Large For Gestational Age Rates Research Articles

Elevated Anti-Müllerian Hormone Is an Independent Risk Factor for Preterm Birth Among Patients With Overweight Polycystic Ovary Syndrome.

ObjectiveTo explore whether elevated anti-Müllerian hormone (AMH) levels affect the rate of preterm birth (PTB) among PCOS patients with different BMIs.MethodsIn this retrospective cohort study, patients with PCOS who had undergone IVF/ICSI from January 2017 to December 2019 were included for potential evaluation. A total of 2368 singleton live births from PCOS patients were included. According to the BMI, all the PCOS patients were divided into two groups: BMI<24 kg/m2 and BMI≥24 kg/m2. In total, 1339 PCOS patients with a BMI<24 kg/m2 were grouped according to their serum AMH levels: ① <2.71 ng/ml (n=333), ② 2.71-4.08 ng/ml (n=330), ③ 4.09-6.45 ng/ml (n=351), and ④ >6.45 ng/ml (n=325). Additionally, 1029 cycles of patients with a BMI≥24 kg/m2 were grouped according to the serum AMH level: ① <2.71 ng/ml (n=255), ② 2.71-4.08 ng/ml (n=267), ③ 4.09-6.45 ng/ml (n=239), and ④ >6.45 ng/ml (n=268), with <2.71 ng/ml being considered the reference group. The grouping was based mainly on the interquartile range of serum AMH levels. The primary outcome of the study was PTB. The secondary outcomes were low birth weight (LBW), small for gestational age (SGA), macrosomia and large for gestational age (LGA).ResultsRegarding PCOS patients with a BMI<24 kg/m2, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rates of the different groups were not significantly different (AMH 2.71-4.08, AOR (95% CI)=1.01 (0.52-2.00), P=0.99; AMH 4.09-6.45, AOR (95% CI)=0.93 (0.45-1.91), P=0.85; AMH>6.45, AOR (95% CI)=0.78 (0.35-1.73), P=0.54). Regarding PCOS patients with a BMI ≥24 kg/m2, compared with the PTB rate of the AMH <2.71 ng/ml group, the PTB rate of the AMH>6.45 ng/ml group was significantly higher (OR=2.47; 95% CI=1.34-4.55). After multiple logistic regression analysis, the risk of PTB in the AMH>6.45 ng/ml group was 2.1 times that in the AMH<2.71 ng/ml group (AOR=2.1, 95% CI=1.01-4.37, P=0.04). However, no statistically significant difference was found in the rate of SGA, LBW, macrosomia or LGA among patients in the different serum AMH groups.ConclusionFor PCOS patients, a BMI≥24 kg/m2 plus serum AMH>6.45 ng/ml (75th percentile) is an independent risk factor for PTB.

Early-Pregnancy Intermediate Hyperglycemia and Adverse Pregnancy Outcomes Among Women Without Gestational Diabetes.

ContextUniversal early-pregnancy screening for overt diabetes reveals intermediate hyperglycemia (fasting plasma glucose [FPG] [5.1-6.9 mM]).ObjectiveWe evaluated the association between early-pregnancy intermediate hyperglycemia and adverse pregnancy outcomes among women without gestational diabetes.MethodsThis retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, from 2013 to 2017. All singleton pregnancies with FPG less than or equal to 6.9 mM in early pregnancy and receiving a 75-g oral glucose tolerance test (OGTT) were included. Women with prepregnancy diabetes were excluded. Individuals with normal OGTT were analyzed. Pregnancy outcomes for FPG less than 5.1 mM and intermediate hyperglycemia were evaluated. The primary outcomes were large for gestational age (LGA) and primary cesarean delivery. Multivariate logistic regressions were conducted. Statistical significance was defined as P less than .05.ResultsIn total, 24 479 deliveries were included, of which 23 450 (95.8%) had normal OGTTs later in pregnancy (NGT). There were 807 (3.4%) women who had an FPG of 5.1 to 6.9 mM in early pregnancy. Compared to the NGT group with an FPG of less than 5.1 mM in early pregnancy (N = 20692), the intermediate hyperglycemia NGT group (N = 693) had a higher age and body mass index (BMI), and significantly higher rates of LGA, primary cesarean delivery, preterm birth, preeclampsia, and neonatal distress. The rates of primary cesarean delivery (adjusted odds ratio [AOR] 1.24; 95% CI, 1.05-1.45), preterm birth (AOR 1.75; 95% CI, 1.29-2.36), and neonatal distress (AOR 3.29; 95% CI, 1.57-6.89) remained statistically significantly higher after adjustments for maternal age, BMI, and other potential confounding factors.ConclusionWomen with intermediate hyperglycemia in early pregnancy are at an increased risk for adverse maternal-fetal outcomes, even with normal future OGTTs.

Association Between HbA1c Levels on Adverse Pregnancy Outcomes During Pregnancy in Patients With Type 1 Diabetes.

ContextDespite optimization of metabolic balance during pregnancy in type 1 diabetes (T1D), maternal–fetal complications remain higher than in the background population.ObjectiveWe examined whether there is an association between glycated hemoglobin (HbA1c) levels and these complications.MethodsRetrospective study of pregnancies in 678 T1D subjects at Lille Hospital (1997-2019). The association between variations in HbA1c levels and complications was examined. The composite criterion (CC) was defined as having at least 1 of the following complications: prematurity, pre-eclampsia, large for gestational age (LGA), small for gestational age (SGA), or cesarean section.ResultsAmong the 678 births, median preconception HbA1c was 7.2% (55 mmol/mol), 361 were LGA (56%), 29 were SGA (4.5%), and 504 were births without preterm delivery (76.1%). The CC occurred in 81.8%. Higher HbA1c during the first trimester was associated with the CC (OR 1.04; 95% CI 1.02-1.06 per 0.1% increase; P < .001). Higher HbA1c during the third trimester was associated with the CC (OR 1.07; 95% CI 1.03-1.10 per 0.1% increase; P < .001). The group defined by a first trimester Hba1c >6.5% (48 mmol/mol) and a third trimester HbA1c <6% was associated with an increased rate of the CC (OR 2.81; 95% CI 1.01-7.86) and an increased rate of LGA (OR 2.20; 95% CI 1.01- 4.78).ConclusionElevated HbA1c is associated with maternal–fetal complications. Despite optimization of metabolic balance during the third trimester, for patients with early glycemic imbalance the risk of LGA persists.

Associations between aspirin prophylaxis and fetal growth and preeclampsia in women with pregestational diabetes.

Current guidelines recommend low-dose aspirin for preeclampsia prophylaxis in all women with pregestational (type one and type two) diabetes mellitus. Most trials showing the efficacy of low-dose aspirin in reducing preeclampsia risk have either excluded or included only small numbers of such women. To evaluate the association of low-dose aspirin prophylaxis in women with pregestational diabetes with the incidence of large for gestational age (LGA) infants and preeclampsia. A retrospective observational study of pregnancies to women with pregestational diabetes. Outcomes included rates of LGA and preeclampsia. Women were prescribed low-dose aspirin prophylaxis from early pregnancy according to physician discretion after considering preeclampsia risk. Statistical analyses assessed the group overall and with stratification by diabetes type and other preeclampsia risk factors. Of 716 pregnancies, aspirin was prescribed in 296 (41%). Preeclampsia occurred more frequently in women who received aspirin (58 of 296, 20%) than those who did not (39 of 420, 9%, P<0.001). This association was maintained after adjustment for diabetes type and other preeclampsia risk factors (adjusted odds ratio (aOR) 1.78; 95% CI 1.02-3.11). LGA infants were commoner in women with type one diabetes of short duration who took aspirin (aOR 2.21; 95% CI 1.05-4.66). Low-dose aspirin use in women with pregestational diabetes may be associated with an increased risk of preeclampsia. In women with type one diabetes of short duration aspirin use may be associated with an increased risk of LGA infants. The retrospective nature of this study is acknowledged and assessment of such prophylaxis by further studies is warranted.

Maternal glucose variability during pregnancy & birthweight percentile in women with pre-gestational diabetes

Introduction Pre-gestational diabetes mellitus (PGDM) is a major risk factor for fetal overgrowth. Interestingly, even in relatively well controlled PGDM women, as determined by average glucose indices such HbA1c, there is an increased rate of LGA (large for gestational age). Glucose variability (GV) has emerged as an important independent risk factor for several diabetes complications. The aim of this study was to determine the relationship between maternal GV indices and neonatal birth percentile. Methods This was a historical cohort study that included all consecutive PGDM women monitored in a single tertiary care center. Clinical and demographic variables, as well as data regarding glucose control, were prospectively recorded. Mean, standard deviation (SD) and coefficient of variance (CV) of glucose values were calculated. Pearson correlations coefficient was used to determine the correlation between glucose indices and birth percentile. The analysis was repeated after adjustment for several confounders. Results Mean birthweight and birthweight percentile were 3212 ± 532 g and 66.9%, respectively. There was a statistically significant correlation between birthweight percentile and maternal glucose SD (β = 0.28, p = .002) and maternal glucose CV (β = 0.21, p = .019). There was no significant correlation between birthweight percentile and mean glucose values. The association between the maternal glucose SD and birthweight percentile remained statistically significant after adjustment for maternal age, pre-pregnancy BMI and duration of diabetes. Conclusion There is an association between maternal glucose variability indices (SD and CV) during pregnancy and neonatal birth percentile. Larger studies are needed to confirm these results.

Effects of Different Glucose-Lowering Measures on Maternal and Infant Outcomes in Pregnant Women with Gestational Diabetes: A Network Meta-analysis.

IntroductionA network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).MethodsWe searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM.ResultsWe included 41 RCTs involving 6245 pregnant women with GDM. Patients treated with insulin had a higher incidence of neonatal intensive care unit (NICU) occupancy (1.3, 95% CI 1.0–1.7) than those treated with metformin. The insulin (1.5, 95% CI 1.1–2.1 and 1.8, 95% CI 1.0–3.3) and glyburide (2.0, 95% CI 1.2–3.2 and 2.5, 95% CI 1.1–8.4) groups exhibited higher incidences of neonatal hypoglycemia and large for gestational age (LGA) newborns than the metformin group. The glyburide group exhibited a lower probability of cesarean section than the metformin (0.76, 95% CI 0.55–1.0) and insulin (0.71, 95% CI 0.52–0.96) groups. Preeclampsia incidence in the diet and exercise groups was significantly lower than in the metformin (0.19, 95% CI 0.043–0.72) and insulin (0.15, 95% CI 0.032–0.52) groups. No intervention significantly reduced the incidences of macrosomia, preterm birth, gestational hypertension, or respiratory distress syndrome (RDS). The ranking results showed that the metformin group had the lowest rates of neonatal hypoglycemia, macrosomia, LGA, and NICU occupancy. The glyburide group had the lowest NICU occupancy and cesarean section rates and the highest neonatal hypoglycemia, LGA, preeclampsia, and gestational hypertension rates. The diet and exercise group had the lowest preterm delivery and preeclampsia rates and the highest NICU occupancy rate.ConclusionMetformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Other hypoglycemic agent or diet groups exhibit high incidences of certain adverse outcomes. Therefore, when selecting a GDM treatment strategy, the efficacies and risks of different treatment programs should be evaluated according to the scenario in hand.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01142-7.

961-P: Management of Gestational Diabetes (GDM): Are New Glycemic Targets Needed?

Background and Aim: There is no consensus on glycemic targets for the management of GDM. Since women with GDM managed with current glycemic targets show still worse pregnancy outcomes than women without it, we aim to identify which glycemic levels are associated to normal pregnancy outcomes with particular reference to Large for Gestational Age (LGA) rate. Methods: This is an observational study, involving women with GDM (IADPSG criteria) from 2016 to 2019. Glycemic values &amp;lt;90 mg/dl at fasting and &amp;lt;130 mg /dl 1h after a meal were "in target." Blood Glucose (BG) levels and clinical factors were related to LGA/GDM adverse outcomes through Data Analysis, Multiple Correspondence Analysis and conceptual maps. The RECPAM (RECursive Partitioning and Amalgamation) analysis was used to identify homogeneous and distinct groups of patients at risk for LGA/adverse outcome and to set the glycemic value cut-off discriminating for LGA/adverse outcome. Results: We analyzed 386 women and 40844 glycemic values. We found 4 natural categories for fasting BG (&amp;lt;78.2; ≥78.2 and &amp;lt;84; 84-89; ≥90 mg/dl) and 5 for post-prandial BG. Women exceeding the cut-off of 84 mg/dl at fasting &amp;gt; 2 times in the week, showed a high rate of LGA than those who did not (p 0.02), were more often overweight and needed insulin, enrolled earlier, had higher HbA1c values and an inadequate weight gain (p .001). The conceptual maps identified 3 clusters of women grouped homogeneously and distinctly according to BG and outcomes: women with fasting and postprandial BG included in the first two natural categories showed better outcomes than those with higher values, with a linear trend. BG&amp;gt; 84 mg/dL in more than 2/7 measurements, BMI&amp;gt; 25 kg/m2, and inadequate weight gain were predictive factors of LGA risk (OR 0.9 CI95% 1.2-5, p .012; OR 0.713 CI95% 1-3.8, p .029 OR 0.792 CI95% 1-4.8, p .04). Finally, RECPAM identified women with BMI&amp;gt; 25 kg/m2 and/or with fasting blood glucose&amp;gt; 97 mg/dl as a higher LGA risk subgroup. Conclusions: Tighter glycemic targets for GDM management are needed. Disclosure C. Festa: None. M. Violati: None. F. Amorosi: None. O. Bitterman: None. A. Convertino: None. C. Giuliani: None. M. Maravalle: None. A. Napoli: None.

Associations between pre-pregnancy body mass index and occurrence and clinical features of preeclampsia

Objective: To investigate the associations between pre-pregnancy body mass index (BMI) and occurrence and clinical features in pregnant women complicated by preeclampsia (PE). Methods: We recruited 42 427 pregnant women who were diagnosed with intrauterine pregnancy at Shenzhen Maternity and Child Healthcare Hospital from July 2017 to December 2019, with a gestational age of 6~8+6 weeks, excluding those with basic diseases and incomplete medical records. Among them, 659 were diagnosed with PE. According to the pre-pregnancy BMI, the pregnant women were divided into underweight group (42 cases), normal body weight group (422 cases), overweight group (138 cases) and obesity group (57 cases). Maternal outcomes (the occurrence of preeclampsia, cesarean delivery rate) and neonatal outcomes (birth weight, Apgar score and neonatal ICU admission) were recorded. The maternal outcomes, gestational age of delivery, delivery mode, newborn birth weight, Apgar score and admission to neonatal ICU were compared among the pregnant women in each group. Logistic regression model was established to analyze the influence of different pre-pregnancy BMI on the occurrence and clinical features of PE. Results: The incidence of PE was 1.55% (659/42 427), and the incidence of PE was 0.61% (42/6 941), 1.44% (422/29 297), 2.62% (138/5 273) and 6.22% (57/916) in the underweight group, the normal weight group, the overweight group and the obesity group, respectively. After adjustment for age, parity, educational level, history of preeclampsia, and in vitro fertilization and embryo transfer (IVF-ET), compared with normal group, the adjusted OR for developing early-onset PE were 0.57 (95%CI: 0.29-1.02) for underweight, 1.03 (95%CI: 0.65-1.56) for overweight and 2.15 (95%CI: 1.03-4.02) for obesity groups. The OR for developing late-onset PE were 0.50 (95%CI: 0.33-0.72) for underweight, 1.57 (95%CI: 1.23-1.99) for overweight and 4.25 (95%CI: 3.00-5.91) for obesity group. The OR for PE without severe features were 0.54 (95%CI: 0.30-0.89), 1.40 (95%CI: 0.97-1.99) and 5.11 (95%CI: 3.22-7.84) for underweight, overweight and obesity groups, respectively. The OR for severe PE were 0.51 (95%CI: 0.33-0.75), 1.42 (95%CI: 1.10-1.83) and 2.97 (95%CI: 1.95-4.38) for underweight, overweight and obesity groups, respectively. The median neonate birth weight in women with PE were 2 420 g (1 602-2 845 g), 2 435 g (1 692-3 030 g), 2 540 g (1 922-3 132 g), and 2 950 g (2 050-3 360 g) for underweight, normal, overweight and obesity groups, respectively. The neonatal birth weight in obesity group was heavier than that in normal group (P<0.05). The incidence rates of large for gestational age (LGA) in PE women were 0 (0/42), 3.3% (14/422), 7.3% (10/138) and 17.5% (10/57) for underweight, normal, overweight and obesity groups, respectively. The incidence rate of LGA in obesity group was higher than that in normal group (P<0.05). Conclusions: Pre-pregnancy obesity is an independent risk factor for PE. Obesity related PE is more likely associated with late-onset PE and LGA. It is recommended to control weight before pregnancy, limit weight gain during pregnancy and control blood pressure to reduce the incidence of PE and ensure the safety of mother and child.

The association between gestational impaired glucose tolerance and hyperglycemic markers: A prospective study.

To investigate the association between gestational impaired glucose tolerance (GIGT), and laboratory and clinical hyperglycemic markers. A prospective study in Holon between 2017 and 2019. Women with a singleton term delivery and one abnormal value in their last three oral glucose tolerance test measurements (OGTTs; GIGT group, n=60) were compared with control women with normal glucose challenge test (GCT) and/or OGTT measurements (n=60). Primary outcomes were elevated cord-blood C-peptide (>90th percentile), maternal hemoglobin A1c (HbA1c), abnormal HbA1c (>5.7%), and neonatal skinfold thickness. Secondary outcomes included large for gestational age (LGA). Women in the GIGT group were older (33.3±5.3 vs 31.1±4.8years; P=0.019), and had a higher rate of LGA (26.7% vs 6.7%; P=0.005), macrosomia (13.3% vs 0%; P=0.006), elevated C-peptide (16.7% vs 1.7%, P=0.008), and abnormal HbA1c (13.3% vs 0%, P=0.006). Skinfold thickness was also significantly higher in the GIGT group. HbA1c (adjusted odds ratio [aOR], 10.48; 95% confidence interval [CI], 1.19-91.91; P=0.033) and GIGT (aOR, 11.43; 95% CI, 1.78-73.39; P=0.01) were independently associated with LGA. Women with GIGT on OGTT demonstrated "hyperglycemic characteristics" relative to those with normal GCT and/or OGTT.

685 Impaired fasting glucose in pregnancy: does treatment improve perinatal outcomes?

To assess the association between active glycemic management and large for gestational age (LGA) neonates and cesarean delivery (CD) among pregnant women with impaired fasting glucose (IFG). Retrospective cohort study of women with IFG who delivered at Kaiser Permanente Northern California from 2012-2017 using electronic health record data. IFG was defined as isolated fasting glucose >95 mg/dL. Women with gestational diabetes (GDM) or in whom GDM could not be ruled out were excluded. Women with IFG who participated in telephonic home glucose monitoring and glycemic management through a centralized standardized program (participants) were compared with those who did not participate (non-participants) regarding baseline and treatment characteristics, and pregnancy outcomes. The relative risks of perinatal complications associated with participation versus non-participation were estimated with Poisson regression models. We identified 1,584 women meeting inclusion criteria, of which 1,151 (72.7%) were participants and 433 (27.3%) were non-participants. There were no differences between groups in baseline characteristics or comorbidities, except for higher mean levels of fasting glucose (FG) at the time of IFG diagnosis in participants than in non-participants (98.9 mg/dL vs 98.0 mg/dL, p=0.008). Participants received hypoglycemic medications more frequently than non-participants (68% vs 1%, p<0.0001). The rate of LGA was significantly lower in participants compared with non-participants (16% vs 21%, p=0.02). After adjusting for age, race/ethnicity, education, body mass index, and level of FG impairment, the RR for LGA for participants compared with non-participants was 0.67, 95% CI: 0.53-0.85. The risk of CD did not differ significantly by participation status, in unadjusted or adjusted analyses. Active standardized glycemic management was associated with a decreased risk of LGA for women with IFG. This finding supports an active glycemic management strategy for patients with IFG during pregnancy to improve perinatal outcomes, similar to GDM management.

Risk of LGA in pregnant women with different GDM status and risk profiles

To compare risk of large-for-gestational age (LGA) infants and pregnancy outcomes between pregnant women with different gestational diabetes (GDM) status. GDM screening was offered to 1510 women during 24–28 weeks of gestation and during first visits for those with GDM risks. Women were categorized into 3 groups: Group1: women without GDM; group2: women at-risk but did not have GDM; and group3: women with GDM. Rate of LGA and other outcomes were compared and associated factors were evaluated. A total of 408 women were in group1 (without GDM), 893 were in group2 (at-risk but without GDM), and 209 had GDM (group3). GDM women were significantly more likely to be older, multiparous, overweight/obese, have previous GDM, have less gestational weight gain, and have preeclampsia. Rates of LGA were 11.3% in group 1, 17.2% in group 2, and 22% in group 3 (p = 0.001). Independent risk of LGA was 2nd trimester weight gain > 7 kg in group1 (adjusted OR 2.65, 95%CI 1.36–5.15). In group 2, independent associated factors were overweight/obesity (adjusted OR 2.04, 95%CI 1.38–3.01) and 2nd trimester weight gain > 7 kg (adjusted OR 1.59, 95%CI 1.1–2.28). In group 3, independent associated factors were 2nd trimester weight gain > 7 kg (adjusted OR 2.3, 95%CI 1.07–4.98) and suboptimal glycemic control (adjusted OR 3.12, 95%CI 1.3–7.69). Women with different GDM status had different characteristics and outcomes. Second trimester weight gain > 7 kg was the common independent risk of LGA and suboptimal glycemic control increased LGA risk in GDM women.

Can the 50-g oral glucose tolerance test predict macrosomia and large for gestational age in pregnant women without gestational diabetes?

Aim: The aim of the present study was to evaluate the relationship between the results of the 50-g oral glucose tolerance test (OGTT) and macrosomia and large for gestational age (LGA) in non-gestational diabetes mellitus (GDM) pregnant women.Materials and Methods: Our retrospective study comprised 980 pregnant women18–40 years old, within 24–28 weeks of gestation, and having a singleton pregnancy. GDM was screened using the 50-g OGTT. Patients were divided into three groups according to the OGTT results as follows: (1) 1-h plasma glucose levels >140 mg/dL and normal 100-g OGTT results (false-positive group), (2) 1-h plasma glucose levels between 130 and 139mg/dL, and (3) 1-h plasma glucose levels <130mg/dL.Results: Maternal characteristics were similar among the groups. Fetal weight was 3050±410g in the false-positive group, 3150±390g in the 130–139mg/dL group, and 3100±420g in the <130mg/dL group. Fetal weight was statistically similar among the groups (p= 0.910). Macrosomia was determined in 2 patients (1.25%) in the false-positive group, 3 (1.07%) in the 130–139mg/dL group, and 6 (1.1%) in the <130mg/dL group. These rates were statistically similar among the groups (p =0.175). LGA was determined in 21 patients (13.1%) in the false-positive group, 38 (13.5%) in the 130–139mg/dL group, and 70 (12.9%) in the <130mg/dL group. These rates were statistically similar among the groups (p = 0.450).Conclusion: Our results indicated that macrosomia and LGA rates were similar among groups and 50-g OGTT seems to have a low capacity for predicting macrosomia and LGA in pregnant women without GDM.

Does Birthweight Represent Imprinting for Life? Preliminary Findings from the Level and Timing of Diabetic Hyperglycemia in Utero: Transgenerational Effect on Adult Morbidity (TEAM) Study

Women with pre-gestational diabetes have a high rate of large for gestational age (LGA) babies compared to women without diabetes. In particular, there is a high rate of asymmetric LGA defined as ponderal index (PI) &gt; 90th percentile for gestational age. We examined the association of birth weight and PI, with body mass index (BMI) and obesity status in adulthood, in a cohort of offspring of women with pre-gestational diabetes. The women participated in the Diabetes in Pregnancy (DiP) study at the University of Cincinnati from 1978 to 1995. The offspring of these women are the cohort participating in an observational study being conducted at Cincinnati Children’s Hospital Medical Center. Once located, the offspring were invited to come in for a one-day clinic visit to assess anthropometrics, and their metabolic, renal and cardiovascular status. Linear and logistic regression was used to assess the association between birth weight and PI with current BMI. We report on 107 offspring. A statistically significant association was found between offspring current BMI with birth PI (β = 1.89, 95% CI 0.40–3.38), and between offspring current obesity status and birth asymmetric LGA (aOR = 2.44, 95% CI 1.01–5.82). This is consistent with in utero “metabolic programming”.

Progesterone Intramuscularly or Vaginally Administration May Not Change Live Birth Rate or Neonatal Outcomes in Artificial Frozen-Thawed Embryo Transfer Cycles.

BackgroundsPrevious studies suggested that singletons from frozen-thawed embryo transfer (FET) were associated with higher risk of large, post-date babies and adverse obstetrical outcomes compared to fresh transfer and natural pregnancy. No data available revealed whether the adverse perinatal outcomes were associated with aberrantly high progesterone level from different endometrium preparations in HRT-FET cycle. This study aimed to compare the impact of progesterone intramuscularly and vaginally regimens on neonatal outcomes in HRT-FET cycles.MethodsA total of 856 HRT-FET cycles from a fertility center from 2015 to 2018 were retrospectively analyzed. All patients had their first FET with two cleavage-staged embryos transferred. Endometrial preparation was performed with sequential administration of estrogen followed by progesterone intramuscularly 60 mg per day or vaginal gel Crinone 90 mg per day. Pregnancy outcomes including live birth rate, singleton birthweight, large for gestational age (LGA) rate, small for gestational age (SGA) rate, and preterm delivery rate were analyzed. Student’s t test, Mann-Whitney U-test, Chi square analysis, and multivariable logistic regression were used where appropriate. Differences were considered significant if p < 0.05.ResultsNo significant difference of live birth rate was found between different progesterone regimens (Adjusted OR 1.128, 95% CI 0.842, 1.511, p = 0.420). Neonatal outcomes like singleton birthweight (p = 0.744), preterm delivery rate (Adjusted OR 1.920, 95% CI 0.603, 6.11, p = 0.269), SGA (Adjusted OR 0.227, 95% CI 0.027, 1.934, p = 0.175), and LGA rate (Adjusted OR 0.862, 95% CI 0.425, 1.749, p=0.681) were not different between two progesterone regimens. Serum P level >41.82 pmol/L at 14 day post-FET was associated with higher live birth rate than serum P level ≤41.82 pmol/L in HRT-FET cycles when progesterone was intramuscularly delivered (Adjusted OR 1.690, 95% CI 1.002, 2.849, p = 0.049). But singleton birthweight, preterm delivery rate, SGA and LGA rate were not different between these two groups.ConclusionsRelatively higher serum progesterone level induced by intramuscular regimen did not change live birth rate or neonatal outcomes compared to vaginal regimen. Monitoring serum progesterone level and optimizing progesterone dose of intramuscular progesterone as needed in HRT-FET cycles has a role in improving live birth rate without impact on neonatal outcomes.

The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus

BackgroundThe decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes.MethodsThis was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20–39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA).ResultsA total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31–0.78]).ConclusionsInitiation of pharmacotherapy for GDM when 20–39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.

Predictors of neonatal adiposity and associations by fetal sex in women with gestational diabetes mellitus and normal glucose-tolerant women.

To determine predictors of neonatal adiposity and differences in associations by fetal sex in women with gestational diabetes mellitus (GDM), normal-weight and overweight (BMI ≥ 25kg/m2) normal glucose-tolerant women (NGT). Skinfold thickness was measured in 576 newborns, and cord blood leptin, c-peptide and lipids in 327 newborns in a multi-centric prospective cohort study. Compared to neonates of normal-weight NGT women (327), neonates of women with GDM (97) were more often large-for-gestational age (LGA) (16.5% vs 8.6%, p = 0.024) ,but the macrosomia rate (8.2% vs 5.8%, p = 0.388), sum of skinfolds (13.9mm ± 2.9 vs 13.3mm ± 2.6, p = 0.067), neonatal fat mass (1333.0g ± 166.8 vs 1307.3g ± 160.9, p = 0.356), and cord blood biomarkers were not significantly different. Compared to neonates of normal-weight NGT women, neonates of overweight NGT women (152) had higher rates of macrosomia (12.5% vs 5.8%, p = 0.012), LGA (17.1% vs 8.6%, p = 0.006), higher sum of skinfolds (14.3mm ± 2.6 vs 13.2mm ± 2.6, p < 0.001), neonatal fat mass (1386.0g ± 168.6 vs 1307.3g ± 160.9, p < 0.001), % neonatal fat mass > 90th percentile (15.2% vs 7.1%, p < 0.001), without significant differences in cord blood biomarkers. Maternal BMI, fasting glycemia, triglycerides, gestational weight gain, cord blood leptin ,and cord blood triglycerides were independent predictors for neonatal adiposity. Gestational weight gain was positively associated with adiposity in boys only. Compared to neonates of normal-weight NGT women, neonates of GDM women have higher LGA rates but similar adiposity, while neonates of overweight NGT women have increased adiposity. Limiting gestational weight gain might be especially important in the male fetus to reduce neonatal adiposity.

Prediction of Large-for-Gestational-Age Neonates by Different Growth Standards.

Compare the accuracy of the Hadlock, the NICHD, and the Fetal Medicine Foundation (FMF) charts to detect large-for-gestational-age (LGA) and adverse neonatal outcomes (as a secondary outcome). This is a secondary analysis from a prospective study that included singleton non-anomalous gestations with growth ultrasound at 26-36 weeks. LGA was suspected with estimated fetal weight > 90th percentile by the NICHD, FMF, and Hadlock charts. LGA was diagnosed with birth weight > 90th percentile. We tested the performance of these charts to detect LGA and adverse neonatal outcomes (neonatal intensive care unit admission, Ph < 7.1, Apgar <7 at 5 minutes, seizures, and neonatal death) by calculating the area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value. Of 1054 pregnancies, 123 neonates (12%) developed LGA. LGA was suspected in 58 (5.5%) by Hadlock, 229 (21.7%) by NICHD standard, and 231 (22%) by FMF chart. The NICHD standard (AUC: .79; 95% CI: .75-.83 vs. AUC .64; 95%CI: .6-.68; p = < .001) and FMF chart (AUC: .81 95% CI: .77-.85 vs. AUC .64; 95%CI: .6-.68; p = < .001) were more accurate than Hadlock. The FMF and NICHD had higher sensitivity (77.2 vs. 72.4 vs. 30.1%) but Hadlock had higher specificity for LGA (97.5 vs. 88.5 vs. 85.4%). All standards were poor predictors for adverse neonatal outcomes. The NICHD and the FMF standards may increase the detection rate of LGA in comparison to the Hadlock chart. However, this may increase obstetrical interventions.

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.

Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes.

Higher blood glucose level during gestational periods has been consistently associated with increased risk of adverse birth outcomes. Evidence regarding the association between higher glycated hemoglobin A1c (HbA1c) within the normal range and adverse birth outcomes is limited. We aimed to examine the association between HbA1c within the normal range and the risk of adverse birth outcomes. The data were abstracted from the Information System of Guangdong Women and Children Hospital, China, from September 2014 to March 2018. A total of 5658 pregnant women with normal gestational HbA1c were included in this analysis. The adverse birth outcomes include preterm birth, macrosomia, and large for gestational age (LGA). Among 5658 subjects, the rates of preterm birth, macrosomia, and LGA were 4.6% (261/5658), 3.5% (200/5658), and 5.7% (325/5658), respectively. The results of multivariate logistic regression model showed that each 1% increase in maternal HbA1c was positively associated with increased risks of preterm birth (OR 1.58; 95% CI, 1.08-2.31), macrosomia (OR 1.70; 95% CI, 1.10-2.64), and LGA (OR 1.38; 95% CI, 0.98-1.96). The association between gestational HbA1c and preterm birth was more evident among women with prepregnancy body mass index (BMI) ≤ 24 kg/m2. Gestational higher HbA1c level within the normal range is an independent risk factor for preterm birth, macrosomia, and LGA. Intervention for reducing HbAc1 may help to prevent adverse birth outcomes.

Pregnancy outcomes according to the definition of gestational diabetes

ObjectiveTo assess the frequency and perinatal outcomes of gestational diabetes mellitus (GDM) defined by the criteria according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the National Institute for Health and Care Excellence (NICE) diagnostic criteria for GDM.DesignA retrospective cohort study.SettingSix secondary and tertiary delivery hospitals in Finland in 2009.PopulationPregnant women (N = 4,033) and their offspring.MethodsWe used data on comprehensive screening of pregnant women with a 2-h 75-g oral glucose tolerance test (OGTT), performed between gestational weeks 24 and 40. OGTT glucose concentrations were used to identify women who fulfilled IADPSG and NICE criteria. While cut-offs according to Finnish national criteria partly overlapped with both criteria, a subgroup of IADPSG- or NICE-positive GDM women remained undiagnosed by Finnish criteria and hence non-treated. They were analysed as subgroups and compared to controls who were negative with all cut-offs.Main outcome measuresGDM prevalence, birth weight SD score (BWSDS), large for gestational age (LGA) and caesarean section (CS) rates.ResultsAmong the 4,033 women screened for GDM, 1,249 (31.0%) and 529 (13.1%) had GDM according to the IADPSG and NICE criteria, respectively. The LGA rate was similar in both groups. Regardless of the diagnostic criteria, women with GDM had a higher risk of induced delivery and CSs than controls. In IADPSG-positive non-treated women, offspring’s BWSDS and CS rate were higher than in controls.ConclusionsGDM prevalence was 2.4-fold higher according to the IADPSG compared with the NICE criteria but the LGA rate did not differ. BWSDS and CS rate were increased already with mild untreated hyperglycaemia.