Risk Factors For Fetal Macrosomia Research Articles

Association between pre-gravid body mass index and clinical outcomes in in vitro fertilization: a multicentered retrospective cohort study

BackgroundWith the increasing incidence of obesity and the childbearing-age delay among women, a debate over obesity’s impacts on pregnancy and neonatal outcomes becomes hot. The potential negative effects of obesity and aging on fertility lead to an idea, whether an obese female pursuing IVF treatment can benefit from an ideal BMI achieved over a long-time weight loss process at the cost of aging? We aimed to assess the association between body mass index (BMI) and clinical or neonatal outcomes in patients undergoing in vitro fertilization (IVF) treatment, for answering whether it is necessary to lose weight first for obese patients, particularly those at advanced age.MethodsA retrospective cohort study was performed using multicentered data from China. The women were stratified into 5 groups in terms of pre-gravid BMI (kg/m2) with the WHO obesity standard (group 1: BMI < 18.5; group 2: 18.5 ≤ BMI < 23.0; group 3: 23.0 ≤ BMI < 25.0; group 4: 25.0 ≤ BMI < 30.0; group 5: BMI ≥ 30.0). The primary outcome was cumulative live birth rate (CLBR), and other clinical and neonatal outcomes were weighed as secondary outcomes. Multivariate logistic regression analyses were carried to evaluate the association between BMI and the CLBR, or between BMI and some neonatal outcomes. Furthermore, we implemented a machine-learning algorithm to predict the CLBR based on age and BMI.ResultsA total of 115,287 women who underwent first IVF cycles with autologous oocytes from January 2013 to December 2017 were included in our study. The difference in the CLBR among the five groups was statistically significant (P < 0.001). The multivariate logistic regression analysis showed that BMI had no significant impact on the CLBR, while women’s age associated with the CLBR negatively. Further, the calculation of the CLBR in different age stratifications among the five groups revealed that the CLBR lowered with age increasing, quantitatively, it decreased by approximately 2% for each one-year increment after 35 years old, while little difference observed in the CLBR corresponding to the five groups at the same age stratification. The machine-learning algorithm derived model showed that BMI’s effect on the CLBR in each age stratification was negligible, but age’s impact on the CLBR was overwhelming. The multivariate logistic regression analysis showed that BMI did not affect preterm birth, low birth weight infant, small for gestational age (SGA) and large for gestational age (LGA), while BMI was an independent risk factor for fetal macrosomia, which was positively associated with BMI.ConclusionsMaternal pre-gravid BMI had no association with the CLBR and neonatal outcomes, except for fetal macrosomia. While the CLBR was lowered with age increasing. For the IVF-pursuing women with obesity plus advanced age, rather than losing weight first, the sooner the treatment starts, the better. A multicentered prospective study with a large size of samples is needed to confirm this conclusion in the future.

Relationship between the Central and Peripheral Thyroid Sensitivity Indices and Fetal Macrosomia: A Cohort Study of Euthyroid Pregnant Women in China

(1) Background: To explore the correlation between central and peripheral thyroid sensitivity indices and macrosomia in euthyroid pregnant women and to provide clinical basis for the prevention and treatment of macrosomia. (2) Methods: This study is a prospective study. A total of 1176 euthyroid women in early pregnancy in the obstetrics department of Peking University International Hospital from December 2017 to March 2019 were enrolled. The women were divided into two groups, namely the macrosomia and non-macrosomia groups, according to birth weight. (3) Results: The level of free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid feedback quantile-based index (TFQI), thyrotropin-T4 resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), and free triiodothyronine/free thyroxine (FT3/FT4) in the macrosomia group was higher than that in the non-macrosomia group (p &lt; 0.05). The multivariate logistic regression model showed that FT3, TFQI, TT4RI, TSHI, and FT3/FT4 were independent risk factors for macrosomia in early pregnancy after adjusting for age, body mass index, parity, blood pressure, blood glucose, and blood lipid levels (p &lt; 0.05, respectively). (4) Conclusions: TFQI, TT4RI, TSHI, and FT3/FT4 are independent risk factors for fetal macrosomia in early pregnancy in euthyroid women.

Prognosis of fetal macrosomy by fetal weight in the third trimester

Introduction. Fetal macrosomy is associated with the risk of maternal and fetal trauma, shoulder dystocia, increase frequency of cesarean section, and obstetric hemorrhage. Prediction of large fetal size at the antenatal stage remains an urgent issue, definitively unresolved even with the use of modern medical imaging techniques. Materials and Methods. A total of 819 women were examined, of whom 365 (the study group) gave birth to a baby weighing more than 4000 grams, and 454 (the control group) gave birth to a full-term baby within the gestational weight norm. At 32–34 weeks of gestational screening in the third trimester, all women underwent an ultrasound examination followed by calculation of estimated fetal weight using the Hadlock formula. The inclusion criteria were fetal anthropometric data at 32–34 weeks' gestational age within the normal range, i.e. within the 10-90th percentile corridor. Results. There was a difference between the groups, the fetal weight in women in the main group in the third trimester, calculated by the Hadlock formula, was significantly higher and was 2123 grams (Q1; Q3 – 1948; 2278) compared to the control group, in which the weight was 1990 grams (Q1; Q3 – 1844; 2101), p &lt; 0.001. ROC-analysis revealed a low, but statistically significant diagnostic value of this parameter for the prognosis of fetal macrosomia. Discussion. The practical importance of determining the risk of fetal macrosomia cannot be overestimated. Using prognostic methods, it is possible to take measures to prevent maternal and fetal trauma and to prevent perinatal morbidity. Our results show that even the isolated use of the estimated fetal weight estimation by the Hadlock method, performed in a Level III institution, allows us to identify a group of pregnant women at risk for fetal macrosomia with acceptable sensitivity and specificity. The threshold fetal weight at 32–34 weeks is 2032 grams. Obviously, ultrasound at 32–34 weeks remains essential as a selective screening technique, e.g. in the presence of known risk factors for fetal macrosomia. Conclusion. Antenatal 2D ultrasound sonography to determine the risk of fetal oversize fetuses performed as part of third-trimester prenatal screening is a tool for selective screening. The development of integral multifactorial prognostic models of fetal macrosomia based on the calculation of estimated fetal weight using the Hadlock method at 32-34 weeks seems to be a promising direction that will significantly improve the quality of perinatal care.

Maternal Obesity, Gestational Diabetes, and Fetal Macrosomia: An Incidental or a Mechanistic Relationship?

Abstract Gestational diabetes mellitus (GDM) is a well-established risk factor for fetal macrosomia. A significant number of patients with GDM also suffer from obesity, a factor associated with fetal macrosomia. An important question is whether GDM is independently associated with fetal macrosomia, or whether this relationship is merely the result of maternal obesity acting as a confounder. In this review of the literature, we attempt to further elucidate the relationship between GDM, maternal obesity, and fetal macrosomia.

Maternal and fetal health effects of working during pregnancy

We provide some of the first empirical evidence of maternal and fetal health effects of working during pregnancy by using a unique dataset from the New Jersey Department of Health that includes information not only on pregnancy and birth outcomes but also on maternal employment. We match the mother’s occupation with the Metabolic Equivalent of Task, provided by the Census Occupational Classification System and used as a measure for the strenuousness of the work activities performed. We find robust evidence that working in a relatively more strenuous job during pregnancy raises the likelihood of fetal macrosomia by about 1.5 percentage points. There are no statistically or economically significant effects on other birth outcomes. Our study further indicates an under-studied link between gestational diabetes (a known risk factor for fetal macrosomia) and intensive physical activities at work during pregnancy, potentially mediated by disrupted sleep due to greater work intensity. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Макросомія плода: акушерські, психологічні та соціальні аспекти

One of the main markers of socially unfavorable pregnancy is anthropometric indicators of newborns. They reflect not only the narrow medical problems of complicated gestation but also social problems in general, the quality and access to the medical care. The objective: to determine the risk factors for fetal macrosomia in pregnancy with high levels of psychosocial stress. Materials and methods. The course of pregnancy and childbirth, demographic and medical risk factors for a fetal macrosomia were analyzed in 140 pregnant women with different levels of psychosocial stress. They were divided into 2 groups: 1 group (main) – 56 women-forced migrants from Luhansk and Donetsk regions, 2 group – 84 women with low and moderate level stress according to the questionnaires and psychological tests (L. Reeder, Spielberg–Khanin scale). Results. Gestational diabetes was the main reason for the birth of heavy children in both groups. Women–forced migrants had late manifestation of impaired tolerance to carbohydrates and a higher frequency of pathological weight gain. Male neonates are at risk for macrosomia. Childbirth in women with macrosomia is accompanied by a high frequency of complications and abnormal births. Conclusions. The frequency of births of macrosomic children in women - forced migrants is higher than in women at low risk of psychosocial stress. Risk factors in this group of pregnants include: the level of stress and behavioral responses to stress, impaired carbohydrate tolerance due to gestational diabetes, abnormal weight gain due to malnutrition and male sex of the fetus. Keywords: macrosomia, pregnancy, childbirth, women–forced migrants psychosocial stress, gestational diabetes, weight gain.

Identification of Newborns With Birth Weight of 4,500 Grams or More: The Impact of Obesity [16O

INTRODUCTION: Obesity is a known risk factor for fetal macrosomia (birth weight [BW] greater than or equal to 4,500g), but prior studies examining its effect on sonographic estimated fetal weight (SEFW) have been equivocal. Our objective was to determine the impact of obesity on sonographic detection of macrosomia. METHODS: We performed a multicenter retrospective cohort study of all non-anomalous singletons with SEFW greater than or equal to 4,000g. All SEFWs were performed by Registered Diagnostic Medical Sonographers within 14 days of delivery and were calculated using a Hadlock equation. Patients were grouped according to body mass index (kg/m2) at delivery (&lt;30.0 [non-obese], 30.0–39.9 [obese], and ≥ 40.0 [morbidly obese]). The primary outcome was the detection rate (DR) of macrosomic newborns. Secondary outcomes were false positive rate (FPR) and area under the receiver operator curve (AUC). RESULTS: Of the 330 women included, 83 (25.2%) were non-obese, 145 (43.9%) were obese, and 102 (30.9%) were morbidly obese. Overall there were 51 (15.5%) macrosomic newborns and its prevalence varied: 8.4% among non-obese, 14.5% among obese, and 22.5% among morbidly obese women. There were no significant differences in DR (42.9%, 52.4%, 60.9%; P=.67), FPR (7.9%, 9.7%, 10.1%; P=.87), or AUC (0.79, 0.77, 0.86; P=.51) for BW greater than or equal to 4,500 g between non-obese, obese, and morbidly obese women, respectively. CONCLUSION: Maternal obesity does not influence sonographic detection of newborns with BW of at least 4,500 g. Clinicians should not consider maternal obesity to be a limitation for identification of macrosomic newborns.

Observational Case-Control Study on The Risk Factors of Fetal Macrosomia and Fetal-Maternal Associated Pathology

AbstractBackground and aims:The purpose of this study was to evaluate the frequency of demographic and clinical risk factors for fetal macrosomia, maternal pregestational, gestational and intra partum pathology associated with macrosomia, and to investigate the dynamic of these parameters in a decade.Material and method:We conducted two studies, a case-control study of 261 mothers who delivered macrosomic babies and 241 mothers who delivered normal weight babies in 2016, and then we compared the parameters obtained from the study group of 261women who delivered in 2016 macrosomic babies with those of a study group of 220 women who delivered macrosomic babies in 2006 at Gynecology I County Hospital of Cluj-Napoca. The data was stored and analyzed using Microsoft Excel.Results and conclusions:Overweight before pregnancy, the excessive weight gain during pregnancy, and the delivery of a macrosomic baby increase the risk to deliver in the future a macrosomic baby. Mothers who delivered macrosomic babies had a higher incidence of thyroid gland pathology (hypofunction) and gestational diabetes than those who delivered normal weight babies.

Ultrasound examination in the diagnosis of fetal macrosomia

Ultrasound examination in obstetrics is a method of screening of pregnant women including identification of fetal macrosomia. Diagnosis of macrosomia is extremely important, along with other indications the conclusion about the presence of a large fetus may affect the tactics of giving birth. Gestational diabetes (GD) is a known clinical risk factor for fetal macrosomia and accounts for the majority of all types of diabetes observed during pregnancy. In women with GD fetal macrosomia is the main complication, which often together with others serves as an indication for a planned cesarean section in order to reduce potentially possible perinatal complications, as macrosomia of diabetic origin is characterized by disproportional distribution of subcutaneous adipose tissue in the fetus with predominant localization in the upper half of the trunk, which increases the probability of dystocia of the shoulders and damage to the brachial plexus. In perinatal morbidity and mortality the major proportion is presented by newborns weighing more than 4 kg but there is insufficient data in the literature on how prenatal ultrasound should be monitored in cases of suspected macrosomia in the fetus, especially in patients without diabetes. At the moment, to determine the estimated weight of the fetus, the formulas created more than 30 years ago are used and their accuracy is not always high. The difficulty is caused by the lack of data on the diagnostic accuracy of macrosomal markers. A search is being made for additional parameters capable of increasing the diagnostic value of ultrasound method for determining the estimated weight of the fetus.

Macrosomia. A Systematic Review of Recent Literature

AbstractBackground and aims: The obesity and overweight rate among women of childbearing age and fetal macrosomia associated with different birth injuries are very frequent all over the world and with an increasing incidence. The huge amount of published literature on this topic in the last decade is putting the practioners in a very challenging position. Material and method: We have done a systematic review on the recent literature (last five years) based on science direct database. Results: A total of 5990 articles were identified and after successive exclusion of some of them, 48 were deeply analyzed. The results were grouped in following topics: risk factors for fetal macrosomia, the pathophysiology of macrosomia, prenatal clinical and lab diagnosis and prevention of macrosomia. Conclusions: Considering the maternal, fetal and neonatal complications of macrosomia, the counseling, and monitoring of the pregnant women risk group are of particular importance for adopting a low calorie / low glycemic diet and avoiding a sedentary behaviour. Long-term follow-up of the mother and the macrosomic baby is required because of the risk of obesity, diabetes, hypertension, and metabolic syndrome later in life.

Influence of maternal obesity on fetal growth at different periods of pregnancies with normal glucose tolerance.

We aimed to examine the influence of maternal obesity on fetal growth in utero at different periods of pregnancies with normal glucose tolerance. A retrospective cohort study on 356 pregnant women with normal glucose tolerance was conducted. The women were categorized by pre-pregnancy body mass index (BMI) as obese (OB; BMI ≥ 25.0 kg/m2 ) or non-obese (n-OB). Z-scores of the fetal abdominal circumference (AC) and the rate of fetal macrosomia (AC ≥ 90th percentile) at 19, 30, and 36 gestational weeks (GW) were compared between the two groups. Maternal demographics (age, parity, height, pre-pregnancy BMI, history of prior large-for-gestational-age delivery) were compared between the pregnancies with and without fetal macrosomia at each gestational age. Multiple logistic regression analysis was performed to determine the independent risk factors for fetal macrosomia. Birthweights of the neonates were significantly higher in the OB group. Z-scores of the fetal AC were significantly higher in the OB group at 30 and 36 GW, while no significant difference was found at 19 GW. The rates of fetal macrosomia in the OB group were also higher at 30 and 36 GW, while maternal obesity was not associated with fetal macrosomia at 19 GW. Pre-pregnancy BMI was detected as the independent predictor of fetal macrosomia at 30 GW (odds ratio, 1.19 [95% CI]) and 36 GW (odds ratio, 1.13 [95% CI]). Maternal pre-pregnancy obesity has a promoting effect on fetal growth from the third trimester through birth.

Rates and Risk Factors in Macrosomic Newborns among Non-Diabetic Parturients at Tiznit City, Morocco: A Case-Control Study

Background: The present study was elaborated to assess the prevalence of high birth weight and its related risk factors for macrosomic infants among women in Southern Morocco. Methods: A case-control study was conducted on term singleton live-births, with no morbidity or malformation, of a sample of (n = 78) nulliparous and multiparous non-diabetic women delivering at Hassan I Provincial Hospital. Cases included neonates ≥ 4000 g, whereas controls comprised infants with birth weight between 2500 and 3999 g. Personal information was collected from pregnant women using a structured questionnaire, and through a review of their medical records. Associations between exposure and dependent variable (macrosomia) were calculated using linear and logistic regressions. Results: Macrosomia prevalence was 35.89%. Mean birth weight in cases was 4310.71 ± 246.96 g, and in controls 3076.00 ± 533.97 g. Maternal lifestyle behaviors, as well as sociodemographic factors were not associated with macrosomia, except for maternal age over 40 years (OR: 4.27, 95% CI: 0.98-18.68). Logistic regression model analysis indicated that macrosomia was strongly associated with hormone therapy (adjusted OR: 18.83, 95% CI: 1.54-214.51), followed by obesity/overweight history (adjusted OR: 7.94, 95% CI: 1.52-41.41), and pre-pregnancy BMI ≥ 25 Kg/m2 for pooled overweight and obesity factor (adjusted OR: 5.24, 95% CI: 1.54-17.82). Conclusion: Pre-pregnancy BMI > 25 kg/m2, pre-existing overweight/ obesity, and hormone therapy should be considered as independent risk factors for fetal macrosomia and require more attention from health professionals.

Risk factors for the delivery of macrosomic infants at the University Hospital of the West Indies.

The aim of this study is to determine the risk factors for the delivery of macrosomic infants at the University Hospital of the West Indies over a 3-year period. A retrospective, descriptive, case-controlled study was performed. Data were extracted from the maternal medical records of 316 macrosomic infants (weighing ≥ 4,000 g) and 316 controls (weighing from 2,500-3,999 g) delivered at the University Hospital of the West Indies. Descriptive analyses were performed comparing maternal characteristics between the two groups. Risk factors were determined using multiple logistic regression models. The incidence of macrosomia for the study period was 4.3%. Women who delivered a macrosomic infant were older, taller, and heavier with a greater body mass index at the start of the pregnancy and gained more weight during pregnancy than their counterparts in the control group (p < 0.05). Maternal obesity, height > 164 cm, abnormalities of glucose control, weight gain > 15 kg, gestational age > 40 weeks, and male gender of the infant were found to increase the risk of delivering a macrosomic infant by over 2-fold (p < 0.05). The greatest risk factor was that of having had a previous macrosomic infant which increased the risk of delivering a macrosomic infant by as much as 6-fold (adjusted odds ratio, 6.0; 95% confidence interval, 1.9-18.7). The maternal risk factors for fetal macrosomia identified in this study mirror those of previous studies.

Prenatal Detection and Consequences of Fetal Macrosomia

Macrosomia is diagnosed when excessive intrauterine fetal growth occurs and the birth weight surpasses an established limit. The causes and risk factors for fetal macrosomia are diverse. Pregnancies with fetal macrosomia are considered high risk and require intensive antenatal care. Prenatal ultrasound appears to be the best method for performing weight estimates before birth, as the correct birth weight is often underestimated when using biometric formulae to determine the fetal weight. Three-dimensional volume sonography has been shown to improve estimates of fetal weight by including limbs volumes. The recent Hart formula has been specifically developed for fetal macrosomia estimation and appears to improve accuracy. Delivery of a macrosomic baby is also high risk and should be performed in tertiary centres with experienced obstetricians.

Higher Carbohydrate Versus Higher Fat Diet in Gestational Diabetes: A Pilot Study

The historic practice of advising a low-carbohydrate and higher fat diet in the management of gestational diabetes mellitus has not been sufficiently tested. In addition to glucose, high maternal triglycerides and free fatty acids are independent risk factors for fetal macrosomia and excess neonatal adiposity. We tested the hypothesis that a higher complex carbohydrate/lower fat diet would result in higher postprandial glucose excursions but an overall 24-hour glucose area-under-the-curve resulted that is no different or lower than that of a low-carbohydrate/higher fat diet.

Prediction and prevention of the macrosomic fetus

Fetal macrosomia is associated with significant maternal and neonatal morbidity. In the long term, infants who are large for gestational age are more likely than other infants to be obese in childhood, adolescence and early adulthood, and are inherently at higher risk of cardiovascular and metabolic complications in adulthood. With over one billion adults in the world now overweight and more than 600 million clinically obese, preventing the vicious cycle effect of fetal macrosomia and childhood obesity is an increasingly pertinent issue. Fetal growth is determined by a complex interplay of various genetic and environmental influences. Consequently the prediction of pregnancies at risk of pathological overgrowth is difficult. Many risk factors for fetal macrosomia, such as maternal obesity and advanced maternal age, are also conversely associated with intrauterine growth restriction. Sonographic detection of fetal macrosomia is notoriously fraught with difficulties, with dozens of formulas for estimated fetal weight proposed but few with sufficient sensitivity to alter clinical practice. This calls into question policies of elective delivery based on projected estimated fetal weight cut-offs alone. More recently the identification of markers of fetal adiposity and maternal serum biomarkers are being investigated to improve the antenatal detection of the large for gestational age fetus. Prevention of fetal macrosomia is entirely dependent upon correct identification of those at risk. Maternal weight, gestational weight gain and glycaemic control are the risk factors for fetal macrosomia that are most amenable to intervention, and have potential maternal health benefits beyond pregnancy and childbirth. The ideal method of optimising maternal weight and glucose homeostasis is yet to be elucidated, though a number of promising advances are recently being reported. In this review we outline the contemporary evidence for the prediction and prevention of fetal macrosomia, which is indeed a contemporary dilemma.

Maternal nutrition and fetal macrosomia in uncomplicated pregnancies: a prospective cohort study

Fetal macrosomia or delivery of a large for gestational age (LGA) infant (birthweight > 4000 g) in uncomplicated pregnancies is increasing in many Western countries which may have serious implications for maternal and neonatal morbidity (1) . While fetal macrosomia has an established link with maternal diabetes the majority of macrosomic infants are born to non-diabetic mothers (2) , with maternal obesity now considered an established risk factor for delivering a macrosomic baby (3) . Evidence relating to maternal nutrition and macrosomia is inconclusive with the majority of studies to date investigating associations between maternal nutrition and birthweight rather than macrosomia specifically. The aim of this study was to investigate maternal nutrition as a potential modifiable risk factor for fetal macrosomia. Low risk pregnant women predicted to deliver LGA infants (study group) and women predicted to deliver appropriate for gestational age (AGA) infants (control group) were recruited from antenatal clinics. Participants maintained a four day food diary in the third trimester of pregnancy. Demographic and obstetric data were collected from maternity records. Completed food diaries were imported into a food analysis database (WISPg). Total energy intake (TEI) and nutrient intakes were calculated. Data were analysed by recruitment groups (study and control group) and by delivery birthweight groups: predicted to and delivered a LGA infant (LGA:LGA); predicted to deliver a LGA infant but delivered an AGA infant (LGA:AGA); and, predicted to and delivered an AGA infant (AGA:AGA). Of the 114 women who participated in the study, 100 women completed the food diary at 32 (2.6) weeks gestation. Intake of PUFA n-3 was significantly higher in the study group (women predicted to deliver LGA infants) when compared to the control group, after adjustment for known variables associated with birthweight (p = 0.047). Further analyses by delivery birthweight demonstrated that intake of PUFA n-3 remained significantly different between delivery groups (p = 0.015), and post hoc analyses revealed that women in the LGA:AGA group consumed significantly higher PUFA n-3 than women in the LGA:LGA group (p = 0.044). Furthermore, LGA:AGA women had significantly higher TEI (p = 0.038), significantly higher intake of total fats (p = 0.029) and PUFA n-6 (p = 0.034) and significantly lower intake of carbohydrates (p = 0.032) after adjustment for variables associated with birthweight. Results suggest that an increased intake of PUFAs, combined with a decreased carbohydrate intake in the third trimester may have had a modifying effect on subsequent birthweight, in women predicted to have macrosomic babies. Further research is required to determine if adopting a diet high in PUFAs and low in carbohydrate can reduce the risk of macrosomia in low risk pregnancies.

275: Risk factors for fetal macrosomia and neonatal morbidity in women with type-2 diabetes (DM-2)

275: Risk factors for fetal macrosomia and neonatal morbidity in women with type-2 diabetes (DM-2)

Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária

OBJETIVO: identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. MÉTODOS: estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos: macrossômicos (casos, n=242) e não macrossômicos (controles, n=561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do chi². Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC 95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p<0,05). RESULTADOS: observou-se associação significativa entre macrossomia e GP maior que 16 kg, IMC >25 kg/m², antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) >120 mg/dL e média de glicemia pós-prandial >130 mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP >16 kg (OR=1,79; IC 95%: 1,23-1,60), o IMC >25 kg/m² (OR=1,83; IC 95%: 1,27-2,64), o antecedente pessoal de diabete (OR=1,56; IC 95%: 1,05-2,31) e de macrossomia (OR=2,37; IC 95%: 1,60-3,50) e a MG >120 mg/dL no terceiro trimestre (OR=1,78; IC 95%: 1,13-2,80) confirmaram risco independente para macrossomia nestas gestações de risco. CONCLUSÃO: o GP superior a 16 kg, o IMC maior ou igual a 25 kg/m², a MG superior a 120 mg/dL no terceiro trimestre e a presença de antecedentes pessoais de diabete ou de macrossomia foram identificados como fatores de risco para macrossomia fetal em gestantes portadoras de diabete ou de hiperglicemia diária.

Cord leptin level and fetal macrosomia

Objective: To determine the relationships among serum leptin, insulin-like growth factor-I, and insulin levels in large for gestational age (LGA) infants. Methods: Serum samples were collected from maternal veins and umbilical arteries of 52 consecutive, term, LGA neonates of nondiabetic mothers. Maternal and neonatal serum samples were analyzed for levels of leptin, insulin-like growth factor-I, and insulin by specific radioimmunoassays. Multiple regression analysis was used to determine independent risk factors for fetal macrosomia. Results: The independent risk factor significantly associated with fetal macrosomia was umbilical cord leptin concentration ( P < .01, β = 0.59). There was a statistically significant correlation between umbilical cord leptin and insulin-like growth factor-I levels and birth weight ( r = 0.51, P < .01; r = 0.37, P < .01; respectively). The correlation between umbilical cord insulin levels and birth weight was not statistically significant ( r = 0.06, P = .63), nor was that between maternal body mass index and birth weight ( r = 0.09, P = .50). Conclusion: Our data showed that umbilical cord leptin concentration was an independent risk factor for fetal macrosomia.