Frequency Of Macrosomia Research Articles

Correlation of Cross-sectional Area of the Umbilical Cord on Antenatal Ultrasound with Neonatal Birth Weight in Pregnant Women with and without Gestational Diabetes Mellitus: A Prospective Cohort Study

Introduction: Many foetal and maternal complications, such as polyhydramnios, macrosomia, birth injuries, and operative interference, are linked with Gestational Diabetes Mellitus (GDM). Among these, macrosomia is particularly significant, as it increases the risk of shoulder dystocia, brachial plexus injury, birth asphyxia, and maternal complications, including emergency Lower Segment Caesarean Section (LSCS), Postpartum Haemorrhage (PPH), and perineal trauma. Therefore, one of the most essential perinatal goals in GDM is to predict macrosomia by estimating birth weight, thereby preventing adverse maternal and foetal outcomes. Aim: To evaluate whether there is a correlation between the cross-sectional area of the Umbilical Cord (UCA) and the Neonatal Birth Weight (NBW) in pregnant women with GDM. Materials and Methods: A prospective cohort study was conducted in the Departments of Radiology and Obstetrics Bangalore Medical College, Bengaluru, Karnataka, India. A total of 100 pregnant women (50 with GDM and 50 without GDM) were recruited from July 2021 to July 2022. Ultrasound examination (USG) was performed on pregnant women after 36 weeks of gestation. The UCA was measured in a free-floating loop, and the NBW was measured using a digital scale. The correlation coefficient was calculated to determine the degree of correlation between UCA and NBW. Results: The mean age of the subjects was 26.5±3.9 years. The frequency of macrosomia was higher in the GDM group (8%) compared to the control group (4%). A strong positive correlation was observed between UCA and NBW in both diabetics (r=0.819) and control groups (r=0.736). Conclusion: A strong positive correlation exists between UCA and NBW in women with GDM. Therefore, it should be estimated during routine antenatal USG for the prediction of birth weight in such women.

Anne yaşı dağılımının gebelikle ilişkili komplikasyonlar ve neonatal sonuçlar üzerindeki etkisi: tek merkezli retrospektif bir deneyim

Aim: To determine possible risks for mother and baby in advanced age pregnancies. Materials and Methods: This study is a retrospective archive review examining 14192 cases who gave live births between 24 and 42 weeks between 2020-2023. Results: The frequency of preeclampsia, gestational hypertension, gestational diabetes mellitus, rupture of membranes and possible miscarriage was high in advanced-age pregnant women compared to other groups. When the groups were compared according to neonatal outcomes, the frequency of low birth weight in adolescence was high than in advanced-age pregnant women. When the groups were compared in terms of macrosomia, the frequency of macrosomia was high in the older age group than in the other groups. Conclusion: It should be known that pregnancies at an advanced-age can be more complicated for both mother and baby, and pregnancy follow-up should be done more carefully.

The Influence of High Glycosylated Hemoglobin Levels on Obstetrical and Neonatal Results in Diabetic Pregnant Women

Amaç: Diyabet metabolik bir hastalıktır ve gebeliğin en sık görülen komplikasyonudur. Retrospektif olarak yaptığımız bu çalışmada, gestasyonel diyabetes mellitus saptanan gebelerde, HbA1c düzeyleri ile perinatal sonuçlar arasındaki ilişkiyi değerlendirmeyi amaçladık.Gereç ve Yöntemler: Çalışmamız, Ocak 2010 ile Aralık 2015 tarihleri arasında, Doğu Anadolu’da referans merkez olan Atatürk Üniversitesi Tıp Fakültesi Hastanesi kadın hastalıkları ve doğum polikliniğine başvuran, 22 hafta ve üzerinde gestasyonel diyabetes mellitus tanısı alan, doğumu kliniğimizde gerçekleştirilmiş çalışma grubunun (93 vaka) verilerini, diyabetik olmayan kontrol grubunun (208 vaka) verilerini ve yenidoğan yoğun bakıma yatış verilerini kapsamaktadır.Bulgular: Gestasyonel diyabetes mellitus olan grup; HbA1c düzeyi %6.5 ve üzerinde (37 hasta) ve %6.5’un altında (56 hasta) olan iki alt gruba ayrılarak kontrol grubuyla karşılaştırmalı olarak incelenmiştir. Gestasyonel diyabetes mellitus olan ve olmayan gruplar arasında sırasıyla; yaş, abortus sayısı, ölü doğum sayısı, doğum şekli ve 1. dakika APGAR skoru açısından istatistiksel olarak anlamlı fark görülmedi (p>0.05). Gravida, parite ve yaşayan sayısı yönünden anlamlı fark olup (p=0.005, p=0.003), bu farkın nedeni kontrol grubuna göre HbA1c <%6.5 olan gestasyonel diyabetes mellitus grubunun gravida ve paritesinin daha düşük olmasıydı (sırayla p=0.004, p=0.005 ve p=0.020, p=0.007 ve p=0.038). Gebelik haftalarına bakılarak olguların dağılımları incelendiğinde, kontrol grubuna göre HbA1c ≥%6.5 olan gestasyonel diyabetes mellitus grubunda term oranı istatistiksel olarak daha düşük, geç preterm oranı ise daha yüksekti (p<0.001 ve p=0.008). HbA1c <%6.5 olan gestasyonel diyabetes mellitus grubunda bebek doğum ağırlığı daha yüksek (p<0.001), her iki alt grupta makrozomi görülme sıklığı daha yüksek bulundu (p=0.023 ve p=0.005). HbA1c ≥%6.5 olan gestasyonel diyabetes mellitus grubunda yenidoğan yoğun bakım gereksinimi daha fazlaydı (p<0.001).Sonuç: Diyabetik gebelerdeki HbA1c değerleri ile yenidoğan yoğun bakım yatış oranları arasında anlamlı bir ilişki saptanmıştır. Bu açıdan bakıldığında, maternal HbA1c seviyesinin yenidoğan yoğun bakıma yatış açısından bir risk faktörü olarak kullanılabileceğini düşünmekteyiz.

Complications of the Early Neonatal Period in Children from Mothers with Gestational Diabetes Mellitus

Background: Changes in the course of gestational diabetes mellitus (GDM) at the present stage determine the emergence of a certain spectrum of completely new problems associated with the health status of newborns from mothers with GDM. The aim of the study was to investigate early neonatal complications in newborns from mothers with GDM. Methods and Results: The study included 404 pregnant women (gestational age of 37.0–41.0 weeks) with GDM. All patients with GDM were divided into 2 groups. Group 1 included 188 patients receiving insulin therapy; Group 2 included 216 patients receiving a well-balanced diet. The control group (Group 3) consisted of 68 pregnant women without disorders of carbohydrate metabolism. In Group 1, macrosomia occurred in 44(23.4%) newborns, in Group 2 - in 48(22.0%) newborns; in newborns from mothers of the control group, the frequency of macrosomia was only in 7.35% of newborns (P=0.01). Morpho-functional immaturity of newborns had the highest frequency of occurrence, despite the fact that all children were born on time; 80(42.6%) newborns from mothers of Group 1 and 77(35.6%) newborns from mothers of Group 2 had signs of morpho-functional immaturity. Conclusion: Diabetic fetopathy in newborns from mothers with GDM is manifested by morpho-functional immaturity of organs and systems developing in unfavorable hyperglycemic conditions.

Women with a predisposition for diabetes have an increased risk of pregnancy complications, especially in combination with pregestational overweight

BackgroundOverweight and gestational diabetes are risk factors for pregnancy complications. We hypothesized that the metabolic impact of overweight on pregnancy outcome, would be different if it was combined with a predisposition for diabetes. The aim of this study was to compare the outcome of pregnancies in women with diabetes diagnosed later in life, to the outcome of pregnancies of women who did not develop diabetes.MethodsWomen in a population-based cohort who also were registered in the Swedish Medical Birth Registry (n = 4738) were included. A predisposition for diabetes (GDM or diabetes after pregnancy) was found in 455 pregnancies. The number of pregnancies with maternal BMI ≥ 25 kg/m2 and without diabetes were 2466, and in 10,405 pregnancies the mother had a BMI < 25 kg/m2 without diabetes at any time. Maternal BMI, gestational length, gestational weight gain, frequency of caesarean section, infant birth weight, frequency of large for gestational age (LGA) and Apgar score were retrospectively compared.ResultsPregnancies with normal maternal BMI ≤25 kg/m2, with predisposition for diabetes had a higher frequency of LGA (11.6% vs. 2.9%; p < 0.001), a higher frequency of macrosomia (28.6% vs. 17.6%; p < 0.001), and a shorter gestational length (39.7 vs. 40 weeks; p = 0.08) when compared to pregnancies in women without a predisposition for diabetes. In addition, pregnancies with both maternal predisposition for diabetes and BMI ≥ 25 kg/m2 there was a higher frequency of LGA (23.3% vs. 7.1%; p < 0.001), caesarean section (24.0% vs. 14.9%, p = 0.031) compared to pregnancies in women who were only overweight. A predisposition for diabetes significantly increases the risk of macrosomia (OR1.5; 95% CI 1.07–2.15; p = 0.02).ConclusionsIn pregnancy, there is an increased frequency of LGA, macrosomia and caesarean section if the woman has a predisposition for diabetes. The frequency of overweight young women is increasing, and it is urgent to identify pregnant women with a predisposition to diabetes. How to distinguish the women with the highest risk for adverse pregnancy outcome and the highest risk of future disease, remains to be studied.

Fresh versus frozen embryo transfer for full-term singleton birth: a retrospective cohort study

BackgroundImprovements in vitrification and frozen embryo transfer (FET) technologies have rapidly increased, and some evidence suggests that FET may increase pregnancy rates and lead to more favourable perinatal outcomes. However, the outcome of interest should be offspring safety. Therefore, the primary objective of our study was to investigate whether FET was preferable to fresh embryo transfer (ET) in terms of full-term neonatal birthweight and congenital malformations.MethodsThis was a retrospective cohort study of patients with no pregnancy-related complications who underwent first fresh ETs (n = 2059) or FETs (n = 2053), resulting in full-term singletons births. Outcome measures were neonatal birthweight, low birthweight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA), macrosomia and congenital malformations. Additionally, we used logistic regression to adjust for baseline characteristics (age, BMI, No. of embryos transferred and embryo stage) between the two groups.ResultsThe mean neonatal birthweight was higher for singletons born after FET than for singletons born after fresh ET (3468.7 ± 475.3 vs. 3386.7 ± 448.1; p < 0.001). The frequencies of full-term singleton LBW and SGA after FET were significantly lower than those after fresh ET (1.7% vs. 3.0 and 4.4% vs. 6.7%, respectively), with adjusted rate ratios of 0.59 (95% CI, 0.37 to 0.98; p = 0.026) and 0.73 (95% CI, 0.55 to 0.99; p = 0.041), respectively. FET resulted in higher frequencies of macrosomia and LGA (15.1% vs 10.2 and 22.8% vs. 17.5%, respectively) than fresh ET, with adjusted rate ratios of 1.43 (95% CI, 1.16 to 1.75; p = 0.001) and 1.26 (95% CI, 1.07 to 1.49; p = 0.007), respectively. Furthermore, the incidence of congenital malformations was not different between the two groups (1.2% vs. 0.9%), with a rate ratio of 0.288.ConclusionsAfter the cycles with pregnancy-related complications were excluded and after adjustments for baseline characteristics, women undergoing FET were associated with a higher neonatal birthweight than women undergoing fresh ET cycles. Additionally, the FET protocol was associated with lower rates of LBW and SGA and higher rates of macrosomia and LGA than the fresh ET protocol. Meanwhile, no difference in the congenital malformation rate was evident between the two groups.

GDM—Impact of BMI in Maternal Bioquimical-Metabolic Variables and Its Association with Macrosomia

Maternal Overweight/obesity increases risk of GDM and macrosomia Objectives: Compare pregestational BMI. Frequency of macrosomia. Correlationship between BMI first trimester fasting glycemia (1stTFG&amp;gt;92) fasting glycemia OGTT (FGOGTT), glycemia 120 minutes OGTT (2HPG), maternal weight gain during pregnancy (MWG) and macrosomía Research Design Methods: Analysis of 120 GDM medical records using ALAD diagnostic criteria. BMI categories were compared in Groups A ≥30 vs. ≤24.9 B 25-29.9 vs. ≤24.9 C ≥30 vs. 25-29.9 Variables: maternal age (MA), 1stTFG&amp;gt;92; FGOGTT, 2HPG, birth weight (BW), HbA1c, maternal triglyceridemia on last trimester (MTAG) maternal weight gain (MWG) SPSS V22. Results: BMI ≥30 N:39 BMI 25-29.9 N:42 BMI≤24.9 N:33 Mean HBA1C for all groups 5%. Table 1 comparison groups. Macrosomía N:13 (N:5 BMI 25-29.9 N:8 BMI ≥30 N:0 BMI group ≤24.9) p0.026. Correlation of macrosomia and FG1stT&amp;gt; 92 FGOGTT 2HPG MWG ≥ 7KG in BMI ≥30 is p0.046 p0.017 p0.096 P0.0001 respectively. Correlation between macrosomia and FG1stT&amp;gt; 92 FGOGTT 2HPG MWG ≥ 11KG in BMI 25-29.9 is p0.0001 P0.011 p0.012 p0.001 respectively Discussion: Pregestational BMI excessive MWG 1stTFG and higher levels of MTAG in BMI ≥30 increases risk of macrosomia. 1stTFG&amp;gt; 92 should considered as an independent risk factor for GD/macrosomia in overweight/obese pregancys. In BMI ≥25 consider lower thresholds of FG for GDM diagnostic criteria to prevent macrosomia. Disclosure M. Argerich: None. R. David: None. A. Bocchini: None.

Trends of Macrosomia at University Clinics of Kinshasa

Context. The prevalence of macrosomia varies through the world according to racial and ethnic factors, life style and importance of non communicable diseases (maternal obesity, diabetes-gestational and type 2), post-term gestation and multiparity. At the University Clinics of Kinshasa (UCK), 30 years ago, the frequency of macrosomia was 2.4%. Objectives. To update data on the frequency of macrosomia at UCK, regarding variations in maternal anthropometrics (obesity) and socio-demographic factors. Methods. A cross-sectional study was conducted at UCK from 1 January 2007 to 31 December 2016. Mothers who delivered babies weighing at least 4000 g were included in this study. Results. The frequency of macrosomia was 3.7%. Trend shows a variation of this frequency over time with lowest frequency (2.1%) in 2012 and highest (5.3%) in 2009. The mother average age and parity were 32.3 ± 5.4 years and 3 ± 2, respectively. Pregnancies were complicated by polyhydramnios (48%) and gestational diabetes (19.7%). Caesarean section was performed in 60.5% cases, mainly for macrosomia (47.8%) and 81.6% of newborns had constitutional macrosomia. Adverse obstetrical outcomes of macrosomia were dominated by caesarean section (28.9%), lacerations of birth canal (23%) and neonatal distress (9.2%). Conclusion. Macrosomia remains a constant finding at UCK, and is associated with maternal, fetal and neonatal adverse outcomes. Trend shows a variation of the frequency over time between 2.1% and 5.3%.

Increased incidence of post-term delivery and Cesarean section after frozen-thawed embryo transfer during a hormone replacement cycle.

This study aimed to clarify the risks of adverse pregnancy outcomes in patients who conceive singletons after frozen embryo transfer (FET) during a hormone replacement cycle and their offspring. A retrospective cohort study was conducted in patients who conceived after FET, based on the Japanese-assisted reproductive technology registry for 2013. The perinatal outcomes in cases with live-born singletons achieved through natural ovulatory cycle FET (NC-FET) (n = 6287) or hormone replacement cycle FET (HRC-FET) (n = 10,235) were compared. Multiple logistic regression analyses were performed to determine the potential confounding factors. The frequencies of macrosomia (1.1% in NC-FET and 1.4% in HRC-FET; P = 0.058) were comparable between patients after NC-FET and HRC-FET. The proportions of post-term delivery (0.2% in NC-FET and 1.3% in HRC-FET; P < 0.001) and Cesarean section (33.6% in NC-FET and 43.0% in HRC-FET; P < 0.001) were higher in patients after HRC-FET than in patients after NC-FET. The risks of post-term delivery (adjusted odds ratio (AOR) 5.68, 95% confidence interval (CI) 3.30-9.80) and Cesarean section (AOR 1.64, 95% CI 1.52-1.76) were also higher in patients after HRC-FET than in patients after NC-FET. Patients who conceived singletons after HRC-FET were at increased risk of post-term delivery and Cesarean section compared with those who conceived after NC-FET.

Clinical course of gestational diabetes mellitus (GDM) and pregnancy outcomes in women with GDM in relation to the method and term of diagnostic

Background and aims. Due to changes in criteria of diagnosis of GDM in Russia from 2013, it is relevant to study clinical course of GDM and pregnancy outcomes depending on terms and methods of diagnosis of GDM.Material and methods. 192 pregnant women aged 29,4±5,5ys, with a body weight 68,8±14,8 kg, BMI 25,3±5,3. 1st group: 86 pregnant women with high fasting glucose level before 20th week of pregnancy, 2nd group: 43 pregnant women with hyperglycemia in OGTT after 20th week of pregnancy, 3rd group: 63 pregnant women without GDM - control group.Results. Pregnant women with GDM were older than non-GDM women (29,5±5,4ys., 30,8±5,3ys., 28,4±5,7ys, р=0,05) and had higher body weight (72,3±16,9 kg, 68,0±12,4 kg, 64,4±11,5 kg, р=0,016). There weren't difference in age, BMI between groups 1st and 2nd. The proportion of compliant women was the same in groups 1st and 2nd (38,4% and 34,9%, p=0,85). Pregnant women who needed insulin were older and had higher BMI (32,4 ± 5,3 ys. vs. 28,9 ± 5,4 ys, р=0,04; 29,7 ± 7,1vs.25,6 ± 5,7, р=0,03 respectively). The number of women treated by insulin was higher in 2nd group (46,6%vs.15,5%, p=0,03). Women, who treated by insulin, were younger and had higher BMI in 1st group compared with 2nd group (29, 0±4,7ys vs 35,0±4,3ys, р=0,03; 34,4±5,7 vs 26,1±5,9 respectively, р=0,02). There was a significant difference in delivery term and summary severe adverse outcomes (macrosomia, preterm delivery, stillbirth) between non-compliant women with GDM and 3rd group (38,6±2,7ws 1st group, 38,0±1,9ws 2nd group, 39,5±1,09ws 3rd group, р=0,008; 34,3% 1st group, 66,7% 2nd group, 19,4% 3rd group, р=0,027). The frequency of macrosomia and summary adverse pragnancy outcomes (hypoglicemia, neonatal jaundice, clavicle fracture, asphyxia) was higher in non-compliant women with GDM compared with compliant women ((29,5% vs. 12,2%, р=0,03; 70,5% vs. 46,3%, р=0,02 respectively).Conclusions: Pregnant women with GDM diagnosed on base of high fasting glucose level, need insulin less frequently. Pregnancy outcomes in women with GDM depend on compliance rather than on terms or methods of diagnosis.

Pregnancy and Neonatal Outcomes in Gestational Diabetes Treated with Regular Insulin or Fast-Acting Insulin Analogues

Background/Aims: Fast-acting insulin analogues (FAIAs) are being used more frequently during pregnancy. Previous studies comparing regular insulin (RI) and FAIA consist primarily of women enrolled with pre-existing diabetes; therefore, we compared pregnancy and neonatal outcomes in women with gestational diabetes. Methods: We retrospectively investigated 197 pregnant women with gestational diabetes mellitus (GDM) requiring insulin treatment for glycemic control. Individuals were divided into 2 groups: RI (n = 55) and FAIA (aspart or lispro; n = 142). Pregnancy outcomes, including caesarean section rate, and neonatal outcomes, including macrosomia and ponderal index, were compared between groups. Results: There were no significant differences in maternal baseline characteristics (age, parity, body mass index and weight gain) between groups or in haemoglobinA_1c before delivery. The frequency of emergency caesarean section (caesarean section after trial of labor) was not significantly different between groups (RI 16.7%, FAIA 24.7%; p = 0.452). There were no differences in frequencies of macrosomia (RI 3.4%, FAIA 6.5%; p = 0.518), ponderal index (RI 2.65 ± 0.5, FAIA 2.71 ± 0.5; p = 0.322), cranial-thoracic circumference ratio (RI 1.07 ± 0.06, FAIA 1.07 ± 0.06; p = 0.386) or neonatal hypoglycemia (RI 5.1%, FAIA 5.8%; p = 1.000). Conclusion: Our data indicate that FAIA achieves similar pregnancy and neonatal outcomes in GDM compared with RI. Considering patient convenience, FAIA may be better to use during pregnancy.

Obésité et primiparité : accouchement à risque ?

To evaluate the risk of materno-foetal complications in obese primiparous women (Body Mass Index (BMI)≥30) MATERIALS AND METHODS: A retrospective study was conducted in our tertiary referral labour ward from 1st January 2009 to 31st December 2010, including primiparous women delivering living cephalic singleton pregnancies after 37 weeks of amenorrhea. Two groups were compared: obese patients (BMI≥30) and non-obese (BMI<30). Obstetrical and neonatal data were collected. Among 1636 primiparous women, 132 (8%) had a BMI≥30. Induction of labor, prolonged pregnancy and post-partum hemorrhage were significatively more frequent in obese group (P<0.001). Those patients have an increased risk of cesarean section (P<0.001). Mean birth weight of newborns from obese mothers is significatively higher (3493g vs 3265g, P<0.001), as is the frequency of macrosomia (16.7% vs 5.2%, P<0.001). Obesity is associated with obstetrical complications in primiparous obese women, who are to be considered risky patients at their arrival in the labour ward, and specific obstetrical management must be planned to improve maternal and neonatal outcomes.

Evaluation of the Prevalence of Macrosomia and the Maternal Risk Factors

AbstractBackground: Macrosomia is a term applied to newborns with a birth weight of 4000 gr or above. Perinatal mortality and morbidity is increased in fetal macrosomia. Clavicular fracture, injury to brachial plexus, and hypoglycemia are important side effects. Mother’s age, body mass index of mother, weight gain in pregnancy, mother’s height, diabetes, history of macrocosmic delivery, gestational age, parity, and fetal sex are factors causing macrosomia. The purpose of this cross-sectional study was to evaluate the frequency and risk factors of macrosomia in Asalian hospital of Khorramabad in the summer of 2010. Methods: The data collection instrument was a questionnaire containing 10 variables as the risk factors of macrosomia. The data were analyzed using the SPSS software.Results: 59 cases of macrosomia were found in 500 living births. The results showed that the frequency of macrosomia was 11.8%. 69.5% of the neonates were male and 30.5% were female. Maternal risk factors were mother's age at pregnancy, mother's obesity (BMI>=30), weight gain more than 18 kg during pregnancy, history of diabetes mellitus, history of macrosomia, prolonged gestational age, and multiparity (parity>=5). There was no significant relationship between mother's job and macrosomia.Conclusion: The prevalence of macrosomia in Khorramabad was high (11.8%). Preventing pregnancy in mothers over 35 years of age by contraception ways, preventing maternal obesity before pregnancy, and control of blood glucose during pregnancy by suitable diet and insulin therapy are recommended to prevent macrosomia.

The Prevalence of Fetal Macrosomia at the Specialized Hospital of Gynecology and Obstetrics of Sidi Bel Abbes (West Of Algeria)

Introduction: Fetal macrosomia is generally defined as a birth weight greater than 4000 grams and it is related to some adverse neonatal outcomes and maternal complications. The aim of our work is to identify the clinical profile of mothers who give birth to a macrosomic infant, and to study the maternal complications associated with delivering infants with a birthweight of 4000 grams or greater. Methods: We did both a retrospective and prospective study, we collected 970 births over a period of one year that ranged from 1st January 2012 to 31 December 2012 for the retrospective study using the archived files, and we recorded 130 birth in the first semester of 2013 for the prospective study by means of interviewing the mother, all births were collected in the specialized hospital center of Gynecology and Obstetrics in Sidi Bel Abbes. Results: The frequency of macrosomia in our study was estimated at 10.19%. Fetal macrosomia was more frequent in mothers aged between 29 and 38 years, who were taller, multiparous, and obese, had diabetes and a history of macrosomia, and had a Fundal height greater than or equal to 34 cm. About the obstetric outcomes, caesarean was indicated in 45.72% of cases and vaginal delivery occurred in 53.90% of cases. The percentage of neonatal morbidity was 4.55%, it was dominated by neonatal infections (4%), and obstetric trauma dominated by shoulder dystocia (0.55%). No maternal deaths were reported in our study Conclusion: The evaluation of the obstetrical management in our series is acceptable given the good neonatal outcomes but is still limited because of insufficient technical capacity, and more efforts should be made for a better monitoring of pregnant women to detect patients at risk such as patient having obesity and diabetes in order to improve maternal and fetal prognosis.

Maternal and Perinatal Outcomes of Pregnancies Complicated with Pregestational and Gestational Diabetes Mellitus in Saudi Arabia

Objectives: The aim of this study was to compare the maternal and the perinatal outcomes of women with Pre- Gestational Diabetes Mellitus (PGDM) with the outcomes of those with Gestational Diabetes Mellitus (GDM). Methods: In a retrospective cohort study the maternal and the neonatal outcomes of women with PGDM, were compared to the outcomes of women with GDM. Data were collected for the period of 12 months, from the 1st of January to the 31st of December 2012, from the labour ward registry. Data compared were; age, parity, mode of delivery, premature delivery, previous history of miscarriage, birth weight, macrosomia, rate of APGAR scores less than 7 at 5 minutes and stillbirth rate. Student t test was used to compare continuous variables and Chi squared was used to compare categorical variables. Multivariate analysis was used to estimate adjusted Odds Ratio (OR). Results: Of the 3413 deliveries during the study period, 3157 fulfilled the inclusion criteria; of those there were a total of 685 deliveries for diabetic women. 569 (83.1%) had GDM and 116 (16.9%) had PGDM. Of those with PGDM, 66 (57%) had T1DM and 50 (43%) had T2DM. Compared to the GDM group, women with PGDM were more likely to be delivered by caesarean section (CS), adjusted OR 2.6, 95% CI (1.66-4.09). The neonates of mothers with PGDM were significantly heavier compared to those of GDM group, p<0.001; and the frequency of macrosomia was more, adjusted OR 3.67, 95% CI (1.75-7.71). Mothers with PGDM have increased risk of preterm delivery less than 37gestations weeks, adjusted OR 2.63, 95% CI (1.49- 4.70). There was no statistically significant difference between the two groups in the rate of APGAR scores less than 7 in 5 minutes or the rate of stillbirth. Conclusion: PGDM is associated with worse pregnancy outcomes compared to GDM.

271: The effect of metformin on insulin requirements in pregnancies complicated by type 2 diabetes

To investigate the effect of metformin on gestational insulin requirements in pregnancies complicated by type 2 diabetes (T2DM) in obese and non-obese populations. A retrospective cohort study was performed on women with singleton term pregnancies with T2DM enrolled in the U.C. San Diego Diabetes and Pregnancy program from February 2008 to October 2011. Exclusion criteria included use of sulfonylureas, delivery at outside institutions, or insufficient prenatal care. Comparisons of patients using insulin alone versus those on insulin/metformin therapy were made using the t-test for continuous variables and the chi-squared or fisher's exact tests for categorical variables. A total of 69 women met inclusion criteria, 40 in the insulin-only cohort and 19 in the insulin/metformin cohort. Demographic variables, including age, ethnicity, parity, initial BMI and HbA1c were not significantly different between the two groups. 75% of patients in the insulin-only cohort and 53% in the insulin/metformin cohort were obese in the first trimester. In the obese population, patients on metformin had significantly higher total and short-acting insulin requirements at 36 weeks compared to the insulin-only cohort (table 1). In the non-obese population, there were no significant differences in insulin requirements between the metformin/insulin and insulin-only cohorts. Gestational age at delivery, infant birthweight, frequency of macrosomia, mode of delivery, and Apgar scores were similar in both groups.Tabled 1Insulin requirements for the insulin-only and metformin/insulin combination therapy cohorts Obese patients with T2DM on metformin as an adjunct to insulin required higher insulin doses in the third trimester as compared to patients on insulin only. Use of metformin did not reveal any negative effect on birth outcomes. A key mechanism of action of metformin, increasing insulin sensitivity, would purport that decreased insulin doses would be required, contrary to our conclusions. Prospective trials are needed to elucidate whether empiric metformin can truly decrease insulin needs.

Gestational diabetes and pre‐pregnancy overweight: Possible factors involved in newborn macrosomia

Good glycemic control in gestational diabetes mellitus (GDM) seems not to be enough to prevent macrosomia (large-for-gestational-age newborns). In GDM pregnancies we studied the effects of glycemic control (as glycosylated hemoglobin [HbA1c]), pre-pregnancy body mass index (PP-BMI) and gestational weight gain per week (GWG-W) on the frequency of macrosomia. We studied 251 GDM pregnancies, divided into two groups: PP-BMI<25.0kg/m(2) (the non-overweight group; n=125), and PP-BMI≥25.0kg/m(2) (the overweight group; n=126). A newborn weight Z-score>1.28 was considered large-for-gestational-age. Statistical analysis was carried out using the Student's t-test and χ(2) -test, receiver-operator characteristic curves and linear and binary logistic regressions. Prevalence of macrosomia was 14.9% among GDM (n=202/251, 88.4%) with good glycemic control (mean HbA1c<6.0%), and 28.1% in those with mean HbA1c≥6.0% (n=49/251, P<0.025). Macrosomia rates were 10.4% in the non-overweight group and 24.6% in the overweight group (P=0.00308), notwithstanding both having similar mean HbA1c (5.48±0.065 and 5.65±0.079%, P=0.269), and similar GWG-W (0.292±0.017 and 0.240±0.021kg/week, P=0.077). Binary logistic regressions showed that PP-BMI (P=0.012) and mean HbA1c (P=0.048), but not GWG-W (P=0.477), explained macrosomia. Good glycemic control in GDM patients was not enough to reduce macrosomia to acceptable limits (<10% of newborns). PP-BMI and mean HbA1c (but not GWG-W) were significant predictors of macrosomia. Thus, without ceasing in our efforts to improve glycemic control during GDM pregnancies, patients with overweight/obesity need to be treated prior to becoming pregnant.

Postterm with favorable cervix: is induction necessary?

Objective: To study the cesarean rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix. Study design: A total of 249 women with uncomplicated pregnancies at 41 weeks plus 3 days (290 days) with favorable cervix (Bishop score ≥6) were randomized to either expectant management ( n=125) or immediate induction of labor ( n=124). The women in the induction group were sent to labor ward for induction by artificial rupture of membranes (ARM) and/or oxytocin infusion. The women with expectant management had nonstress test (NST) and amniotic fluid index (AFI) performed once a week and twice a week after 43 weeks of gestation until spontaneous labor. Results: The cesarean rate was not different between expectant management and immediate induction (21.6% versus 26.6%; P=0.36). Ninety-five percent of the expectant group delivered within 1 week after enrollment, and all of them delivered within 9 days after randomization. Maternal and fetal complications in both groups were not different. There was also no difference in the mean birth weight ( P=0.24) and the frequency of macrosomia (birth weight ≥4000 g) between the two groups ( P=0.23). Conclusion: Cesarean section rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix was not different. Due to the very low adverse perinatal outcome, both expectant management and immediate induction are acceptable.

Perinatal Complications in Women With Gestational Diabetes Mellitus: Significance of a Diagnosis Early in Pregnancy

Background. The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non-diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus. Methods. Included were 327 women with gestational diabetes mellitus and 295 non-diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low-caloric diet and insulin when appropriate, while women in the control group received routine antenatal care. Results. Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1”1.7 weeks versus 39.8”2.0 weeks, p,0.05) and only those with spontaneous onset of labor (38.8”2.0 weeks versus 40.0”1.6 weeks, p,0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p‰0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p,0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p,0.05) and a significantly higher occurrence of diabetes mellitus at follow-up from two months until three years postpartum. Conclusions. This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.

Estimators of birth weight in pregnant women requiring insulin: A comparison of seven sonographic models

To determine if the relative accuracy of the sonographic estimate of birth weight among diabetic gravidas requiring insulin improves significantly as more fetal measurements are used. We studied 172 diabetic women requiring insulin who had sonographic measurements of fetal parts within 7 days of delivery. Friedman nonparametric analysis of variance followed by Dunn multiple comparison and chi 2 were used to assess the relative accuracy of the seven models. Prediction limits were calculated to determine the estimate of fetal weight that would ensure (with 90% accuracy) that the newborn was macrosomic (at least 4 kg). The mean (+/- standard deviation [SD]) birth weight was 3388 +/- 727 g, and the frequency of macrosomia at term gestation was 19.4% (29 of 149). The mean standardized absolute error (g/kg) based on abdominal circumference (AC) and femur length (FL) (86 +/- 72 g/kg) was not significantly different from the other models (range 84 +/- 72 to 116 +/- 99 g/kg, P > .05). The percent of estimate within 10% of actual birth weight using AC and FL (65%) was similar to the other models (53.4-66.2%). Regardless of the White classification, the estimation of fetal weight using AC and FL had an accuracy similar to the other six regression equations. To ensure that the birth weight is at most 3999 g, the estimated fetal weight should be 3200 g, and, conversely, if the predicted weight is 4700 g, then the newborn is macrosomic. Among patients requiring insulin, estimation of birth weight using AC and FL is as accurate as more complicated models. The ability to detect macrosomia by ultrasound is limited.