Occurrence Of Macrosomia Research Articles

Machine learning approach for the prediction of macrosomia

Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models. The early screening and evaluation of macrosomia in the third trimester can improve delivery outcomes and reduce complications. However, traditional clinical and ultrasound examinations face difficulties in obtaining accurate fetal measurements during the third trimester of pregnancy. This study aims to develop a comprehensive predictive model for detecting macrosomia using machine learning (ML) algorithms. The accuracy of macrosomia prediction using logistic regression, k-nearest neighbors, support vector machine, random forest (RF), XGBoost, and LightGBM algorithms was explored. Each approach was trained and validated using data from 3244 pregnant women at a hospital in southern China. The information gain method was employed to identify deterministic features associated with the occurrence of macrosomia. The performance of six ML algorithms based on the recall and area under the curve evaluation metrics were compared. To develop an efficient prediction model, two sets of experiments based on ultrasound examination records within 1-7 days and 8-14 days prior to delivery were conducted. The ensemble model, comprising the RF, XGBoost, and LightGBM algorithms, showed encouraging results. For each experimental group, the proposed ensemble model outperformed other ML approaches and the traditional Hadlock formula. The experimental results indicate that, with the most risk-relevant features, the ML algorithms presented in this study can predict macrosomia and assist obstetricians in selecting more appropriate delivery models.

First-trimester fasting plasma glucose as a predictor of subsequent gestational diabetes mellitus and adverse fetomaternal outcomes: A systematic review and meta-analysis

BackgroundThe implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain. PurposeThe primary outcome of the meta-analysis was to analyze if intermediately elevated first-trimester FPG could predict development of GDM at 24–28 weeks. The secondary outcomes were to determine if the commonly used FPG cut-offs 5.1 mmol/L (92 mg/dL), 5.6 mmol/L (100 mg/dL), and 6.1 mmol/L (110 mg/dL) correlated with adverse pregnancy events. Data sourcesDatabases were searched for articles published from 2010 onwards for studies examining the relationship between first-trimester FPG and adverse fetomaternal outcomes. Study selectionA total of sixteen studies involving 115,899 pregnancies satisfied the inclusion criteria. Data extraction and data synthesisWomen who developed GDM had a significantly higher first-trimester FPG than those who did not [MD 0.29 mmoL/l (5 mg/dL); 95 % CI: 0.21–0.38; P < 0.00001]. First-trimester FPG ≥5.1 mmol/L (92 mg/dL) predicted the development of GDM at 24–28 weeks [RR 3.93 (95 % CI: 2.67–5.77); P < 0.0000], pre-eclampsia [RR 1.55 (95%CI:1.14–2.12); P = 0.006], gestational hypertension [RR1.47 (95%CI:1.20–1.79); P = 0.0001], large-for-gestational-age (LGA) [RR 1.32 (95%CI:1.13–1.54); P = 0.0004], and macrosomia [RR1.29 (95%CI:1.15–1.44); P < 0.001]. However, at the above threshold, the rates of preterm delivery, lower-segment cesarean section (LSCS), small-for gestational age (SGA), and neonatal hypoglycemia were not significantly higher. First-trimester FPG ≥5.6 mmol/L (100 mg/dL) correlated with occurrence of macrosomia [RR1.47 (95 % CI:1.22–1.79); P < 0.0001], LGA [RR 1.43 (95%CI:1.24–1.65); P < 0.00001], and preterm delivery [RR1.51 (95%CI:1.15–1.98); P = 0.003], but not SGA and LSCS. LimitationsOnly one study reported outcomes at first-trimester FPG of 6.1 mmol/L (110 mg/dL), and hence was not analyzed. ConclusionThe risk of development of GDM at 24–28 weeks increased linearly with higher first-trimester FPG. First trimester FPG cut-offs of 5.1 mmol/L (92 mg/dL) and 5.6 mmol/L (100 mg/dL) predicted several adverse pregnancy outcomes.

Advances in free fatty acid profiles in gestational diabetes mellitus.

The morbidity of gestational diabetes mellitus (GDM) is increasing and is associated with adverse perinatal outcomes and long-term maternal and infant health. The exact mechanism underlying changes in plasma free fatty acid (FFA) profiles in patients with GDM is unknown. However, it is believed that changes in diet and lipid metabolism may play a role. Fatty acids contain many specific FFAs, and the type of FFA has different impacts on physiological processes; hence, determining changes in FFAs in individual plasma is essential. Alterations in FFA concentration or profile may facilitate insulin resistance. Additionally, some FFAs show potential to predict GDM in early pregnancy and are strongly associated with the growth and development of the fetus and occurrence of macrosomia. Here, we aimed to review changes in FFAs in women with GDM and discuss the relationship of FFAs with GDM incidence and adverse outcomes.

Comprehensive analysis of macrosomia: exploring the association between first-trimester alanine aminotransferase and uric acid measurements in pregnant women.

Investigating the relationship between liver enzymes, uric acid (UA), and macrosomia will benefit physicians in the early detection of complications that may emerge during/after pregnancy. The study analyzed liver enzyme activity and UA levels in first-trimester pregnant forthe risk of macrosomia. This retrospective cross-sectional research analyzed the data of pregnant women who gave birth between Jan 2021-2023. All data were extracted from medical records, and UA and AST-ALT were examined in all the participants. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in the macrosomia (p<0.05). Similarly, UA levels were higher in the macrosomia (p<0.001). There was a moderate positive correlation between ALT and birth weight (r=0.168, p<0.01), while we found a strong positive correlation between UA and birth weight (r=0.355, p<0.01). In the ROC (receiver operating characteristic), Area Under the Curve (AUC) for ALT and UA was significant (p<0.0001) but not for AST (p=0.157). UA showed a predictive value for macrosomia with 68.1 % sensitivity and 63.8 % specificity at a 3.15 cut-off (AUC:0.689; p:0.0001; CI:0.644-0.725). These results indicate that ALT and UA may be potentially important in determining the risk of macrosomia. The UA had a more potent marker for macrosomia than ALT. The occurrence of macrosomia might be more closely related to the mother's metabolic syndrome rather than NAFLD.

Obesity in Pregnant Women and Its Impact on Maternal and Neonatal Morbidity

Obesity in pregnancy is currently a health problem that is associated with increased maternal and neonatal morbidity. Along with the times and lifestyles that are more modern, the incidence of obesity is also increasing. Clinically, obesity is defined as the condition of having excess adipose tissue. Obesity is related to insulin resistance and chronic inflammation. This makes obesity a risk factor for various non-contagious diseases such as cardiovascular disease, hypertension, diabetes mellitus, and cancer. The health consequences of maternal obesity are based on low-grade, chronic (meta-inflammatory) inflammation that occurs as a result of changes in the immune system and proinflammatory cytokines in maternal obesity and pregnancy. Obesity can have a negative impact on maternal, neonatal and labor outcomes. Several maternal complications that can occur due to obesity (BMI 30-34.9) and morbid obesity (BMI ≥ 35) are hypertension during pregnancy (10.2-12.3%), preeclampsia (3-6.3%), gestational diabetes (6.3-9.5%). Risks that can occur to the fetus, such as the occurrence of macrosomia (15.4-17.2%), preterm birth (4-5.5%) and impaired fetal growth (1-0.8%). Maternal obesity is also associated with an increased risk of neural tube defects (NTD) in babies, as well as a higher risk of abortion (1.70-3.11%). Obesity also has an impact on the delivery process. Mothers with obesity have a higher rate of vaginal operative procedures (8.5-11.1%), labor induction and longer duration of labor. The increase in caesarean section deliveries is caused by the occurrence of complications due to maternal obesity, namely the occurrence of preeclampsia, fetal distress, macrosomia, and induction failure.

Overexpression of IGF2 affects mouse weight and glycolipid metabolism and IGF2 is positively related to macrosomia.

To investigate the effects of insulin-like growth factor 2 (IGF2) on growth and glycolipid metabolism, as well as the underlying mechanism. A mouse model of IGF2 overexpression was constructed to measure weight gain before adulthood, to obtain the values of adult glycolipid metabolism indicators in the peripheral blood and to detect the expression of genes in the IGF2 signaling pathway in different mouse tissues. The present study also explored the independent association between the IGF2 gene and macrosomia by detecting and comparing the expression levels of IGF2 mRNA/H19 RNA in maternal peripheral blood and fetal cord blood of 26 human pregnancies. In the mouse model, weights of the IGF2-overexpressing mice were significantly higher than those of the control mice at the age of 5-10 weeks. The glucose concentration, total cholesterol and high-density lipoprotein cholesterol (HDL-C) levels of IGF2-overexpressing mice were significantly lower than those of wild-type (WT) mice. Compared with the WT mice, the expression of H19 was significantly decreased in the pancreas and IGF1R was significantly decreased in the muscle of mice with IGF2 overexpression. The expression levels of STAT3 and AKT2 showed significant decrease in liver, muscle and increase in muscle of IGF2-overexpressing mice, respectively. GLUT2 expression showed significant increase in liver, kidney, muscle and decrease in pancreas of mice with IGF2 overexpression. This study also found that in normal mothers with the similar clinical characteristics, IGF2 expression in the maternal peripheral blood and fetal cord blood is an independent factor influencing macrosomia. IGF2 expression was independently correlated with the occurrence of macrosomia, and overexpression of IGF2 significantly increased the weights of mice at the age of 5-10 weeks and significantly affected the values of adult glycolipid metabolism indicators, which might be the result of changes in the IGF2-IGF1R-STAT3/AKT2-GLUT2/GLUT4 pathway. These findings might suggest that IGF2 plays an important role in growth and glycolipid metabolism during both pregnancy and postnatal development.

Association between prenatal exposure to ambient ozone, birth weight, and macrosomia in healthy women.

Studies have shown that prenatal ozone exposure is associated with an increased risk of adverse pregnancy outcomes, among which abnormal birth weight is a detrimental factor for diseases in adulthood, but the association between birth weight and ozone is inconclusive. Herein, we conducted this study by enrolling 407 couples of pregnant women and collected their demographical materials, their exposure to ambient ozone was assessed according to the place of their residence. The hourly monitored ozone was first averaged to the daily level, then monthly and whole-gestationally levels. After adjusting confounders, we processed a multivariate generalized addictive analysis to predict the association between prenatal ozone exposure and birth weight. We also divided the cohort into two categories according to whether the infant met the standard of macrosomia, and the occurrence of macrosomia was studied via univariate and multivariate logistic regression analyses as extreme conditions of the effects of ozone exposure on birth weight. We found that the ground-level ozone in Jinan changed with temperature periodically, higher in summer and lower in winter. Over the past 8 years from 2014, the ambient ozone increased by 1.74 μg/m3 per year. Of the 407 singleton-pregnant women, 21 infants were diagnosed with macrosomia. After adjusting confounders, we found that each unit increase in prenatal ozone exposure caused 8.80% [ORozone90%CI: 0.912 (0.850, 0.978)] decreased risk of macrosomia, but the splined ambient ozone exposure data was not statistically associated with birth weight, which is probably due to the limited sample size. In conclusion, prenatal ozone exposure is associated with decreased risk of macrosomia but is weakly linked to birth weight.

Factors Related to the Event of Macrosomia in Infants at the Atikah Clinic for the Period of 2018-2020

Macrosomia or baby giant is a large newborn at the time of delivery of more than 4000 grams. Babies who are large for gestational age typically have swollen and red bodies. The emergence of these babies is due to several factors, the first factor is due to obese parents (heredity), the second is that pregnant women suffer from diabetes mellitus, the third factor is mothers who are overweight during pregnancy and the last factor is mothers who experience late pregnancy. time over post date. Based on the results of the initial survey, from the number of mothers giving birth as many as 76 cases, in the period 2018-2020 there were 15 cases (19.73%) experiencing macrosomia babies. The design of this research is analytic, namely the characterization technique directly through the explanation by the author and the approach, observation or data collection at the same time. Based on the results of the chi-square test, the value of p = 0.000 (p &lt;0.05), which means that statistically it shows a significant relationship between the factor of gestational age and the occurrence of macrosomia in infants. Factors of multigravida pregnancy associated with the incidence of macrosomia in infants.

Three-dimensional power Doppler ultrasonography indicates that increased placental blood perfusion during the third trimester is associated with the risk of macrosomia at birth.

To investigate the association between placental blood perfusion and the occurrence of macrosomia at birth. This was a prospective cohort study including women with singleton pregnancies that aimed to measure placental blood perfusion using three-dimensional (3D) power Doppler ultrasonography in the second and third trimester. We acquired three indices of placental blood flow, including vascularization index (VI), flow index (FI), vascularization flow index (VFI), along with routine two-dimensional (2D) biometric measurements, including abdominal circumference (AC) and estimated fetal weight (EFW). Pregnancy outcomes were divided into two groups: newborns with a normal birth weight and those with macrosomia. We then compared all of the recorded variables between these two groups. We also determined the predictive efficiency of each variable using receiver-operating characteristic (ROC) curves. The placental 3D power Doppler indices, including VI and FI, were significantly higher in the third trimester of pregnancies developing macrosomia, but not during the second trimester, as compared to those with a normal birth weight. ROC curves analysis for third-trimester VI and FI suggested a slight ability to predict macrosomia; this was also the case for AC and EFW. Interestingly, VI showed high sensitivity and low specificity, while FI showed low sensitivity and high specificity; this was also the case for AC and EFW. Three-dimensional power Doppler ultrasound indices were significantly higher during the third-trimester for pregnancies developing macrosomia. However, these indices had only moderate ability to predict macrosomia.

Maternal and fetal outcome in gestational diabetic women

Background and objective: Gestational diabetes mellitus affects 7% of all pregnancies. It is defined as glucose intolerance that begins or is first diagnosed during pregnancy. It is crucial to detect women with gestational diabetes mellitus because the condition can be associated with several maternal and fetal complications. This study aimed to determine the maternal and fetal outcome of gestational diabetes mellitus in maternity teaching hospital in Sulaimani city, Kurdistan, Iraq. Methods: This prospective observational study had involved 100 pregnant women with gestational diabetes mellitus. Data were collected from 1st January 2014 to 1st July 2014. Results: Most women were in the age group 30-39 years (57%) and were multigravida (75%). Regarding women’s BMI, 69% of women had a BMI of >30 kg/m2. Most of the women delivered by cesarean section (68%). Also, 63% delivered term baby ≥ 37weeks. Of the women who used insulin, 30.6% delivered babies >4 kg. Complications occurred in 10%, 12.9%, and 11.1% of women who treated by diet, insulin, and the group used metformin then insulin, respectively. Conclusion: The results conclude that pregnant women with gestational diabetes mellitus have increased the risk of hypertension in pregnancy, preterm delivery, and cesarean section. Increasing age, family history of diabetes, increasing parity, and increase in BMI are a risk factor for developing gestational diabetes mellitus. Also, most of the maternal complications occurred in those women who were on metformin. The occurrence of macrosomia was low in the treated cases of gestational diabetes mellitus.

Complications and Risk Factors of Neonatal Macrosomia: A Case-Control Study

Background: Macrosomia is defined as the birth weight of greater than or equal to 4,000 grams, which is considered to be a public health issue threatening mothers and neonates. Studies indicate that the prevalence rate of macrosomia is on the rise in developing countries. The present study aimed to evaluate the influential factors in the occurrence of neonatal macrosomia. Methods: This case-control study was conducted at Al-Zahra Hospital in Tabriz, located in the north-west of Iran, during March 2013-February 2014. Sample population included all the live-born neonates and their mothers. The case group consisted of the neonates with the birth weight of ≥4,000 grams (n=404), and the control group included 404 newborns weighing 2,500-3,999 grams. Data were collected using a maternal and neonatal information form (maternal age, neonatal gender, mode of delivery, maternal height, and maternal history of diabetes). Data were extracted from the medical files of the samples and recorded in the form. Data analysis was performed in SPSS version 20 using descriptive and inferential statistics (independent t-test and 2χ) at the significance level of α=0.05. Results: In total, 8,012 neonates were born during the study, 404 of whom has macrosomia (5.04%). Mean maternal age in the case and control groups was 29.6±6.1 and 27.9±8.3 years, respectively (P<0.001). Significant differences were observed in the gender (male) (odds ration [OR]=2.2 [95% CI: 1.33-3.04]; P<0.001), mode of delivery (OR=0.51 [95% CI: 0.37-0.69]; P<0.001), maternal history of diabetes (OR=4.5 [95% CI: 2.3-8.73]; P<0.001), and number of deliveries (birth rank) (OR=1.6 [95% CI: 1.19-2.39]; P<0.001) between the case and control groups. Conclusion: According to the results, there were significant associations between macrosomia at birth and maternal age, maternal history of diabetes, and birth rank. Therefore, proper planning and educational interventions are recommended for the control of the influential factors in the occurrence of macrosomia.

The impact of physical activity during pregnancy on maternal weight and obstetric outcomes.

The goal of the paper was to compare weight gain in pregnant women in relation to the week of gestation at birth, the delivery method, and the occurrence of macrosomia and low birth weights for patients with different durations of physical activity during pregnancy. The full course of study was completed by 57 pregnant women enrolled in an 18-week physical activity programme during their second and third trimesters. The actual duration of their physical activity was monitored with the ActiGraph GT3X monitor. The patients were divided into two groups: L_MPA (n = 28) - pregnant women with daily physical activity of over 21.38 minutes and S_MPA (n = 29) - pregnant women who exercised less than 21.38 minutes a day. The study compared obstetric results in both groups. Significantly more patients in the S_MPA group exhibited excess weight gain as compared with the L_MPA group (p = 0.01). There was found to be no significant impact from the duration of physical activity on the occurrence of macrosomia or low birth weight, the gestation age at birth or the delivery method. However, there were two times fewer cases of macrosomia in the L_MPA group. The results demonstrate that physical activity during pregnancy for at least 21 minutes per day in the second half of the pregnancy reduces the risk of excess weight gain during pregnancy.

Three patients presenting with severe macrosomia and congenital hypertrophic cardiomyopathy: a case series

BackgroundMacrosomia and hypertrophic cardiomyopathy are two features often associated in neonates of diabetic mothers. We report the cases of three patients with severe macrosomia and critical hypertrophic cardiomyopathy without severely unbalanced maternal diabetes. Only three patients with those two features and no uncontrolled maternal diabetes have been previously reported.Case presentationThe first patient was a 39-week-old girl, the second patient was a 39-week-old girl, and the third patient was a 41-week-old boy. The two French girls and the French boy had severe macrosomia and hypertrophic cardiomyopathy, leading to the death of the boy. The outcome of the two girls was favorable, with a standardization of growth curves and ventricular hypertrophy. Their mothers presented with high body mass index but no severe documented maternal diabetes; glycemic imbalance was only suspected on postnatal analyses. There was no hydramnios during pregnancy and no other environmental factor, especially toxic exposure. Their parents are from Mayotte, Guadeloupe, and Guinea-Conakry. The usual genetics causes, Beckwith–Wiedemann syndrome, and chromosomal copy number variation, were also excluded.ConclusionsThis report suggests the implication of other factors in addition to glycemic disorders, including genetic factors, in the occurrence of macrosomia and severe hypertrophic cardiomyopathy in neonates. These three original observations indicate that gynecologists and neonatologists should pay attention to neonates from mothers with a high body mass index and when maternal diabetes is not documented.

Research progress on the related factors of the occurrence of macrosomia

At present, China's description of macrosomia diagnosis is single, Only in the quality evaluation of 4 000 or higher, and BMI, body index can better response body quality development. Macrosomia is related with many factors, and its mechanism remains unknown. Therefore, this article summarized the research status in those aspects of hormones, cell, gene, motherhood diabetes, pregnancy weight, gestational age, and the related factors of macrosomia in order to improve the knowledge of these aspects. Key words: Fetal macrosomia; Review

Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control

Macrosomia risk remains high in type 1 diabetes (T1DM) complicated pregnancies. A linear relationship between macrosomia risk and glycated hemoglobin A1c (HbA1c) was described; however, low range of HbA1c has not been studied. We aimed to identify risk factors and examine the impact of HbA1c on the occurrence of macrosomia in newborns of T1DM women from a cohort with good glycemic control. In this observational retrospective one-center study we analyzed records of 510 consecutive T1DM pregnancies (1998–2012). The analyzed group consisted of 375 term singleton pregnancies. We used multiple regression models to examine the impact of HbA1c and self-monitored glucose in each trimester on the risk of macrosomia and birth weight. The median age of T1DM women was 28 years, median T1DM duration—11 years, median pregestational BMI—23.3 kg/m2. Median birth weight reached 3520 g (1st and 3rd quartiles 3150 and 3960, respectively) at median 39 weeks of gestation. There were 85 (22.7 %) macrosomic (>4000 g) newborns. Median HbA1c levels in the 1st, 2nd, and 3rd trimester were 6.4, 5.7, and 5.6 %. Third trimester HbA1c, mean fasting self-monitored glucose and maternal age were independent predictors of birth weight and macrosomia. There was a linear relationship between 3rd trimester HbA1c and macrosomia risk in HbA1c range from 4.5 to 7.0 %. Macrosomia in children of T1DM mothers was common despite excellent metabolic control. Glycemia during the 3rd trimester was predominantly responsible for this condition.

Analysis of the correlation between the dietary and nutritional status of late pregnancy and the macrosomia

Objective To explore the correlation between the dietary and nutritional status of late pregnancy and the macrosomia .Methods Two hundred and ten pregnant women without severe complication were chosen, and were surveyed by the dietary and nutritional status of late pregnancy and the data from whose pregnancy outcome were collected .210 patients were divided into the low （n=12）, normal （n=178） and high （n=20） birth weight groups according to the neonatal birth weight , and Logistic regression was used to analysis the risk factors.Results The gestational age and the level of proline were respectively （39.88 ±0.83） week, （195.00 ±13.35） μmol/L in the high birth weight groups, and were （27.50 ±18.63） week, （110.60 ± 80.81） μmol/L in the low birth weight groups , and were （38.82 ±1.28） week, （93.57 ±83.80） μmol/L in the normal birth weight groups , and the differences were statistically significant （ F =17.603, 5.693, respectively;P〈0.01）.The Logistic regression analysis showed that the related factors on the occurrence of macrosomia were respectively gestational age , body mass index of late pregnancy and the level of proline （ OR=4.200,0.329,1.046, respectively）.Conclusions The dietary and nutritional status of late pregnancy has effect on the occurrence of macrosomia , and we should carry out the health education to promote the health of maternal and children . Key words: Late pregnancy; Dietary and nutrition; Macrosomia; Correlation

Association of adiponectin gene polymorphisms +45T/G with gestational diabetes mellitus and neonate birth weight

To determine the association of single-nucleotide polymorphisms (SNPs)+45T/G of adiponectin gene with gestational diabetes mellitus (GDM) and neonate birth weight. A total of 264 GDM and 272 pregnant women with normal glucose (NG) were enrolled. DNA was successfully extracted from peripheral blood leucocyte samples. And SNPs+45T/G of adiponectin gene were examined. We also analyzed differences in the genotypic distribution and allelic frequencies in SNP+45T/G of adiponectin gene among GDM group with different neonate birth weights. There was no significant difference between two groups with respects to SNP +45T/G polymorphisms of adiponectin gene (P > 0.05). But significant genotypic difference existed in SNP+45T/G among three GDM groups with different birth weights. Frequencies of T allele were significantly higher in the GDM group with higher birth weight, 68.75% in GDM group with macrosomia and 72.86% in GDM group with 3000-4000 g birth weight (both P < 0.01). And there was no significant difference in SNP +45T/G polymorphisms of adiponectin gene between GDM women and NG group with macrosomia. SNP +45T/G polymorphisms of adiponectin gene are not associated with GDM. However, SNP+45T/G polymorphisms of adiponectin gene of GDM women are closely associated with neonate birth weigh. The G/T polymorphisms of SNP+45 of adiponectin are not obviously associated with a higher occurrence of macrosomia in GDM women.

Pre-pregnancy weight and excess weight gain are risk factors for macrosomia in women with gestational diabetes

To determine whether women with gestational diabetes mellitus (GDM) whose weight gain exceeded the 2009 Institute of Medicine (IOM) recommendations were more likely to have macrosomia. Retrospective cohort study of the association of weight gain in women with Class A1 GDM, with term (≥37 weeks) singleton liveborns and macrosomia (birthweight ≥4000 g). Multivariate logistic regression models were used to adjust for covariates and test for interactions. Of 1502 women studied, pre-pregnancy body mass index (BMI) categories were: normal (39.6%), overweight (28.5%) and obese (31.9%). The mean (±standard deviation ) weight gain (lbs) for these groups was: 27.6±10.9, 24.2±13.0 and 18.8±16.3 (P<0.0001), whereas the occurrence of macrosomia was 7.4, 11.4 and 19.0%, respectively. Women with an obese BMI were twice as likely to have a macrosomic infant compared with women in the normal BMI group (odds ratio, OR 2.0; 95% CI 1.4-3.0; P=0.0005). Independently, women who exceeded the IOM guidelines were three times more likely to have a macrosomic infant (OR 3.0, 95% CI 2.2-4.2, P<0.0001). Maternal pre-pregnancy weight and weight gain during pregnancy appear to be significant and independent risk factors for macrosomia in women with GDM.

Fatores determinantes da incidência de macrossomia em um estudo com mães e filhos atendidos em uma Unidade Básica de Saúde no município do Rio de Janeiro

to investigate factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. a prospective study, with 195 pairs of mothers and progeny, in which the dependent variable was macrosomia (weight at delivery > or =4,000 g -- independent of the gestational age or of other demographic variables), and socioeconomic, previous pregnancies/gestation course, biochemical, behavioral and anthropometric, the independent variables. Statistical analysis has been done by multiple logistic regression. Relative risk (RR) values have been estimated, based on the simple form: RR=OR/ (1 - I0) + (I0 versus OR), in which I0 is the macrosomia incidence in non-exposed people. Macrosomia incidence was 6.7%, the highest value being found in the progeny of women > or =30 years old (12.8%), white (10.4%), with two or more children (16.7%), with male newborns (9.6%), with height > or =1.6 m (12.5%), with overweight or obesity as a nutritional pre-gestational state (13.6%), and with excessive gestational gain of weight (12.7%). The final model has shown that having two or more children (RR=3.7; CI95%=1.1-9.9), and having a male newborn (RR=7.5; CI95%=1.0-37.6) were the variables linked to the macrosomia occurrence. macrosomia incidence was higher than the one observed in Brazil as a whole, but inferior to the one reported in studies from developed countries. Having two or more children and a newborn male were the factors accountable for the occurrence of macrosomia.

Occurrence of gestational diabetes mellitus, maternal and fetal outcomes beyond the 28th week of gestation in women at high risk of gestational diabetes. A prospective study

Aim Among the numerous guidelines defining the diagnostic strategy of gestational diabetes mellitus (GDM), none of them suggest a follow-up in women with risk factors beyond the 28th week of gestation (WG). The primary objective of this study was to assess the incidence of GDM beyond 28 WG in a group of women at high risk. The secondary objectives were to evaluate maternal and fetal outcomes in early and late GDM (between 24–28 WG, and beyond 28 WG), as well as to compare them to a normal glucose tolerance (NGT) group. Methods A prospective study conducted in 191 consecutive women. Between 24–28 WG, the diagnosis of GDM was performed in a two-step approach (50 then 75 g). Beyond the 28 WG, the diagnosis of GDM was based on self-monitoring blood glucose (SMBG). All women were educated about an individualized diabetic diet and to perform SMBG daily glucose profiles. Results Seventy-two percent of the women at risk had developed GDM. Among these, 54% had developed early GDM, between 24–28 WG, and 18% had developed late GDM, beyond the 28th WG. Gestational age of late GDM was estimated 30 WG. In late GDM, onset of diabetes seems to be predicted by an increase in capillary glucose value determined at 22:00 hours, but this needs to be confirmed. Women who develop GDM2 have a significantly higher rate of macrosomia and more important pre-pregnancy overweight, underlining this impact in the occurrence of macrosomia. Finally maternal outcomes were not different in the 3 groups with intensive intervention.