Large For Gestational Age Infants Research Articles

Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood.

Background: Breastfeeding appears to reduce the risk of childhood overweight/obesity. However, it remains unclear whether this protective effect persists among high-risk populations. This study aims to investigate the association of breastfeeding with the risk of overweight/obesity in early childhood and whether this association is altered by gestational diabetes mellitus (GDM) or size at birth. Methods: Feeding practices during the first 12 months of age and weight and length at 12-36 months of age were collected. Full breastfeeding includes exclusive and predominant breastfeeding. Children with body mass index (BMI) values greater than 1 standard deviation from the mean of sex- and age-specific BMI were classified as overweight/obese. Multiple generalized estimating equations models were applied to analyze the associations of full breastfeeding duration with overweight/obesity risk. Results: Among all participants (n = 9329), infants with a longer full-breastfeeding duration had a reduced risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Infants exposed to GDM and those born large for gestational age (LGA) had a higher risk of overweight/obesity in early childhood. Among infants of mothers with GDM (n = 1748), infants with full breastfeeding for greater than 6 months (aOR: 0.58; 95% CI: 0.44, 0.78) showed a decreased risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Among LGA infants (n = 1279), infants with full breastfeeding for 3-5 months (aOR: 0.66; 95% CI: 0.57, 0.76) and greater than 6 months (aOR: 0.70; 95% CI: 0.56, 0.88) showed a decreased risk of overweight/obesity in early childhood. Similar results were observed among LGA infants of mothers with GDM. Conclusions: Initiating and prolonging breastfeeding would reduce the risk of overweight/obesity in early childhood, and LGA infants and infants born to mothers with GDM would experience greater benefits.

Mean Glucose and Gestational Weight Gain as Predictors of Large-for-Gestational-Age Infants in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitoring.

Aims/hypothesis: To compare glycemic metrics during pregnancy between women with type 1 diabetes (T1D) delivering large-for-gestational-age (LGA) and appropriate-for-gestational-age (AGA) infants, and to identify predictors of LGA infants. Materials and Methods: A cohort study including 111 women with T1D using intermittently scanned continuous glucose monitoring from conception until delivery. Average sensor-derived metrics: mean glucose, time in range in pregnancy (TIRp), time above range in pregnancy, time below range in pregnancy, and coefficient of variation throughout pregnancy and in pregnancy intervals of 0-10, 11-21, 22-33, and 34-37 weeks were compared between women delivering LGA and AGA infants. Predictors of LGA infants were sought for. Infant growth was followed until 3 months postdelivery. Results: In total, 53% (n = 59) delivered LGA infants. Mean glucose decreased during pregnancy in both groups, with women delivering LGA infants having a 0.4 mmol/L higher mean glucose from 11-33 weeks (P = 0.01) compared with women delivering AGA infants. Mean TIRp >70% was obtained from 34 weeks in women delivering LGA infants and from 22-33 weeks in women delivering AGA infants. Independent predictors for delivering LGA infants were mean glucose throughout pregnancy and gestational weight gain. At 3 months postdelivery, infant weight was higher in infants born LGA compared with infants born AGA (6360 g ± 784 and 5988 ± 894, P = 0.04). Conclusions/interpretations: Women with T1D delivering LGA infants achieved glycemic targets later than women delivering AGA infants. Mean glucose and gestational weight gain were independent predictors for delivering LGA infants. Infants born LGA remained larger postdelivery compared with infants born AGA.

Association between extrapolated time in range and large for gestational age infants in pregnant women with type 1 diabetes

AimsTo evaluate the association between extrapolated time in range (eTIR), measured by self-monitoring of blood glucose (SMBG), and large-for-gestational-age (LGA) infants in pregnancies with type 1 diabetes (T1D). MethodsRetrospective cohort analysis including singleton pregnancies with T1D who started antenatal care before 20 gestational weeks and delivered live newborns at a Brazilian hospital between 2010 and 2019, with LGA fetuses as the main outcome. Glycemic records acquired using SMBG were categorized as eTIR, extrapolated time below range (eTBR), and extrapolated time above range (eTAR). Women were divided into two groups (LGA and adequate for gestational age [AGA]) and compared regarding clinical characteristics, obstetric outcomes, and frequencies of eTIR, eTBR, and eTAR. Logistic regression analysis verified the independent predictive variables for LGA infants. ResultsData from 125 pregnancies were analyzed. For the first, second and third trimesters, each 1 % increase in eTIR was associated with a decreased risk of LGA by 2.9 % (OR: 0.971; 95%CI: 0.945–0.998), 2.5 % (OR: 0.975; 95%CI: 0.951–0.999) and 2.3 % (OR: 0.977; 95%CI: 0.955–0.998) and each 1 % increase in eTAR was associated with an increased risk of LGA by 2.7 % (OR: 1.027; 95%CI: 1.005–1.050), 3.9 % (OR: 1.039; 95%CI: 1.014–1.063) and 4.6 % (OR: 1.046; 95%CI: 1.018–1.075), respectively. ConclusionThe concept of TIR can be extrapolated to patients undergoing SMBG to assess the risk of LGA infants in pregnant women with T1D.

Prepregnancy dieting and obstetrical and neonatal outcomes: Findings from a national surveillance project in the United States

Problem and BackgroundWomen with overweight or obesity are recommended to lose weight before pregnancy. Dieting is one of the most used weight control strategies. However, the health implications of dieting before pregnancy remain unclear. AimTo evaluate the associations of dieting during the year before pregnancy with obstetrical and neonatal outcomes, including gestational weight gain (GWG), gestational diabetes, low birthweight, macrosomia, small-for-gestational-age infants (SGA), large-for-gestational-age infants (LGA), and preterm birth. MethodsThis study analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a surveillance project in the United States that collects data on maternal health before, during, and after pregnancy. Women who participated in PRAMS phase 7 with a prepregnancy body mass index ≥25 kg/m2 and a singleton birth were eligible. Statistical analyses included logistic regressions and post-hoc mediation analysis (Sobel Test). FindingsA total number of 51,399 women were included in the analysis. Women who self-reported prepregnancy dieting (42.8 %) had lower odds of SGA (adjusted odds ratio [aOR]: 0.87; 95 % CI: 0.79–0.97), and higher odds of excessive GWG vs adequate GWG (aOR: 1.42; 95 % CI: 1.32–1.52), gestational diabetes (aOR: 1.12; 95 % CI: 1.02–1.22), and LGA (aOR: 1.18; 95 % CI: 1.08–1.28). Furthermore, the association between prepregnancy dieting and LGA was mediated by excessive GWG (Sobel Test z-value = 5.72, p < 0.01). Discussion and ConclusionThis analysis revealed that prepregnancy dieting was associated with several adverse consequences, including excessive GWG, gestational diabetes, and LGA infants. Findings contribute to an improved understanding of the perinatal implications of prepregnancy dieting.

The impact of maternal and paternal birth weights on infant birth weights: the Japan environment and children's study.

This study aimed to evaluate the association between parental and infant birth weights in Japan. In total, 37,504 pregnant Japanese women and their partners were included in this birth cohort study. A multinomial logistic regression model was used to evaluate the associations of parental birth weights with small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants. Associations between parental birth weight and low birth weight (LBW) infants or macrosomia were also examined, and linear associations between parental birth weight and SGA or LGA were found. The adjusted odds ratios (aORs) for SGA infants per 500 g decrease in maternal and paternal birth weights were 1.50 (95% confidence interval [CI],1.43-1.58) and 1.31 (95% CI, 1.25-1.38), respectively. The aORs for LGA infants per 500 g increase in maternal and paternal birth weights were 1.53 (95% CI, 1.47-1.60) and 1.41 (95% CI, 1.35-1.47), respectively. The association between parental birth weight and LBW infants or macrosomia was also linear. The aORs for LBW infants per 500 g decrease in maternal and paternal birth weights were 1.47 (95% CI, 1.40-1.55) and 1.25 (95% CI, 1.19-1.31), respectively. The aORs for macrosomia per 500 g increase in maternal and paternal birth weights were 1.59 (95% CI, 1.41-1.79) and 1.40 (95% CI, 1.23-1.60), respectively. Parental birth weight was found to be associated with infant birth weight even after adjusting for various parental factors. Furthermore, maternal birth weight was more strongly associated with infant birth weight than with paternal birth weight.

Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018.

We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.

Association of duration of embryo culture with risk of large for gestational age delivery in cryopreserved embryo transfer cycles

To examine the relationship between the day of embryo cryopreservation and large for gestational age (LGA) infants in women undergoing frozen embryo transfers (FETs) after cryopreservation on days 2-7 after fertilization and to compare the risk of the day of embryo cryopreservation to other possible risk factors of LGA after FET cycles. Retrospective cohort study. Society of Assisted Reproduction Clinical Outcomes Reporting System. Women undergoing FET cycles. Day of cryopreservation. Singleton LGA infant. A total of 33,030 (18.2%) FET cycles in the study group (n = 181,592) resulted in LGA infants during the study period of 2014-2019. There was an increase in LGA risk when cryopreservation was performed from day 2 (13.7%) to days 3-7 (14.4%, 15.0%, 18.2%, 18.5%, and 18.9%). In the log-binomial model, the risk increased compared with days 2-3 combined when cryopreservation was performed on days 5-7 (adjusted relative risk [aRR] 1.32, 95% confidence interval [CI] 1.22-1.44 for day 5, aRR 1.34, 95% CI 1.23-1.46 for day 6, and aRR 1.42, 95% CI 1.25-1.61 for day 7). Other factors most associated with LGA risk in the log-binomial model were preterm parity of >3 compared with 0 (aRR 1.82, 95% CI 1.24-2.69) and body mass index (BMI) of >35 kg/m2 compared with normal weight (aRR 1.94, 95% CI 1.88-2.01). Increasing gravity, parity, BMI, number of oocytes, and embryo grade were also associated with LGA in this model. Asian, Black, Hispanic, and combined Hawaiian and Pacific Islander were protective factors in the model compared with White patients. Low BMI (<18.5 kg/m2) was also considered a protective factor in the model compared with normal BMI. Duration of embryo culture was associated with an increased risk of LGA in this study cohort when controlling for known confounders such as maternal BMI and parity. This study sheds new light on the possible link between FET and LGA infants.

Continuous glucose monitoring in pregnancies with type 1 diabetes: small increases in time-in-range improve maternal and perinatal outcomes

BackgroundContinuous glucose monitors (CGM) provide detailed information regarding glycemic control in pregnant patients with type 1 diabetes (T1D). Little data have been published examining the association between CGM parameters and perinatal outcomes among gravidas with T1D using CGM. ObjectiveTo examine the association between perinatal outcomes and time-in-range (TIR) as assessed by CGM used in pregnant individuals with T1D. We hypothesized that higher TIR would be associated with lower risk of adverse perinatal outcomes. Study designThis multicenter retrospective cohort study included all gravidas with T1D using CGM who delivered in 2020-2022 at 5 University of California sites. Only those with CGM target range set to 70-140 mg/dL (±10 mg/dL) were included. TIR (%) was recorded at 12, 16, 20, 24, 28, and 32 weeks. The primary maternal and neonatal outcomes were preeclampsia and large for gestational age (LGA), defined as birthweight (BW) ≥ 95th percentile. Kruskal-Wallis tests were used to compared median TIR in those with and without the primary outcomes. Log-binomial regression was used to obtain risk ratios, with adjustment for microvascular disease and years with T1D. ResultsA total of 91 patients were included. Most used an insulin pump (81%) and did not have diabetic microvascular disease (72%). Median time since diagnosis of T1D was 16 years, and median periconception A1c was 6.7%. Compared to those with preeclampsia, normotensive gravidas had significantly higher TIR at nearly every time point. A similar pattern was seen for those with normal BW infants compared to LGA infants. On adjusted analyses, every 5-unit increase in TIR at 12 weeks was associated with a 45% and 46% reduction in the risk of preeclampsia and LGA, respectively (ARR 0.55, 95% CI 0.30-0.99 for preeclampsia; ARR 0.54, 95% CI 0.29-0.99 for LGA). ConclusionsHigher TIR is associated with lower risk of preeclampsia and LGA. This association is seen early in gestation, when each 5-unit increase in TIR is associated with ∼50% reduction in the risk of these complications. These findings can be used to counsel patients regarding risk of pregnancy complications at specific TIR values and to encourage patients that even small improvements in TIR can have significant impact on pregnancy outcomes. Larger studies are needed to further explore these findings and to identify optimal TIR to reduce perinatal complication rates.

Functional analysis of daily glycemic profiles and excessive fetal growth in pregnant patients with well-controlled type 1 diabetes: Retrospective cohort

AimsThe study objective was to compare daily glycemic profiles throughout gestation between the mothers of large-for-gestational-age (LGA) and non-LGA newborns in patients with type 1 diabetes (T1D). MethodsWe selected 102 eligible pregnant women who were treated with sensor-augmented pumps in our single-center retrospective cohort study. We used functional data analysis to compare glycemic control across gestation. ResultsMedian HbA1c values in the first, second, and third trimester were 6.23 %, 5.49 %, and 5.75 % respectively. Median time‐in‐range (TIR) exceeded 70 % in each trimester (72.4 %, 72.5 %, and 75.9 %, respectively). From 59 % up to 77 % of women met the criteria for well-controlled T1D defined by the mean HbA1c and TIR in each trimester. Despite that, 27 % (28/102) of pregnancies were complicated by LGA. Mothers of LGA infants had significantly increased HbA1c levels and decreased TIR values in the second and third trimesters. The most significant differences in daily mean glucose values between LGA and non-LGA newborns’ mothers occurred between 26 and 32 weeks of pregnancy. These discrepancies were noted in daytime glucose values rather than nocturnal and fasting glucose levels. ConclusionsMothers of LGA newborns present significantly worse glycemic control. Our findings may emphasize the need for more rigorous daytime glycemic control.

Lipid-focused dietary education intervention in pregnant women: study protocol for an open-label, parallel, randomised, intervention study addressing adverse pregnancy outcomes in China

IntroductionThe incidence of infants who are large-for-gestational-age (LGA) is on the rise in China, and its detrimental effects on health have received increasing attention. Diet-based interventions have the potential to...

Neuropsychological development of large for gestational age infants at the age of 12 months

To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months. The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age. After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05). The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.

Impact of a modified screening approach during the COVID-19 pandemic on the diagnosis and outcomes of gestational diabetes mellitus: A population-level analysis of 90,518 pregnant women.

To provide real-world evidence on the uptake of and outcomes associated with the modified gestational diabetes mellitus (GDM) screening approach offered during the COVID-19 pandemic compared with the standard screening approach. All pregnancies between 01 January 2020 and 31 December 2021, in Alberta, Canada, were included in the study. We examined GDM screening and diagnosis rates, and large-for-gestational-age (LGA) outcomes. Annual GDM screening rates were > 95% during the study time period. Overall, 84.7%, and 11.6% of the 92,505 pregnancies underwent standard and modified screening for GDM, respectively. The use of modified screening was the highest among deliveries in August 2020 (49.8%) which corresponded to the early first wave of the pandemic. GDM diagnosis rate was lower in the modified screening (7.4%) than in the standard screening (12.3%, p < 0.001) group. The LGA rates in the modified screening with GDM and the standard screening with GDM groups were 24.8% and 12.6%, respectively (p < 0.001). Women in the modified screening with GDM group were at a higher risk of having an LGA infant (adjusted odds ratio: 3.46; 95% confidence interval: 2.93, 4.08) compared to the standard screening with no GDM group. The COVID-19 epidemic had no impact on screening for GDM. Women who underwent modified screening, based on HbA1c/random plasma glucose, had lower rates of GDM cases.

FRI632 Metformin Use In Gdm Is Not Associated With Increased Incidence Of Preterm Labor And Small For Gestational Age Infants Compared To Diet Control Alone

Abstract Disclosure: A. D'Souza: None. F. Badri: None. H. Abdullahi: None. I. Ibrahim: None. Gestational diabetes mellitus (GDM), the most frequent medical complication of pregnancy, is becoming a growing public health issue with its national prevalence of 21.5% greater than the estimated global prevalence of 17%.1,2 Among those who required treatment for GDM in Qatar, 91.8% were on metformin either alone or in combination with insulin.1 Given the limited data on the effects of metformin exposure in pregnancy, the study aimed to investigate the association between the use of metformin in GDM and the incidence of various maternal and neonatal outcomes. It was hypothesized that metformin use in GDM is not associated with increased incidence of adverse maternal and neonatal outcomes in this high-risk population. This retrospective cohort study looked at women with GDM who sought prenatal care at Sidra Medicine, Doha, Qatar between January 2019 and December 2020 and compared the incidence of various maternal and neonatal outcomes in patients on metformin to those on diet control alone. 649 women with GDM were included in the study; of which 438 were on diet control alone and 211 were on metformin. Women in the metformin group were older and heavier at baseline and gained lesser weight during pregnancy (p&amp;lt;.001). Subjects in the metformin-treated arm had a significantly lower gestational age at delivery (37.8 vs. 38.6 weeks, p&amp;lt;.001), higher incidence of C-section (50.7 vs. 42.2%, p=.042), and higher incidence of polyhydramnios (6.6 vs. 2.1%, p=.003) compared to those in the diet-controlled group. The mean birth weight percentile (66.5 vs. 59.9, p=.008), incidence of large for gestational age (LGA) infants (27 vs. 18%, p=.008) and incidence of neonatal jaundice (1.9 vs. 0.2%, p=.041) in the metformin-treated group were higher, but there was no significant difference in the incidence of other neonatal outcomes between the two groups. In particular, metformin was not associated with increased incidence of preterm labor and small for gestational age (SGA) infants in pregnancy as suggested by previous studies. However, women on metformin had a higher incidence of C-section, polyhydramnios, LGA infants, and neonatal jaundice, and increased mean neonatal weight percentile at birth compared to diet control alone. This could be attributed to the higher degree of maternal hyperglycemia and increased severity of disease in the patients on metformin. In conclusion, our study showed that the use of metformin in GDM is not associated with the increased incidence of preterm labor and SGA infants.

Glycemic status during pregnancy according to fasting and post-load glucose values: The association with adverse pregnancy outcomes. An observational study

AimPrognosis of treated hyperglycemia in pregnancy (HIP) may differ according to whether diagnosis following an oral glucose tolerance test (OGTT) is based on high fasting and/or high post-load glucose values. MethodsFrom a multiethnic prospective study, we included 8,339 women screened for HIP after 22 weeks of gestation. We evaluated the risk of large-for-gestational-age (LGA) infant (primary endpoint) and other adverse pregnancy outcomes according to HIP status in four groups defined as follows: no HIP (n = 6,832, reference); isolated fasting HIP (n = 465), isolated post-load HIP (n = 646), and fasting and post-load HIP (n = 396). ResultsAfter adjusting for age, body mass index, ethnicity, smoking during pregnancy and parity, compared with no HIP, the adjusted odds ratios [95% confidence interval] for LGA infant were higher in the isolated fasting HIP (1.47 [1.11–1.96]) and fasting and post-load HIP (1.65 [1.23–2.21]) groups, but not in the isolated post-load HIP (1.13 [0.86–1.48]) group. The adjusted odds ratios for preterm delivery and neonatal intensive care unit were higher in the post-load HIP group (1.44 [1.03–2.03] and 1.28 [1.04–1.57], respectively), the fasting and post-load HIP group (1.81 [1.23–2.68] and 1.42 [1.10–1.81], respectively) but not in the isolated fasting HIP group (1.34 [0.90–2.00] and 1.20 [0.94–1.52], respectively). ConclusionDespite glucose-lowering care and adjustment for confounders, compared with no HIP, fasting HIP was associated with a higher rate of LGA infant, whereas post-load HIP was associated with higher preterm delivery and neonatal intensive care unit admission rates.

180-LB: Associations of Phthalate Metabolites with Glycemic Parameters and Fetal Growth in Type 1 Diabetes (T1D) Pregnancies

Background: The risk of delivering a large for gestational age (LGA) infant is higher in pregnant individuals with T1D compared to individuals without diabetes, despite advances in managing T1D in pregnancy. Exposure to endocrine disrupting chemicals (e.g., phthalates) can affect both glucose homeostasis and fetal growth. Objective: To estimate associations of urinary phthalate metabolite levels with continuous glucose monitoring (CGM) data in pregnancy and birthweight. Methods: We analyzed urinary levels of 14 phthalate metabolites and derived trimester-specific CGM summary measures in 32 pregnant women with T1D. We estimated associations of log2-transformed urinary metabolite levels with continuous CGM outcomes and infant weight (GROW percentile) using linear regression, and estimated associations between metabolite levels and odds of LGA (GROW percentile ≥90) vs. AGA (&amp;lt;90) using logistic regression. Models were adjusted for maternal age and gestational week of study visit. Results: Participants were primarily white (85%), nulliparous (53%), with a mean age of 33 years, and 50% had LGA infants. Concentrations of mono-benzyl phthalate (mBzP) and mono-carboxy octyl phthalate (mCNP), were associated with glycemia in the 3rd trimester. Specifically, each doubling of mBzP and mCNP concentration was associated with 8.5 mg/dL (95% CI: 1.4, 15.6) and 8.9 mg/dL (-1.3, 19.0) higher average glucose, -6.0% (-10.9, -1.0) and -8.9% (-15.1, -2.7) less time spent in range (63-140mg/dL), and 5.9% (0.7, 11.2) and 7.4% (0.3, 14.5) more time spent above range (&amp;gt;140 mg/dL). Phthalates were not associated with continuous GROW percentile. Conclusion: Exposure to certain phthalates in later pregnancy may affect glycemic control in pregnant individuals with T1D. However, effects of phthalate exposure on birthweight are unclear. Future studies may disentangle the extent to which phthalate exposure and its effects on glycemic control may impact fetal growth. Disclosure E. V. Preston: None. F. M. Brown: Other Relationship; Dexcom, Inc. G. A. Hansbury: None. J. C. O'connell: None. D. Wolfs: None. J. Dreyfuss: None. S. Wolpowitz: None. Z. Wang: None. T. James-todd: None. E. M. Isganaitis: None. Funding National Institute of Environmental Health Sciences; National Institute of Diabetes and Digestive and Kidney Diseases

Interpregnancy weight change as a potential risk factor for large-for-gestational-age infants: the Japan Environment and Children’s Study

Objective This study aimed to estimate the impact of interpregnancy weight change from the first to the second pregnancy on the risk of infants being large for gestational age (LGA). Methods This nationwide prospective birth cohort analysis included 3245 women who delivered their first two live singletons between 2011 and 2014. Interpregnancy weight change was calculated as the difference between the prepregnancy body mass index (BMI) of the first and second pregnancies. LGA infants were compared among three interpregnancy weight change groups: weight loss (a BMI loss >1 unit), weight gain (a BMI gain >1 unit), and stable weight (BMI maintained within − 1 to <1 unit). Interpregnancy weight change was assessed in mothers with a BMI <25 and ≥25 kg/m2, and adjusted odds ratios (ORs) were calculated for LGA infants by multiple logistic regression. Results The incidence of LGA infants was 8.6% (279 out of 3245). Compared with the stable weight group, interpregnancy weight gain was associated with an increased risk of infants being LGA (adjusted OR: 1.69, 95% confidence interval: 1.21–2.36) in the normal BMI (<25 kg/m2) group. In contrast, in the overweight/obese BMI (≥25 kg/m2) group, interpregnancy BMI was not a significant risk factor for LGA infants. Conclusions Accurate risk stratification using interpregnancy BMI could assist the clinical management of women with a normal BMI who are at risk of delivering LGA infants.

Association between second- and third-trimester maternal lipid profiles and adverse perinatal outcomes among women with GDM and non-GDM: a retrospective cohort study

BackgroundLipid metabolism disorder during pregnancy has been reported in women with gestational diabetes mellitus (GDM). However, controversy remains regarding the relationship between maternal changes in lipid profiles and perinatal outcomes. This study investigated the association between maternal lipid levels and adverse perinatal outcomes in women with GDM and non-GDM.MethodsIn total, 1632 pregnant women with GDM and 9067 women with non-GDM who delivered between 2011–2021 were enrolled in this study. Serum samples were assayed for fasting total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels during the second and third trimesters of pregnancy. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were calculated via multivariable logistic regression analysis to determine the association of lipid levels with perinatal outcomes.ResultsThe serum TC, TG, LDL, and HDL levels in the third trimester were significantly higher than those in the second trimester (p < 0.001). Women with GDM had significantly higher levels of TC and TG in the second and third trimesters than those with non-GDM in the same trimesters, while HDL levels decreased in women with GDM (all p < 0.001). After adjusting for confounding factors by multivariate logistic regression, every mmol/L elevation in TG levels of women with GDM in second and third trimesters was associated with a higher risk of caesarean section (AOR = 1.241, 95% CI: 1.103–1.396, p < 0.001; AOR = 1.716, 95% CI: 1.556–1.921, p < 0.001), large for gestational age infants (LGA) (AOR = 1.419, 95% CI: 1.173–2.453, p = 0.001; AOR = 2.011, 95% CI: 1.673–2.735, p < 0.001), macrosomia (AOR = 1.220, 95% CI: 1.133–1.643, p = 0.005; AOR = 1.891, 95% CI: 1.322–2.519, p < 0.001), and neonatal unit admission (NUD; AOR = 1.781, 95% CI: 1.267–2.143, p < 0.001; AOR = 2.052, 95% CI: 1.811–2.432, p < 0.001) cesarean delivery (AOR = 1.423, 95% CI: 1.215–1.679, p < 0.001; AOR = 1.834, 95% CI: 1.453–2.019, p < 0.001), LGA (AOR = 1.593, 95% CI: 1.235–2.518, p = 0.004; AOR = 2.326, 95% CI: 1.728–2.914, p < 0.001), macrosomia (AOR = 1.346, 95% CI: 1.209–1.735, p = 0.006; AOR = 2.032, 95% CI: 1.503–2.627, p < 0.001), and neonatal unit admission (NUD) (AOR = 1.936, 95% CI: 1.453–2.546, p < 0.001; AOR = 1.993, 95% CI: 1.724–2.517, p < 0.001), which were higher than the relative risk of these perinatal outcomes in women with non-GDM. Additionally, every mmol/L increase in second and third-trimester HDL levels of women with GDM was associated with decreased risk of LGA(AOR = 0.421, 95% CI: 0.353–0.712, p = 0.007; AOR = 0.525, 95% CI: 0.319–0.832, p = 0.017) and NUD (AOR = 0.532, 95% CI: 0.327–0.773, p = 0.011; AOR = 0.319, 95% CI: 0.193–0.508, p < 0.001), and the risk reduction was not strong than that of women with GDM.ConclusionsAmong women with GDM, high maternal TG in the second and third trimesters was independently associated with an increased risk of cesarean section, LGA, macrosomia, and NUD. High maternal HDL during the second and third trimesters was significantly associated with decreased risk of LGA and NUD. These associations were stronger than those in women with non-GDM, suggesting the importance of monitoring second and third-trimester lipid profiles in improving clinical outcomes, especially in GDM pregnancies.

Neonatal Outcomes Associated With Personalized Text Messages for Diabetes Self-Management in Pregnancy [ID: 1373396

INTRODUCTION: The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes. METHODS: Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (&gt;24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration. RESULTS: One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance. CONCLUSION: Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal outcomes.

The impact of the COVID-19 lockdown on birthweight among singleton term birth in Denmark.

In Denmark, a nationwide COVID-19 lockdown was implemented on March 12, 2020 and eased on April 14, 2020. The COVID-19 lockdown featured reduced prevalence of extremely preterm or extremely low birthweight births. This study aims to explore the impact of this COVID-19 lockdown on term birthweights in Denmark. We conducted a nationwide register-based cohort study on 27,870 live singleton infants, born at term (weeks 37-41), between March 12 and April 14, 2015-2020, using data from the Danish Neonatal Screening Biobank. Primary outcomes, corrected for confounders, were birthweight, small-for-gestational-age (SGA), and large-for-gestational-age (LGA), comparing the COVID-19 lockdown to the previous five years. Data were analysed using linear regression to assess associations with birthweight. Multinomial logistic regression was used to assess associations with relative-size-for-gestational-age (xGA) categories. Adjusted mean birthweight was significantly increased by 16.9 g (95% CI = 4.1-31.3) during the lockdown period. A dip in mean birthweight was found in gestational weeks 37 and 38 balanced by an increase in weeks 40 and 41. The 2020 lockdown period was associated with an increased LGA prevalence (aOR 1.13, 95% CI = 1.05-1.21). No significant changes in proportions of xGA groups were found between 2015 and 2019. The nationwide COVID-19 lockdown resulted in a small but significant increase in birthweight and proportion of LGA infants, driven by an increase in birthweight in gestational weeks 40 and 41.

Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

Objective(1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants...