Incidence Of Fetal Macrosomia Research Articles

Effects of the online and offline hybrid continuous group care on maternal and infant health: a randomized controlled trial

BackgroundThe group care is a well-established maternal care model that has been widely used in many developed countries, but in China, it is confined to prenatal care services. In addition, affected by traditional birth culture, Chinese women tend to focus more on their fetuses and newborns but lack attention to their own intrapartum and postpartum care. The aim of this study was to construct and implement a prenatal, intrapartum, and the postpartum continuous group care model that combines online and offline service in Hainan Province, China, and to evaluate the effect on maternal women and newborns.MethodsThis study was a randomized controlled trial involving 144 pregnant women in a first-class tertiary general hospital in Hainan Province, China. Women were divided into an intervention group and a control group using the random number table, with 72 women in each group. The control group received routine maternal care services, and the intervention group received the continuous group care based on the routine maternal care services. Count data such as rate of cesarean section and incidence rate of fetal macrosomia were analyzed with the chi-square test or Fisher’s exact test, and the General Self-efficacy Scale scores were analyzed by repeated measures ANOVA. P < 0.05 was considered statistically significant, with two-sided probability values.ResultsCompared with the control group, the rate of excessive prenatal weight gain, cesarean section, and 42-day postpartum depression were significantly lower in the intervention group (P < 0.05), and higher General Self-efficacy Scale scores (in the expectant period and 42 days postpartum) and exclusive breastfeeding rate (42 days postpartum) (P < 0.05). The incidence of fetal macrosomia was significantly lower in the intervention group (P < 0.05). But there was no significant difference in birth weight, preterm birth, the incidence of low-birth-weight infants and 1-min Apgar score (P > 0.05).ConclusionThe continuous group care with online and offline service can effectively control the gestational weight gain, reduce the rate of cesarean section, macrosomia, and postpartum depression. It can improve the self-efficacy of women and the rate of exclusive breastfeeding effectively.Trial registrationChinese Clinical Trial Regestry (ChiCTR2200065765, 04/11/2022, Retrospectively registered).

Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial

AimsGestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM.Materials and methodsThis was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose—SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes.ResultsThere was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47–2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16–27.22). ConclusionsStudy results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM.Trial registration clinicaltrials.gov ID: NCT04422821.

Comparison of Pregnancy and Neonatal Outcomes Between Fresh Embryo Transfer and Frozen-Thawed Embryo Transfer.

This study compared the pregnancy and neonatal outcomes between fresh embryo transfer and frozen-thawed embryo transfer (FET). These patients were split into two groups: the fresh embryo transfer group and the FET group. The general conditions, pregnancy outcomes, and neonatal outcomes between these groups were compared. The influencing factors of fetal macrosomia occurrence were explored as well. Compared with the fresh embryo transfer group, the FET group had a significantly higher mean age (32.59 ± 4.77 vs. 31.90 ± 4.71, p < 0.05) and lower multiple pregnancy rate (21.2% vs. 26.9%, p < 0.05). There was no significant difference in the incidence of congenital anomalies of neonates between the two groups (1.32% vs. 0.37%, p > 0.05). In the FET group, compared with the fresh embryo transfer group, the mean birth weight of singleton live births, the cesarean section rate, and the incidence of fetal macrosomia were significantly increased, while the incidence of low birth weight was significantly decreased. The logistic analysis showed that the occurrence of fetal macrosomia was primarily associated with the embryo transfer protocol (odds ratio [OR] = 2.769, 95% confidence interval [CI]: 1.246-6.154, p < 0.05), endometrial thickness (OR = 1.144, 95% CI: 1.043-1.256, p < 0.05), and gestational age (OR = 1.710, 95% CI: 1.338-2.184, p < 0.05). Macrosomia (OR = 2.938, 95% CI: 1.436-6.010, p = 0.003) and multiple pregnancy (OR = 3.574, 95% CI: 2.616-4.882, p < 0.001) significantly increased the cesarean section rate. The risk of fetal macrosomia and congenital anomalies in the offspring of the fresh embryo transfer group was lower than that in the offspring of the FET group, we preferred to fresh embryo transfer for patients with assisted reproductive technologies. FET should be used as supplementary therapeutic strategy with strengthened pregnancy management and screening to reduce the occurrence of birth defects in newborns.

Fetal complications associated with GDM: a matter to worry?

Background: The consequences of GDM to the fetus are more serious than those to mother. Amongst fetal effects, incidence of fetal macrosomia is increased in women with GDM and DM type 2. Study was conducted to study prevalence of gestational diabetes mellitus using diabetes in pregnancy study group India (DIPSI) criteria in our hospital and to study fetal outcome in pregnancy with Gestational diabetes mellitus.Methods: Case control study was conducted on 500 females between 24-28 weeks of pregnancy. 31 (6.2%) were diagnosed as gestational diabetes mellitus (GDM). 31 other pregnant females between 24-28 not having diabetes were taken in control group. Follow up of all pregnant females was done. Babies were evaluated for any gross anomaly, birthweight of babies were taken, APGAR score was noted.Results: Maximum females (38.7%) with GDM were in age group of 25-29 years. Mean Basal Metabolic Index in GDM was 26.74 while in NGDM it was 22.48. Perinatal loss in GDM was 90.3%. Post-partum haemorrhage was seen in 9.7%. Intrauterine growth retardation (IUGR) in GDM was seen in 12.9%. Macrosomia was seen in 16.1%, preterm delivery in 9.7%, APGAR score &lt;7 at 5 min in 6.5%, birth injury in 3.2%GDM. Mean weight in GDM was seen in 2.944 kgs and NGDM in 2.726 kgs.Conclusions: Postpartum screening should be at regular interval to detect recurrence of future diabetes. With effective screening and management of GDM, from “diabetes capital of the world,” we (INDIA) can lay claim to be “diabetes care capital of world.”

The Contribution of Ultrasonography to the Detection of Fetal Macrosomia in the Later Pregnancy and Its Impact on Neonatal Morbidity

Fetal macrosomia is associated with several maternal and fetal complications. Early detection of macrosomia may allow preventive measures to be taken to avoid the occurrence of these complications. The aim of our study was to evaluate the value of ultrasound in late pregnancy in the detection of fetal macrosomia and its impact on obstetric and neonatal outcomes. Patients and Methods: We conducted a retrospective cross-sectional study from 01 January to 31 June 2017. The study included 123 women who gave birth in the obstetric gynaecology department of the Groupe Hospitalier Intercommunal le Raincy-Montfermeil in France. The data were entered using Microsoft Excel 2013 and analysed with Epi info Version 6 software. The fisher's exact test and Pearson correlation were used with a significance level set at 0.05. Results: Out of 1082 live births, the incidence of fetal macrosomia was 6.3%. An emergency caesarean section was performed in 26.1% of cases. Neonatal status was better with a good Apgar (&gt;7) in 89%. There was a weak correlation of 0.01 between uterine height and birth weight of the child, but a significant correlation between ultrasound fetal weight estimation at the end of pregnancy and birth weight of the child was found (0.56). Conclusion: Screening for fetal macrosomia appears to be more effective in late pregnancy with ultrasound. Rigorous training in the technique of measuring ultrasound biometrics should be required.

The influence of blood donation before pregnancy on neonatal birth weight.

ObjectiveTo evaluate the effect of blood donation before pregnancy on neonatal birth weight.MethodsA total of 14996 women with singleton pregnancies at full-term in Ningbo Medical Center Lihuili Hospital and Ningbo Women’s and Children’s Hospital from November 2019 to November 2020 were enrolled in this study. Detailed records of whole blood donation before pregnancy were obtained through Alipay software. The records were classified into three groups: nondonors, low-frequency donors and high-frequency donors according to the total numbers of blood donations in the 3-year period before pregnancy. The demographics and clinical information of the enrolled participants and their fetuses were collected from electronic medical records (EMRs). The effect of blood donations in the 3-year period before pregnancy on neonatal birth weight was analyzed.ResultsThere was no significant difference in neonatal birth weight among the three groups (P = 0.373). In line with this, there was no association between the number of blood donations in the 3-year period before pregnancy and neonatal birth weight (β = 14.5; 95% confidence interval [CI]: -3.9, 31.4; P = 0.094) in the bootstrapped multivariate linear regression analysis models, adjusted for maternal age, number of pregnancies, number of deliveries, gestational age, mode of delivery, years of education and blood type in pregnant women. Compared to the nondonors, the risk of fetal macrosomia was higher in both low-frequency donors and all donors (OR: 1.539, 95% CI: 1.058, 2.134, P = 0.016; OR: 1.454, 95% CI: 1.033, 1.952, P = 0.021, respectively), in the bootstrapped binary logistic regression analysis models after adjusting for the variables mentioned above.ConclusionOur study showed that maternal blood donation in the 3-year period before pregnancy may not lead to a reduction in neonatal birth weight, but may be associated with the incidence of fetal macrosomia.

Comparison of the Effect of Glycemic Control on the Incidence of Fetal Macrosomia and Large for Gestational Age in Gestational Diabetes Mellitus Patients; A Systematic Review

Background: Gestational diabetes mellitus (GDM) can be managed with blood glucose control management, which includes a healthy lifestyle, insulin therapy, and oral anti-diabetic drug (OAD) medications when needed. Sub-optimally or poorly managed GD Mmay lead to arisk of complications, one of which is an abnormal growth in the fetus. This study aimed to compare the effect of blood glucose control management on the incidence of fetal macrosomia and large for gestational age (LGA) births in patients with GDM. Methods: This systematic review study obtained data from formerly published studies from the Science Direct database. The article search method used the characteristics of PICO (Population, Intervention, Comparison, Outcome) and compiled using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. Conclusion: The use of medical nutrition therapy (MNT) and exercise in the therapeutic regimen, as well as routine monitoring of glycemic levels are very important to control the patient’s glycemic level. The use of metformin can increase the success of therapy due to reduced levels of LGA and macrosomia in GDM patients

Prescribing patterns and outcomes among patients treated for gestational diabetes mellitus

Insulin is recommended as first-line pharmacologic therapy for gestational diabetes (GDM); however, glyburide and metformin are often used. This study aimed to identify the most commonly prescribed agents for treating GDM, along with the maternal and fetal outcomes associated with their use. Electronic medical records were used to identify the medications prescribed for GDM at a large health system. Data were collected comparing medication failure rate, maternal weight gain, and incidence of fetal macrosomia, neonatal hypoglycemia, and premature delivery between the agents used. Of the 368 patients who met the inclusion criteria, 76.9% were initiated on glyburide, 13.6% were initiated on metformin, 8.2% were initiated on insulin, and 1.4% were initiated on a combination of glyburide and metformin. Glyburide was associated with less medication failure compared to insulin and metformin. There was no significant difference in maternal weight gain, fetal macrosomia, or neonatal hypoglycemia between the three classes of medications. However, recipients of basal and bolus insulin had a higher rate of preterm delivery compared to recipients of glyburide and metformin. Our findings suggest that glyburide and metformin are frequently prescribed over insulin as the initial treatment for GDM and appear to be safe and effective alternatives.

The second pregnancy has no effect in the incidence of macrosomia: a cross-sectional survey in two western Chinese regions

BackgroundAfter the implementation of the universal two-child policy in China, the increase in parity has led to an increase in adverse pregnancy outcomes. The impact of one and two fetuses on the incidence of fetal macrosomia has not been fully confirmed in China. This study aimed to explore the differences in the incidence of fetal macrosomia in first and second pregnancies in Western China after the implementation of the universal two-child policy.MethodsA total of 1598 pregnant women from three hospitals were investigated by means of a cross-sectional study from August 2017 to January 2018. Participants were recruited by convenience and divided into first and second pregnancy groups. These groups included 1094 primiparas and 504 women giving birth to their second child. Univariate and multivariate logistic regression analyses were performed to discuss the differences in the incidence of fetal macrosomia in first and second pregnancies.ResultsNo significant difference was found in the incidence of macrosomia in the first pregnancy group (7.2%) and the second pregnancy group (7.1%). In the second-time pregnant mothers, no significant association was found between the macrosomia of the second child (5.5%) and that of the first child (4.7%). The multivariate logistic regression model showed that mothers older than 30 years are not likely to give birth to children with macrosomia (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4,0.9).ConclusionsThe incidence of macrosomia in Western China is might not be affected by the birth of the second child and is not increased by low parity.

Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971-2017.

Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28-42weeks inclusive. This was a retrospective cohort study covering the period 1971-2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000-4499g), Grade 2 (4500-4999g) and Grade 3 (≥ 5000g). A total of 147,331,305 singleton births over the entire study period of 47years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain. This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.

Evaluation of Pregnancy Outcomes among Women with Pregnancies Complicated by Diabetes Mellitus in Abakaliki, South-East, Nigeria

Background: Pregnancies complicated by diabetes are associated with significant increase in maternal and perinatal morbidity and mortality. The management of diabetes in pregnancy is a great challenge in a low resource setting because of limited resources and facilities to care for these women. Aim: To determine the maternal and perinatal outcomes of diabetic pregnant women managed at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Southeast, Nigeria. Materials and methods: This was a 7-year retrospective case-control study that compared pregnancy outcomes among women with pregnancies complicated by diabetes and those without diabetes managed at Alex Ekwueme Federal University Teaching Hospital, Abakalikibetween January 1st, 2012 and December 31st, 2018. The statistical analysis was done using SPSS version 22. Results: The incidence of diabetes in pregnancy in this study was 6.6 per 1000 deliveries. Of 126 women in diabetic arm of the study, 81 were diagnosed during pregnancy and 45 were known diabetic prior to conception. Over two-thirds of 126 women with pregnancy complicated by diabetes achieved good blood glucose control during pregnancy. Both groups differ in their mean BMI and women with diabetes in pregnancy were more likely to be obese compared with control (diabetic; 30.1 ± 2.5 versus control; 23.4 ± 2.1, P < 0.0001). Pregnant women with diabetes were more likely to be delivered by cesarean section when compared with non-diabetic women (86 versus 23, OR = 9.6, 95% CI: 5.35 - 17.32, P < 0.0001). Similarly, the incidence of polyhydramnious was higher in paturients with diabetes when compared with the control groups (26 versus 13, OR = 2.2, 95%CI: 1.10 - 4.63, P = 0.02). There were no differences between both study groups with regards to other maternal outcomes. The incidence of fetal macrosomia, neonatal hypoglycemia and neonatal respiratory distress syndrome were significantly higher among women whose pregnancies were complicated by diabetes when compared with the control [Diabetics; fetal macrosomia (62.7%), neonatal hypoglycemia (44.4%) and neonatal respiratory distress syndrome (22.2%) versus Control; fetal macrosomia (34.1%), neonatal hypoglycemia (7.9%) and neonatal respiratory distress syndrome (5.6%) respectively]. Conclusion: Women with pregnancies complicated by diabetes had a higher incidence of adverse maternal and perinatal outcomes. Clinical recognition of diabetes in pregnancy is important because institution of therapy, and antepartum fetal surveillance can reduce the maternal and perinatal morbidity and mortality associated with the condition.

The influence of D-chiro-inositol and D-myo-inositol in pregnant women with glucose intolerance.

The aim of the present study was to demonstrate that the use of inositol and folic acid from the first trimester of pregnancy, counteracts the onset of gestational diabetes mellitus (GDM) in women at risk, preserving the infants from macrosomia, hypoglycemia and preterm delivery. The authors collected data from the pregnant women at the laboratory (Unit of Cytogenic and Molecular Genetics), from January 2014 to April 2016, all with first trimester fasting plasma glucose (FPG) >92 mg/dl. A total of 40 women were treated with 250 mg/day D-chiro-inositol, 1.75 g/day D-myo-inositol, 12.5 mg/day zinc, 10 mg/day methylsulfonylmethane, 400 µg/day 5-methyltetrahydrofolic acid. The other 43 women (control group) were treated with only 400 µg/day folic acid. The primary outcome measure was the incidence of maternal GDM. The secondary outcome measures were the incidence of fetal macrosomia, preterm delivery and neonatal hypoglycemia. At the 24th week of pregnancy, the incidence of maternal GDM was recorded in 18 women in the control group and in 5 women in the treated group [relative risk (RR)=3.35; 95% confidence interval (CI)=1.37-8.17; P=0.0028). A significant difference was observed between treated and control groups in terms of risk of macrosomia. A total of seven infants in the control group, and two in the treated group, weighed >4,000 g (RR=5,12; 95% CI=1.21-21.68; P=0.0099). No significant difference was identified between two groups, regarding the other two secondary outcomes, neonatal hypoglycemia (RR=4.650; 95% CI=0.57-38.11; P=0.1086) and preterm delivery (RR=1.74; 95% CI=0.83-3.66; P=0.1301). The current study demonstrated the potential benefit of supplementation with the association of D-chiro-inositol and D-myo-inositol in pregnant 'at risk' women, with first trimester FPG >92 mg/dl, in preventing the onset of maternal GDM and macrosomia in newborns.

Incidence of fetal macrosomia among single live birth neonates and influencing factors in Xi' an, 2010-2013

To analyze the incidence and influencing factors on fetal macrosomia among single live birth neonates in Xi' an. A questionnaire survey was conducted among women at the childbearing age who were selected through multi stage stratified random sampling in Xi 'an during 2010-2013. All the childbearing aged women involved, were in pregnancy or having definite pregnancy outcomes. A total of 4 970 women at childbearing age and their infants were investigated. The overall incidence of fetal macrosomia weight among the single live birth neonates under study, was 9.7% during 2010-2013 (8.9% in 2010, 8.1% in 2011, 10.0% in 2012 and 10.1% in 2013, respectively). The incidence rates of fetal macrosomia appeared 10.5% in the central district and, 8.6% in the rural-urban area of Xi'an. There were statistically significant differences (P<0.05) seen between the two areas. RESULTS of logistic regression analysis suggested that factors as: having male newborn (OR=1.717, 95%CI: 1.402-2.102), drinking during pregnancy (OR=2.174, 95%CI: 1.042-4.533), gestational diabetes (OR=1.680, 95%CI: 1.100-2.568) gestational age≥42 (compared with 37-41, OR=2.565, 95% CI: 1.306-5.039), being multipara (OR=1.874, 95% CI: 1.492-2.354) were risk factors for the fetal macrosomia. The incidence of fetal macrosomia in Xi' an was higher than the national figures. The incidence of fetal macrosomia was higher in the central district than in rural-urban area. Having male neonate, postmature birth, gestational diabetes, being multipara, drinking during pregnancy were the risk factors related to fetal macrosomia.

Macrosomie fœtale à Lubumbashi: facteurs de risque et pronostic maternel et périnatal

IntroductionLa macrosomie fœtale est habituellement définie par un poids de naissance supérieur ou égal à 4000 grammes. L'objectif de cette étude est de déterminer la fréquence de la macrosomie, d'identifier les facteurs étiologiques et d’évaluer le pronostic maternel et périnatal.MéthodesIl s'agit d'une étude cas-témoins menéeau sein des maternités de 10 hôpitaux généraux de référence de la ville de Lubumbashi en République Démocratique du Congoentre le 1er décembre 2013 et le 31 mars 2014. Les accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs nouveau-nés: groupe I (≥4000 grammes ou plus) et groupe II (2500 à 3500 grammes). Les caractéristiques maternelles, l'environnement obstétrical ainsi que le pronostic maternel et périnatal ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide du logiciel Épi info version 7.1. Les différences étaient jugées significatives pour un seuil de p<0,05.RésultatsAu total, 668 mères et leurs nouveau-nés ont été inclus dont 167 macrosomes et 501témoins. L'incidence de la macrosomie fœtale était de 5,7%. Comparativement aux mères de témoins, nous avons trouvé que les mères des nouveau-nés macrosomes étaient plus âgées, multipares, multigestes, obèses, diabétiques et avaient antérieurement donné naissance à un macrosome. Les taux de césarienne et de délivrance pathologique étaient significativement élevés chez les mères de macrosomes que chez celles de témoins. Lesexe masculin était significativement plus prédominant chez macrosomes que chez les témoins. La dystocie des épaules étaitenregistrée uniquement dans le groupe des macrosomes.ConclusionLa prévalence de l'accouchement d'un macrosome à Lubumbashi est de 5,7%. La macrosomie est souvent à l'origine de complications maternelles et périnatales. La réduction de ces dernières passe par une meilleure connaissance des facteurs de risque et un dépistage précoce.

Determinants and outcome of fetal macrosomia in a Nigerian tertiary hospital

Background:To determine the incidence and risk factors of fetal macrosomia and maternal and perinatal outcome.Patients and Methods:This was a 1-year prospective case–control study of singleton pregnancies in a Nigerian tertiary hospital. Only women who gave consent were recruited for the study. The maternal and perinatal outcomes in women who delivered macrosomic infants (birth weight ≥ 4000 g) were compared with the next consecutive delivery of normal birth weight (2500–3999 g) infants.Results:The total deliveries for the study period were 2437, of which 135 were macrosomic babies. The incidence of fetal macrosomia was 5.5%. The mean birth weights of macrosomic and nonmacrosomic babies were 4.26 ± 0.29 kg and 3.20 ± 0.38 kg, respectively, P = 0.000. Mothers with macrosomic babies were more likely to be older (P = 0.047), of higher parity (0.001), taller (P = 0.007), and weighed more at delivery (P = 0.000). Previous history of fetal macrosomia (P = 0.000) and maternal diabetes (P = 0.007) were factors strongly associated with the delivery of macrosomic infants. Pregnancies associated with fetal macrosomia had increased duration of labor (P = 0.007), interventional deliveries (P = 0.000), shoulder dystocia, and genital laceration (P = 0.000). There was no significant difference in the incidence of primary postpartum hemorrhage (P = 0.790), birth asphyxia, and perinatal mortality (P = 0.197).Conclusion:Fetal macrosomia is associated with maternal and fetal morbidities. The presence of the observed risk factors should elicit the suspicion of a macrosomic fetus and the need for appropriate management to reduce maternal and fetal morbidities.

Myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes

OBJECTIVETo check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) onset in pregnant women with a family history of type 2 diabetes.RESEARCH DESIGN AND METHODSA 2-year, prospective, randomized, open-label, placebo-controlled study was carried out in pregnant outpatients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 µg folic acid twice a day (n = 110) and in the placebo group (n = 110), who were only treated with 200 µg folic acid twice a day. The main outcome measure was the incidence of GDM in both groups. Secondary outcome measures were as follows: the incidence of fetal macrosomia (>4,000 g), gestational hypertension, preterm delivery, caesarean section, shoulder dystocia, neonatal hypoglycemia, and neonatal distress respiratory syndrome. GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations.RESULTSIncidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group: 6 vs. 15.3%, respectively (P = 0.04). In the myo-inositol group, a reduction of GDM risk occurrence was highlighted (odds ratio 0.35). A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery. In the other secondary outcome measures, there were no differences between groups.CONCLUSIONS myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses.

Anthropometric data, fetal and neonatal complications in infants of diabetic mothers. Results of a 10-year retrospective study

Disturbances in carbohydrate metabolism during pregnancy may result in harmful fetal and neonatal consequences. To assess the fetal and neonatal complications of pregnancy in mothers with gestational and pregestational diabetes during a 10-year period in a county hospital in Hungary. Retrospective analysis of infants of diabetic mothers admitted to the neonatal unit between 2001 and 2010. 32% of the infants were transferred to the neonatal unit. Neonatal macrosomia (birth weight >90 centile) was observed in one quarter of the infants. 39% of the infants developed hypoglycemia (blood glucose <2.6 mmol/l), in the majority of the cases within the first 8 hours. Hypoglycaemia was symptomatic in 55% of the infants. Hypocalcemia was observed in 17%, hyperviscosity in 23%, hyperbilirubinaemia in 32%, respiratory distress syndrome and/or transient tachypnoe in 22% and cardiac complications in 13% of the infants. 10% of the inafnts were affected with birth injuries. Congenital anomalies were seen in 17% of the cases, and severe malformations were present in 4% of the infants. Despite modern diabetes management, there is still a higher incidence of fetal macrosomia, adverse neonatal outcomes and a higher rate of severe congenital malformations in neonates of diabetic mothers.

Fetal macrosomia: Obstetric outcome of 311 cases in UNTH, Enugu, Nigeria

In modern obstetrics, fetal macrosomia is a major contributor to obstetric morbidity. It is an important cause of perinatal morbidity and mortality. This study aims to determine the maternal characteristics, fetal and neonatal complications associated with fetal macrosomia, and its contribution to obstetric morbidity in Enugu, Nigeria. This was a 3-year retrospective study carried out from 1 st January 2005 to 31 st December 2007. There were a total of 434 cases of fetal macrosomia out of 5,365 deliveries. The incidence of fetal macrosomia was 8.1%. Only 311 case notes (71.6%) were available for analysis. Statistical analysis showed that mothers of macrosomic newborns were older (30.6 ± 5.6 vs. 27.4 ± 4.74; P = 0.001), higher parity (4.1 ± 2.7 vs. 2.5 ± 1.07; P = 0.001), and weighed more at term (89.13 ± 6.17 kg vs. 71.43 ± 5.27 kg; P = 0.002). The study group had more mothers with previous history of macrosomic babies (39.5% vs. 12.5%), diabetes (3.2% vs. 1%), significant higher cesarian section rate (27.3% vs. 11.9%, P = 0.001), and operative vaginal delivery (3.6% vs. 1%; P = 0.001) compared with the control. There was male dominance in the study group compared with the control (63% vs. 56.3%; P = 0.001), higher risk of fetal asphyxia (P = 0.001), and greater mean birth weight (3.6 ± 1.2 kg vs. 3.2 ± 0.6 kg; P = 0.002). There were 7 (2.3%) cases of shoulder dystocia in the macrosomic group and none in the non-macrosomic group. The stillbirth rate (3.2/1000) was the same in both study group and control. This was not statistically significant (P = 0.124). The precise determination of fetal weight is only done at delivery. Clinical and ultrasound determination of fetal weight are highly imprecise especially at the third trimester. The route of delivery should therefore be individualized.

Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies

OBJECTIVETo perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003.RESEARCH DESIGN AND METHODSThis was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits, and ethnicity.RESULTSIn type 1 diabetes, preeclampsia was significantly more frequent (OR 4.47 [3.77–5.31]) as was delivery by cesarean section (5.31 [4.97–5.69]) compared with results for the general population. Stillbirth (3.34 [2.46–4.55]), perinatal mortality (3.29 [2.50–4.33]), and major malformations (2.50 [2.13–2.94]) were more common in type 1 diabetic than in control pregnancies. The risk of very preterm birth (<32 gestational weeks) was also higher among type 1 diabetic women (3.08 [2.45–3.87]). The incidence of fetal macrosomia (birth weight ≥2 SD above the mean) was increased in the diabetic group (11.45 [10.61–12.36]).CONCLUSIONSType 1 diabetes in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The eightfold increased risk for fetal macrosomia in type 1 diabetic pregnancies is unexpected and warrants further investigation.

Use of insulin glargine during pregnancy: a case–control pilot study

To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. A matched case-control study. Women's Centre, John Radcliffe Hospital, Oxford, UK. Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.