associations of GDM with fetal growth were of similar magnitude in both ethnic groups. Growth trajectories, however, differed by ethnicity with South Asians being smaller than White Europeans irrespective of GDM status. Consequently, South Asian fetuses exposed to GDM were smaller across gestation than fetuses of White Europeans without GDM.ConclusionsIn both ethnic groups, GDM is associated with early fetal size deviations prior to GDM diagnosis, highlighting the need for novel strategies to diagnose pregnancy hyperglycemia earlier than current methods. Our findings also suggest that ethnic-specific fetal growth criteria are important in identifying hyperglycemia-associated pathological effects.
Highlights
Maternal gestational diabetes (GDM) is an established risk factor for large size at birth, but its influence on intrauterine fetal growth in different ethnic populations is less well understood
Understanding the joint associations of Gestational diabetes (GDM) and South Asian ethnicity, two key risk factors for variation in birthweight, on fetal growth is important for identifying mechanisms that might explain lower birthweight in South Asians despite their greater GDM risk, and for determining whether hyperglycemia-related pathological growth in South Asians can be determined from fetal growth patterns
GDM gestational diabetes, CI confidence interval of GDM), South Asian fetuses exposed to GDM were smaller across gestation than White European fetuses not exposed to GDM (Fig. 2, Table 2)
Summary
Maternal gestational diabetes (GDM) is an established risk factor for large size at birth, but its influence on intrauterine fetal growth in different ethnic populations is less well understood. We examine the joint associations of GDM and ethnicity with longitudinal fetal growth in South Asian and White European origin women. Consistent evidence shows that despite having a greater risk of developing GDM, South Asian women give birth to lower weight infants than women of White European origin [2, 3]. This ethnic difference in weight appears to be present in the fetus from as early as 20 weeks’ gestation based on fetal ultrasound scan assessment [4,5,6]. Understanding the joint associations of GDM and South Asian ethnicity, two key risk factors for variation in birthweight, on fetal growth is important for identifying mechanisms that might explain lower birthweight in South Asians despite their greater GDM risk, and for determining whether hyperglycemia-related pathological growth in South Asians can be determined from fetal growth patterns
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