Abstract
To assess how maternal body mass index and gestational weight gain are related to on fetal venous liver flow and birthweight in pregnancies with pre-gestational diabetes mellitus. In a longitudinal observational study, 49 women with pre-gestational diabetes mellitus were included for monthly assessments (gestational weeks 24-36). According to the Institute Of Medicine criteria, body mass index was categorized to underweight, normal, overweight, and obese, while gestational weight gain was classified as insufficient, appropriate or excessive. Fetal size, portal flow, umbilical venous flow and distribution to the fetal liver or ductus venosus were determined using ultrasound techniques. The impact of fetal venous liver perfusion on birthweight and how body mass index and gestational weight gain modified this effect, was compared with a reference population (n = 160). The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population. Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population. Fetuses of overweight women with pre-gestational diabetes mellitus had higher umbilical (p = 0.02) and total venous liver flows (p = 0.02), and a lower portal flow fraction (p = 0.04) than in the reference population. In pre-gestational diabetes mellitus pregnancies with excessive gestational weight gain, the umbilical flow to liver was higher than in those with appropriate weight gain (p = 0.02). The results support the hypothesis that umbilical flow to the fetal liver is a key determinant for fetal growth and birthweight modifiable by maternal factors. Maternal pre-gestational diabetes mellitus seems to augment this influence as shown with body mass index and gestational weight gain.
Highlights
In pregnancies with pre-gestational diabetes mellitus (PGDM), the risk of adverse perinatal outcome is increased [1], and complications are often associated with large for gestational age neonates [2,3]
The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population
Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population
Summary
In pregnancies with pre-gestational diabetes mellitus (PGDM), the risk of adverse perinatal outcome is increased [1], and complications are often associated with large for gestational age neonates [2,3]. Recent improvements in glucose monitoring demonstrate that reduced glucose excursions/variability improve pregnancy outcomes [5]. These women have on average higher pre-pregnancy body mass index (BMI) and more gestational weight gain than women without diabetes mellitus [7,8]. Overweight and obesity add significantly to the risk of large for gestational age offspring in these pregnancies [7], and excess gestational weight gain is linked to risk for neonatal macrosomia independent of glycemic control in women with type 1 diabetes [8]. Women with PGDM are advised to aim for pre-pregnancy BMI in the normal range, less gestational weight gain than women without diabetes, and strict glycemic control [5,8,9]
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