Large For Gestational Age Neonates Research Articles

Burden and Trend of Macrosomia and Large-for-Gestational-Age Neonates Attributable to High Pre-Pregnancy Body Mass Index in China, 2013-2017: A Population-Based Retrospective Cohort Study.

Background: The world is transitioning to an obese future, but few studies have measured the burden of increased maternal body mass index (BMI) on pathological fetal overgrowth, especially the trends in this burden and its heterogeneity in populations with different characteristics. Methods: A population-based retrospective cohort study was conducted with 7,998,620 Chinese females who had participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2017. The proportions of macrosomic and LGA neonates attributable to high BMI (population attributable fraction, PAF) and annual percent change of yearly PAFs were estimated. Results: We found that the burden of macrosomic and LGA (large-for-gestational-age) neonates attributable to high pre-pregnancy BMI increased among Chinese females with planned pregnancies during 2013-2017. The PAF of macrosomia attributable to high BMI increased from 3.16% (95% confidence interval: 2.97-3.35%) to 7.11% (6.79-7.42%) by 23.60% (16.76-30.85%) annually, and the PAF of LGA increased from 2.35% (2.21-2.48%) to 5.00% (4.79-5.21%) by 21.98% (16.14-28.11%) annually. Our study identified that participants with disadvantaged socioeconomic status (including those without higher education, living in provinces with GDP per capita < 40,000 CNY, tier IV, and tier V cities) and residing in northern and southwestern China were at high risk of a rapidly expanding burden. Conclusions: Government authorities should control pre-pregnancy BMI through nationwide intervention programs and direct more resources to focus on the unfair burden on females with disadvantaged socioeconomic status.

Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

G-ROP criteria for predicting retinopathy of prematurity among neonates with different birth weight percentiles

The Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study showed that adding postnatal weight gain to birth weight and gestational age detected 100% of cases with type 1 retinopathy of prematurity (ROP) while reducing the ROP examinations by 30%. The purpose of this study was to investigate whether being small for gestational age (SGA) affects the sensitivity and specificity of the G-ROP model. We applied the G-ROP criteria for premature infants. The infants were classified as three subgroups: SGA, appropriate for gestational age (AGA), and large for gestational age (LGA). The performance of G-ROP criteria was assessed for each group for ROP. There were 41 (10.5%) SGA, 312 (80%) AGA, and 37 (9.5%) LGA neonates. Twenty-six (6.7%) neonates were treated for ROP, and the G-ROP model identified all of them. The sensitivity of the model for treatment-requiring ROP (TR-ROP) was found to be 100% in the whole patient group and for each subgroup. The specificity for TR-ROP was 46.4% for the whole group, 50% for SGA, 44% for AGA, and 63.6% for LGA. By applying the G-ROP model, the number of ROP examinations could be reduced by 25% for the whole group, 27% for SGA, 24% for AGA, and 31% for LGA, without missing TR-ROP. The sensitivity and specificity of the G-ROP model for TR-ROP in SGA infants were similar to the whole group. The model did not miss any cases of TR-ROP.

One-Step Compared With Two-Step Gestational Diabetes Screening and Pregnancy Outcomes: A Systematic Review and Meta-analysis.

To estimate short-term maternal and neonatal outcomes with one-compared with two-step testing for gestational diabetes mellitus (GDM). A systematic review of randomized controlled trials (RCTs) and observational studies comparing one-step and two-step GDM testing strategies before September 2021 was conducted. We searched Ovid Medline (1946-), EMBASE (1947-), Scopus (1960-), Cochrane Central, and ClinicalTrials.gov . The primary outcome was rate of large-for-gestational age (LGA) neonates. Secondary outcomes were clinically relevant outcomes for GDM that were selected a priori. Titles, abstracts, and manuscripts were screened, selected, and reviewed by the first two authors. Four RCTs (24,966 patients) and 13 observational studies (710,677 patients) were analyzed. Pooled relative risks (RRs) were calculated with 95% CIs using random-effects models and were plotted graphically with forest plots. Study heterogeneity was evaluated using Cochran Q and Higgins I 2 tests. The quality of studies that met the inclusion criteria was evaluated with the Downs and Black checklist. Publication bias was assessed by using asymmetry of funnel plots and Harbord's test. There was no difference in the rate of LGA neonates (pooled RR 0.95; 95% CI 0.88-1.04) by testing strategy among RCTs, but patients who underwent one-step testing were more likely to be diagnosed with GDM (pooled RR 2.13; 95% CI 1.61-2.82) and treated with diabetes medications (pooled RR 2.24; 95% CI 1.21-4.15). One-step testing was associated with higher rates of neonatal intensive care unit (NICU) admission (pooled RR 1.12; 95% CI 1.00-1.26) and neonatal hypoglycemia (pooled RR 1.23; 95% CI 1.13-1.34). In analysis of high-quality RCTs and observational studies, one-step testing was associated with a lower rate of LGA neonates (pooled RR 0.97; 95% CI 0.95-0.98), but higher rates of GDM diagnosis, treatment, NICU admission, and neonatal hypoglycemia. Despite a significant increase in GDM diagnosis and treatment with one-step testing, there is no difference in rate of LGA neonates compared with two-step testing among RCTs. PROSPERO, CRD42021252703.

Glycemic Variability in Type 1 Diabetes Mellitus Pregnancies-Novel Parameters in Predicting Large-for-Gestational-Age Neonates: A Prospective Cohort Study.

Pregnancies with type 1 diabetes mellitus (T1DM) have a high incidence of large-for-gestational-age neonates (LGA) despite optimal glycemic control. In recent years, glycemic variability (GV) has emerged as a possible risk factor for LGA, but the results of the conducted studies are unclear. This study analyzed the association between GV and LGA development in pregnancies with T1DM. This was a prospective cohort study of patients with T1DM who used continuous glucose monitoring (CGM) during pregnancy. Patients were followed from the first trimester to birth. GV parameters were calculated for every trimester using the EasyGV calculator. The main outcomes were LGA or no-LGA. Logistic regression analysis was used to assess the association between GV parameters and LGA. In total, 66 patients were included. The incidence of LGA was 36%. The analysis extracted several GV parameters that were significantly associated with the risk of LGA. The J-index was the only significant parameter in every trimester of pregnancy (odds ratios with confidence intervals were 1.33 (1.02, 1.73), 3.18 (1.12, 9.07), and 1.37 (1.03, 1.82), respectively. Increased GV is a risk factor for development of LGA. The J-index is a possible novel GV parameter that may be assessed in all three trimesters of pregnancy together with glycated hemoglobin and time-in-range.

Association between gestational abnormal glucose tolerance and maternal-fetal outcomes.

To investigate the relationship between abnormal glucose tolerance during pregnancy and maternal-fetal outcomes, after categorizing women into groups with different levels of gestational abnormal glucose tolerance. A total of 1858 pregnant women who received two-step screening for gestational diabetes mellitus (GDM) at Fooyin University Hospital were categorized into four groups, according to their glucose abnormalities, and their maternal-fetal outcomes were investigated from October 2015 to June 2020. Among the groups having different levels of abnormal glucose tolerance, there were significant differences and trends in mother's age, currently married status, and prepregnancy overweight or obesity, incidences of cesarean section, preterm, and gestational hypertension or preeclampsia; and with respect to neonatal incidence of large for gestational age (LGA), average weight, and average height (p < 0.05). After adjusting for potential factors, there were higher incidences of cesarean section (AOR=1.71; 95% confidence interval [CI]: 1.12-2.61), preterm (AOR=2.20; 95% CI: 1.23-3.91), neonatal LGA (AOR=4.94; 95% CI: 2.87-8.51), and neonatal intensive care unit (NICU) admission (AOR=2.66; 95% CI: 1.14-6.24) in the GDM group, relative to the control group. Furthermore, the women in the oral glucose tolerance test (OGTT)-1 group had a higher incidence of neonatal LGA when compared with the women in the normal group (AOR=2.31; 95% CI: 1.02-5.33). We found higher incidences of cesarean section, preterm, and neonatal LGA and NICU admission in the GDM women, and a higher incidence of neonatal LGA in the OGTT-1 group, relative to control group.

417 IS ACCELERATED GROWTH VELOCITY A RISK FACTOR OF ADVERSE PERINATAL OUTCOME

Introduction: Large for gestational age and macrosomia are known risk factors of adverse perinatal outcome. Less is known on the association between accelerated growth velocity and placental insufficiency which results in such adverse outcomes as intrauterine death, reduced Apgar scores and cesarean section for fetal distress. Aim of the study: The aim of this study was to assess the incidence of accelerated growth velocity (AGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. The study included singleton deliveries that had an ultrasound performed between 28-32 weeks of gestation and subsequently delivered at our maternity unit. We defined appropriate-for-gestational-age (AGA) as between the 10-90th centile, large-for-gestational-age (LGA) as above the 90th centile, by the Intergrowth chart. Accelerated growth velocity was defined as increase by at least 50 centiles between birthweight and estimated fetal weight on ultrasound at 28-32 weeks of gestation. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: LGA, LGA+AGV, AGA+AGV, AGA. Results: The final database of combined ultrasound and delivery records comprised of 2209 records (AGA n=1688, AGA+AGV n=86, LGA n=391, LGA+AGV n=44; 88.56%, 4.51%, 20.51%, 2.31% respectively). The highest risk of APO was in AGA neonates with AGV 26.74%, followed by LGA with AGV 18,18%. The lowest risk of APO was among LGA neonates 16.37%. Conclusions: The role of accelerated growth velocity needs further assessment. The highest risk of APO is among AGA neonates with AGV. This could be explained by the disproportion between fetal and placental size resulting in placental insufficiency.

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

AimsWe aimed to determine the effect of early pregnancy hyperglycaemia on having a large for gestational age (LGA) neonate.MethodsA prospective cohort study was conducted among pregnant women in their first trimester. One-step plasma glucose (PG) evaluation procedure was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) in pregnancy as defined by the World Health Organization (WHO) criteria with International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was large for gestational age neonates (LGA).ResultsA total of 2,709 participants were recruited with a mean age of 28 years (SD = 5.4) and a median gestational age (GA) of eight weeks (interquartile range [IQR] = 2). The prevalence of GDM in first trimester (T1) was 15.0% (95% confidence interval [CI] = 13.7–16.4). Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2,285 live births with a median delivery GA of 38 weeks (IQR = 3), 7.0% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 (95% CI = 1.23–4.28) and 1.80 (95% CI = 1.27–2.53), respectively. The attributable risk percentage of a LGA neonate for hyperglycaemia was 15.01%. T1 fasting PG was significantly correlated with both neonatal birth weight and birth weight centile.ConclusionsThe proposed WHO criteria for hyperglycaemia in pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for Fasting PG, for risk assessment in early pregnancy in high-risk populations is recommended.

ОЦЕНКА СОСТОЯНИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У КРУПНОВЕСНЫХ И МАЛОВЕСНЫХ К СРОКУ ГЕСТАЦИИ НОВОРОЖДЕННЫХ ДЕТЕЙ

The aim of the study was to assess the cardiovascular status of large-forgestational-age (LGA) and small-for-gestational-age (SGA) full-term newborns. A survey of 192 newborns was carried out on the basis of the Republican Scientific and Practical Center “Mother and Child”. Group 1 (Gr1) consisted of 54 large-for-gestational-age newborns, group 2 (Gr2) – 43 small-for-gestational-age newborns, group 3 (Gr3) – 95 newborns with physical development corresponding to gestational age (appropriate for gestational age). Echocardiographic parameters were compared between study groups, as corrected to body surface area. Morphometric assessment of heart structures in the course of Echo-CG in Gr1 patients showed a statistically significant thickening of the heart walls with predominant localization in the posterior wall of the left ventricle (LV) and interventricular septum (IVS). Significant differences were found in all derivatives of echocardiographic indicators in the examined groups of newborns. In Gr2, signs of diastolic myocardial dysfunction were revealed reflecting an impairment of the age-related evolution of myocardial relaxation processes. The intragroup analyses of LGA and SGA neonates (subgrouped according to the birth weight percentile) revealed no statistically significant differences in the direct and derived echocardiographic parameters analyzed. The frequency of detection of open foramen ovale (PFO), IVS thickness of 5.0 mm and more in LGA newborns had greater as compared with the group of conditionally healthy infants (р = 0.038, р = 0.001). Fetal communications in SGA newborns occurred significantly more often (PFO – р = 0.031, patent ductus arteriosus – р = 0.026) than in newborns with normal weight. LGA and SGA newborns are characterized by the specific cardiovascular status. The revealed changes make it possible to assign infants with large and small birth weight to the risk group for the development of cardiovascular pathology, which requires dynamic observation as well as therapeutic and prophylactic measures.

The mediating role of gestational diabetes mellitus in the associations of maternal prepregnancy body mass index with neonatal birth weight.

BackgroundBoth prepregnancy obesity and gestational diabetes mellitus (GDM) have been linked to adverse neonatal birth weight. However, the mediating role of GDM between prepregnancy obesity and neonatal birth weight is unclear.MethodThe cohort study included 17 260 singleton pregnant women and their newborns. Participants' demographic characteristics, disease history, family history of the disease, and the perinatal outcomes were recorded. The association between maternal prepregnancy body mass index (BMI) status and small for gestational age (SGA) or large for gestational age (LGA) neonates was analyzed using logistic regressions, before and after adjusting for covariates and GDM. The potential mediation of GDM on the association between prepregnancy BMI and adverse birth weight was examined.ResultMultivariate logistic regression demonstrated that prepregnancy underweight women were more likely to deliver SGA neonates compared to those who had normal weights, whereas prepregnancy obese pregnant women were more likely to have LGA neonates. The RMediation analyses illustrated that the mediation effect of GDM on the maternal prepregnancy BMI (continuous variable) and the risk of SGA was not significant, whereas the association between prepregnancy BMI and LGA was statistically mediated by GDM (95%CI of a*b: 0.009‐0.051). The Iacobacci (2012) method indicated that the impact of maternal prepregnancy overweight (Zmediation = 2.418, P = .015) and obesity (Zmediation = 2.165, P = .030) on LGA was partially mediated by GDM, with an indirect effect of 16.3% and 13.1%, respectively.ConclusionPrepregnancy BMI was observed to be associated with SGA and LGA. The association of prepregnancy overweight and obesity with LGA was found to be partially mediated by GDM.

Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus: A Randomized Controlled Trial.

To evaluate differences in short-term perinatal outcomes between the two prominent screening strategies for gestational diabetes mellitus, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan. In this single-site, blinded, randomized, comparative effectiveness trial, participants received a nonfasting 50-g oral glucose tolerance test and, if less than 200 mg/dL (less than 11.1 mmol/L), were randomized to further screening with either IADPSG or Carpenter-Coustan criteria. Gestational diabetes treatment occurred per routine clinical care. The primary outcome was incidence of large-for-gestational-age (LGA) neonates. Prespecified secondary outcomes included small-for-gestational-age (SGA) neonates, cesarean birth, and neonatal and maternal composites of adverse perinatal outcomes. Assuming a 15% incidence of LGA neonates in the Carpenter-Coustan group, 782 participants provided more than 80% power to detect a 7% absolute risk reduction with the use of IADPSG; planned recruitment was 920 for anticipated attrition. From June 2015 to February 2019, 1,016 participants were enrolled and 921 were randomized to IADPSG (n=461) or Carpenter-Coustan (n=460) groups. Gestational diabetes incidence (14.4% vs 4.5%, P<.001) and diabetes medication use (9.3% vs 2.4%; P<.001) were more common in the IADPSG group; there were no differences in LGA neonates, either overall (risk reduction 0.90, 97.5% CI 0.53-1.52) or among women without gestational diabetes (risk reduction 0.85, 97.5% CI 0.49-1.48). Those screened with IADPSG had higher rates of neonatal morbidity but fewer study-related adverse events. Rates of SGA neonates, cesarean birth, and maternal morbidity composite did not differ significantly between study groups. The IADPSG screening criteria resulted in more women diagnosed and treated for gestational diabetes than Carpenter-Coustan without reducing the incidence of LGA birth weight or maternal or neonatal morbidity. ClinicalTrials.gov, NCT02309138.

736 Comparing neonatal outcomes among patients undergoing intravenous glucose tolerance testing for diagnosis of gestational diabetes

To assess neonatal outcomes associated with abnormal intravenous glucose tolerance test (IV GTT) results in a cohort of patients unable to tolerate the standard oral glucose tolerance test for diagnosis of gestational diabetes (GDM). Patients who could not tolerate an oral glucose load, were > 24 weeks gestation, had a viable singleton or multifetal gestation, and spoke English or Spanish were enrolled prospectively between February 2019 and February 2020. Patients with pre-existing diabetes mellitus (DM) or clinically significant hemoglobinopathies were excluded. Enrolled patients underwent an IV GTT and glucose monitoring was initiated if the IV GTT resulted in a glucose metabolism rate below trimester-specific normative values. The primary outcome of interest was large for gestational age (LGA) infants. The study was powered to detect a 25% difference in LGA infants between patients with an abnormal IV GTT result compared to those with a normal IV GTT result. Of the 120 patients consented, 115 completed glucose testing and 13 (11.3%) had an abnormal IV GTT. Age, race/ethnicity, parity, family history of DM, insurance status, gestational age at testing, and body mass index did not differ between those with abnormal compared to normal IV GTT results. Participants with an abnormal IV GTT result were more likely to have multifetal pregnancies (15.4% vs 0%, p=0.01). Infants delivered to patients with an abnormal IV GTT result were more likely to be LGA, have lower mean neonatal blood glucose nadirs, and require treatment with supplemental glucose (Table). Participants with an abnormal IV GTT result were more likely to have an LGA neonate and clinically significant hypoglycemia. The IV GTT is a reasonable diagnostic test for GDM-related morbidities when an oral glucose load cannot be tolerated.

Benefit of insufficient gestational weight gain in obese women with gestational diabetes mellitus: A multicenter study in Portugal

BackgroundBoth obesity and gestational diabetes mellitus (GDM) are independent risk factors for adverse maternal and fetal outcomes. The Institute of Medicine (IOM) recommends different targets for an adequate gestational weight gain (GWG), depending on the prepregnancy body mass index, but they have been questioned. We aim to compare obese pregnant women with GDM according to GWG stratification (insufficient, adequate and excessive) with regard to maternal and neonatal outcomes and to clarify whether insufficient GWG can be associated with better outcomes. MethodsA multicenter observational study with prospectively collected data of obese singleton pregnant women with GDM was conducted. GWG was expressed according to the 2009 IOM’s recommendations. ResultsOf 4563 obese women with GDM, 34.5%, 30.4% and 35.2% registered insufficient, adequate and excessive GWG, respectively. Multiple logistic regression analysis revealed that women with insufficient GWG had lower odds of gestational hypertension, preeclampsia, caesarean section, large for gestational age (LGA) neonates and prediabetes in postpartum. Despite the higher incidence of small for gestational age (SGA) neonates, they were not associated with adverse outcomes. Women with excessive GWG had higher odds of caesarean section, macrosomic and LGA neonates. ConclusionsInsufficient GWG in obese women with GDM was beneficial due to better maternal and neonatal outcomes. In clinical practice, we should be strict with regard to weight gain in obese pregnant women with GDM and encourage a reduced GWG, provided an adequate fetal growth is guaranteed.

Caucasian and Asian difference in role of type 1 diabetes on large-for-gestational-age neonates

IntroductionRacial differences in the association between type 1 diabetes mellitus (T1DM) and large-for-gestational-age (LGA) neonates remain unclear. The objective of this study was to compare the effect of T1DM on...

Pregnancy in Patients with Type One Diabetes Mellitus Treated with Continuous Subcutaneous Insulin Infusion—Preconception Basal Insulin Dose as a Potential Risk Factor for Fetal Overgrowth?

Despite widespread use of technology, type one diabetes mellitus (T1DM) is still a great clinical challenge during pregnancy. This study aims to assess how prenatal variables of T1DM patients using continuous subcutaneous insulin infusion (CSII) influence pregnancy outcomes. We performed a retrospective study of 35 patients with T1DM treated with CSII during pregnancy. Alterable preconception variables (A1C, body mass index, basal and bolus insulin dose) were analysed as possible contributors to birth weight and large-for-gestational-age (LGA) prevalence. Inclusion criteria were presence of T1DM for more than two years, A1C < 7.4% and treatment with CSII for at least three months prior to conception. The preconception basal insulin dose and A1C had a significant correlation to the neonatal birth weight (p = 0.01, r = 0.4 and p = 0.04, r = 0.3, respectively) and were significant in regression analysis together contributing 22% of the variance in birth weight percentiles (sig = 0.17, R square = 0.22). Prevalence of LGA was 46%. Women who had LGA neonates also had a higher preconception basal insulin dose compared to women with non-LGA neonates (26 ± 9 vs. 18 ± 7 IU (international units), p = 0.01). The LGA group had a higher preconception A1C, but it did not reach statistical significance (6.5 ± 0.5% vs. 6.2 ± 0.9%, respectively, p = 0.2). Women with T1DM treated with CSII who had unregulated glycaemia and more basal insulin were at greater risk for development of LGA neonates.

The value of fetal growth biometry velocities to predict large for gestational age (LGA) infants

Objective The use of growth velocities derived from fetal biometrics have been suggested to improve prediction of large for gestational age (LGA). Our objective was to determine if ultrasonographic growth velocities (GV) for abdominal circumference (AC) and estimated fetal weight (EFW) improve the prediction of LGA infants when compared to Hadlock EFW. Methods This was a secondary analysis of data from a prospective study of women referred for growth ultrasounds during the 3rd trimester. Growth velocities (GV) for AC (AC − GV) and EFW (EFW − GV) were derived from the difference in Z-scores between measurements at the time of anatomy survey (18–24 week) and third trimester ultrasound (26–36 weeks). Change in AC − GV and EFW − GV >90th %ile alone or in combination with Hadlock EFW >90th%ile were compared for prediction of a LGA neonate. The primary outcome was the sensitivity and specificity of the (1) Hadlock EFW >90%ile, (2) AC − GV, (3) EFW − GV, (4) Hadlock EFW + AC − GV, and (5) Hadlock EFW + EFW − GV for the prediction of neonatal LGA. Test characteristics and area under the ROC curve (AUC) were determined. The association between the ultrasound predicted growth and adverse neonatal outcome was assessed using logistic regression. Results Of 630 women meeting inclusion criteria, 85 (13.5%) had LGA neonates. Hadlock EFW showed a better NPV (98.0%) and sensitivity (71.1%) when compared to AC − GV (NPV 87.5%, sensitivity 17.7%) and EFW − GV (NPV 88.0%, sensitivity 22.6%). Combining Hadlock EFW and AC-GV or EFW − GV did little to improve the test characteristics for the prediction of LGA (AUC 0.65 and 0.64, respectively). All five measurements were unable to predict a composite of adverse neonatal outcome or need for maternal cesarean delivery. Adjustment of the growth velocities for gestational age at anatomy scan or 3rd trimester growth scan did not change these results. Conclusion AC and EFW growth velocities do not appear to improve the prediction of LGA infants when compared to using the third trimester Hadlock EFW.

OR08-01 One-Step Versus Two-Step Approach for Gestational Diabetes Mellitus Screening: Comparison of Maternal and Fetal Outcomes in a Canadian Population

Screening for gestational diabetes mellitus (GDM) is internationally recommended however there is no universal approach. Impact of the different diagnostic strategies on maternal and neonatal complications’ rates and cost-effectiveness need to be studied.ObjectiveTo compare maternal and neonatal outcomes between the two supported screening methods for GDM; the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 75g one-step oral glucose tolerance test (OGTT) versus the 50g two-step OGTT.MethodsA retrospective cohort study was performed regrouping all deliveries between 2016 and 2018 in two centers, each using one different screening method. GDM was diagnosed in center A when meeting IADPSG odds ratio (OR) 1.75 cut-offs values after a one-step 75g-OGTT. Center B used a two-step strategy and diagnosed GDM with 50g-OGTT 1hr glycemic value ≥11.1 mmol/L or failed 50g followed by 75g-OGTT results over the IADPSG OR 2.0 cut-offs.Primary outcome was the rate of large for gestational age (LGA) babies. Outcomes were analysed for singleton pregnancies with deliveries >32 weeks.Subgroup analysis of borderline GDM women (OGTT results in between IADPSG OR 1.75 and 2.0 values) were done. Group A’s borderline patients were treated as per GDM patients. Group B’s borderline patients were not considered diabetic and had normal pregnancy care. Results were adjusted for maternal age, BMI and gestational weight gain.ResultsAt interim analysis for the year 2016, a total of 6188 pregnancies, 2664 women in center A (one-step) and 3524 in center B (two-step) were included. The prevalence of GDM was 17.1% in center A (n=456) and 14.8% in center B (n=520). Both populations were comparable in terms of risk factors for LGA except for its ethnic distribution and proportion of obese women (13.1 vs 21.6%). GDM women in center B compared to center A had significant increase in rates of LGA neonates (adjusted OR (ORa) 2.1, p=0.012); neonatal hypoglycemia (ORa 2.1, p=0.0001) and neonatal intensive care unit (NICU) admission (2.1, p=0.048). Gestational hypertension’s rate was more prevalent in center B (ORa 2.1, p=0.020) and there was a non statistical trend towards increased rate of caesareans (1.6, p=0.084).Regular prenatal care for borderline women in center B (n=94) compared to GDM care in center A (n=150) resulted in increased rate of LGA babies (ORa 3.2, p=0.049). Worse maternal outcomes were identified for gestational hypertension (9.7 vs 1.3%, p=0.035) and preeclampsia (4.3 vs 0%, p=0.021) in group B vs A, respectively.ConclusionsChoosing the one-step IADPSG criteria’s for GDM screening is associated with lower rates of LGA, neonatal hypoglycemia and NICU admissions, at the expense of increased prevalence in our population. The ongoing study will include a cost-benefit evaluation to assess if improved outcomes overbalance the increased prevalence inherent to lower diagnostic criteria.

Pregnancy Outcomes for Patients With Excessive Gestational Weight Gain Stratified by Class of Obesity [33D

INTRODUCTION: Excessive gestational weight gain (EWG) increases risk of large for gestational age (LGA) neonates, hypertensive disorders of pregnancy and cesarean delivery. There is limited data on EWG in the obese population. We aim to compare pregnancy outcomes among obesity classes in women with EWG. METHODS: This is a secondary analysis from a prospective study of pregnant women undergoing fetal growth assessment. Obese participants were sorted into cohorts of adequate gestational weight gain (AWG) and EWG as defined by the Institute of Medicine guidelines. The groups were further stratified by class 1, class 2, and class 3 obesity (BMI 30–34.9, 35–39.9, &gt;40 respectively). The primary outcome was LGA neonates. Secondary outcomes included: hypertensive disorders of pregnancy, gestational diabetes (GDM), preterm delivery (PTD), composite adverse neonatal outcomes (CANO, including neonatal ICU admission, neonatal death, seizures, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, and pH &lt;7.10) and small for gestational age (SGA) neonates. Chi-square tests were used to compare outcomes between the cohorts when stratified by class of obesity. RESULTS: 405 obese women were identified, of which 256 experienced EWG and 68 experienced AWG. Among all obese women, EWG was not associated with LGA (P=.35), GDM (P=.12), CANO (P=.75), gestational hypertension (0.87), preeclampsia (P=.68), PTD (P=.91), or SGA (0.21). When stratified by class of obesity there were no differences in the primary or secondary outcomes. CONCLUSION: EWG among obese women was not associated with increased risk of LGA, CANO, GDM, PTD, hypertensive disorders of pregnancy and SGA regardless of obesity class.

Pregnancy Outcomes in Patients With Inadequate Gestational Weight Gain [31N

INTRODUCTION: The objective of this study is to compare the risks for small for gestational age (SGA) neonates and composite adverse neonatal outcomes (CANO) in patients with inadequate gestational weight gain (IWG) versus adequate gestational weight gain (AWG). METHODS: This is a secondary analysis of a prospective study of women undergoing fetal growth assessment. Participants were sorted into AWG and IWG cohorts based on IOM guidelines. Primary outcomes were SGA and CANO (neonatal ICU admission, death, seizures, IVH, respiratory distress syndrome, necrotizing enterocolitis, and pH &lt;7.10). Secondary outcomes included: hypertensive disorders of pregnancy, preterm delivery (PTD), gestational diabetes (GDM), and large for gestational age (LGA) newborns. We performed chi square, t-test, and adjusted multivariable logistical regression. A stratified analysis was performed by pre-pregnancy BMI category. RESULTS: 214 patients experienced IWG and 282 patients experienced AWG. The risk of SGA was increased in patients with IWG, 47 patients (22.0%) compared to 34 patients (12.2%) with AWG (aOR 1.99, CI 1.19–3.33). CANO were similar between groups (14.5% versus 11.8%, P=.384). IWG was associated with decreased risk of LGA (aOR 0.29, CI 0.12–0.71) but did not have an effect on GDM, PTD, gestational hypertension, or preeclampsia. In obese patients, IWG was protective against GDM (RR 0.44, CI 0.21–0.93) and LGA neonates (RR 0.10, CI 0.03–0.44) without increased risk of SGA neonates. CONCLUSION: IWG increases risk of SGA but did not increase neonatal morbidity. IWG was protective against GDM and LGA without increasing other risks in obese patients, suggesting lower weight gain in this population may be beneficial.

Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates.

To examine the racial differences in the population attributable fraction (PAF) of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age (LGA) neonates. We conducted a population-based retrospective cohort study among all women who had prenatal screening and had a singleton live birth in a hospital (1 April 2016-31 March 2017) using data from Ontario birth registry in Canada. We used multivariable log-binomial regression models to estimate the PAF and 95% confidence interval (CI) of LGA neonates due to prepregnancy obesity and excessive gestational weight gain. All models were stratified by race (White, Asian, and Black). Of the 74,402 eligible women, the prevalence of prepregnancy obesity, excessive gestational weight gain, and LGA neonate was 21.1%, 60.0%, and 11.3%, respectively, for Whites; 9.3%, 45.9%, and 5.4%, respectively, for Asians; and 28.6%, 52.4%, and 7.9%, respectively, for Blacks. The association of prepregnancy obesity was greater than that of excessive gestational weight gain on LGA for all racial groups. Excessive gestational weight gain contributed more than prepregnancy obesity in Whites (PAF 32.9%, 95% CI [30.3-35.5%] and 16.6%, 95% CI [15.3-17.9%], respectively, for excessive gestational weight gain and prepregnancy obesity) and in Asians (PAF 32.1%, 95% CI [27.2-36.7%] and 11.8%, 95% CI [9.5-14.1%], respectively, for excessive gestational weight gain and prepregnancy obesity). Prepregnancy obesity (PAF 22.8%, 95% CI [17.1-28.1%]) and excessive gestational weight gain (PAF 20.1%, 95% CI [4.7-33.0%]) contributed to LGA neonates almost the same in Blacks. Excessive gestational weight gain contributed more to LGA neonates than prepregnancy obesity in Whites and Asians, while there was no difference between excessive gestational weight gain and prepregnancy obesity in their contributions to the LGA neonates in Blacks. The differences are mostly driven by the differential prevalence of the two risk factors across racial groups.