Gestational Diabetes Mellitus: Predictive Value of Fetal Growth Measurements by Ultrasonography at 22-24 Weeks: A Retrospective Cohort Study of Medical Records.

Danyao Jin,Zheng Liu,Janet Wilson Rich-Edwards,Siyu Zou,Yaqing Gao,Yinping Wang,Xiangrong Xu,Jue Liu,Chunyi Chen,Hong Zhou,Haijun Wang,Yue Huang

doi:10.3390/nu12123645

Abstract

Early intervention of gestational diabetes mellitus (GDM) is effective in reducing pregnancy disorders. Fetal growth, measured by routine ultrasound scan a few weeks earlier before GDM diagnosis, might be useful to identify women at high risk of GDM. In the study, generalized estimating equations were applied to examine the associations between ultrasonic indicators of abnormal fetal growth at 22–24 weeks and the risk of subsequent GDM diagnosis. Of 44,179 deliveries, 8324 (18.8%) were diagnosed with GDM between 24 and 28 weeks. At 22–24 weeks, fetal head circumference (HC) < 10th, fetal femur length (FL) < 10th, and estimated fetal weight (EFW) < 10th percentile were associated with 13% to 17% increased risks of maternal GDM diagnosis. Small fetal size appeared to be especially predictive of GDM among women who were parous. Fetal growth in the highest decile of abdominal circumference (AC), HC, FL and EFW was not associated with risk of subsequent GDM. The observed mean difference in fetal size across gestation by GDM was small; there was less than 1 mm difference for AC, HC, and FL, and less than 5 g for EFW before 24 weeks. Despite similar mean fetal growth among women who were and were not later diagnosed with GDM, mothers with fetuses in the lowest decile of HC, FL and EFW at 22–24 weeks tended to have higher risk of GDM.

Highlights

Gestational diabetes mellitus (GDM) is a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy [1]
The risk of developing gestational diabetes mellitus (GDM) did not vary by fetal growth parameters among mothers with fetuses in the highest decile (Table 2)
The interaction terms of GDM and parity did not reach statistical significance (Table 3), ORs for fetal undergrowth appeared stronger for parous women, who had 28%, 34% and 26% higher odds of GDM if they carried fetuses < 10th percentile of head circumference (HC), femur length (FL), and estimated fetal weight (EFW), respectively

Summary

Introduction

Gestational diabetes mellitus (GDM) is a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy [1]. GDM affects 10–26% of pregnancies throughout the world [2]. The prevalence of GDM is high in Chinese women, estimated at. 14.8% in mainland China according to a meta-analysis of 25 papers between 2010 and 2017 [3]. GDM is associated with adverse health outcomes for both mothers and their offspring, including preeclampsia, Nutrients 2020, 12, 3645; doi:10.3390/nu12123645 www.mdpi.com/journal/nutrients. Nutrients 2020, 12, 3645 preterm birth and macrosomia [4,5,6]. Women with a history of GDM are at increased risk of type 2 diabetes and cardiovascular disease [7,8].

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