Risk Factors For Macrosomia Research Articles

A retrospective cohort study on the influencing factors for macrosomia in singleton pregnancies.

To explore the influencing factors of singletons with macrosomia, and to develop interventions for the prevention of macrosomia. A retrospective cohort study was conducted on 26,379 pregnant women who established the Maternal and Child Health Record and gave birth from January 1, 2019 to December 31, 2019 in a community health service center in Haidian district, Beijing. The study analyzed factors such as maternal age, ethnicity, education level, prepregnancy body mass index (BMI), parity, folic acid supplementation, gestational diabetes mellitus, gestational hyper, hypothyroidism in pregnancy (including subhypothyroidism), hyperthyroidism in pregnancy, and infant gender. Univariate analysis was performed using the χ2 test, and multivariate analysis was performed using non-conditional multivariate logistic regression analysis. Out of 26,379 live births, 5.8% (1522/26,379) were macrosomia and 94.2% (24,857/26,379) were non-macrosomia. Univariate analysis revealed that maternal age, prepregnancy BMI, education level, parity, hypothyroidism during pregnancy, and infant gender were identified as influencing factors for macrosomia (P < .05). Multivariate analysis showed that maternal age ≥ 35 years, education level of high school or below, pre-pregnancy BMI, hypothyroidism, male infant, and parity were all influencing factors for macrosomia (P < .05). Prepregnancy overweight or obesity, male infants, multiparity, and low education level are risk factors for macrosomia. Multiple factors can contribute to macrosomia, and therefore, maternal health care should be strengthened, and early interventions should be taken for the above-mentioned factors in the local area.

Maternal Diabetes, Respiratory and other Disorders in Offspring: Shortterm and Long-term Outcomes

Abstract: Maternal diabetes during pregnancy, regardless of the type, is a risk factor for macro-somia or excessive fetal growth. Macrosomia and subsequent complications are the main short-term consequences of intrauterine exposure to gestational diabetes mellitus (GDM). Additionally, they have an increased risk of neonatal complications, such as congenital heart defects (CHDs) and cen-tral nervous system (CNS) congenital birth defects, hyperbilirubinemia, hypoglycemia, hypocalce-mia, and polycythemia with their subsequent complications. More and more indisputable data are evidencing long-term consequences on offspring health in the case of diabetes. While most of this research has focused on metabolic and cardiovascular consequences, there is a growing body of ev-idence suggesting an impact of maternal diabetes on respiratory health, which is influenced by in-trinsic and extrinsic environmental factors during fetal and postnatal development, with important implications for respiratory disorders in later life.

Foetal macrosomia — incidence, determinants and neonatal outcomes: 10-years retrospective review, 2010–2019

Objectives: Prevalence of macrosomia differs worldwide according to studied population and has been variable over last few decades. The objective of the study was to determine the trends in incidence and clinical characteristics of infants with macrosomia born in two diverse Polish neonatal centres from 2010–2019. Material and methods: Trends in the incidence of macrosomia, maternal age, delivery mode and neonatal complications were analysed over a 10 year period based on birth medical records. Results: The total number of 43 165 term neonates were analysed with macrosomia incidence of 16.63% (n = 7179). The prevalence of macrosomia was stable from 2010–2019 irrespectively of referentiality and geographical area. Mean maternal age increased over the decade with higher age of mothers of macrosomic neonates. Recognizability of gestation diabetes among pregnant women increased from 9.61% in 2010 to 15.27% in 2019 and it was comparable in mothers of macrosomic infants. The percentage of caesarean sections was higher in macrosomic neonates and gradually increased over last decade. The highest percentage of birth injuries was observed in the first grade of macrosomia (4000–4499 g). The number of neonatal complications including lower Apgar score, respiratory and cardiology symptoms correlated with severity of macrosomia, with highest morbidity in children above 5000 g. Conclusions: The prevalence of macrosomia in the studied cohort remained invariable over the last decade. Macrosomia is associated with an increased rate of caesarean sections, higher maternal age and increased neonatal morbidity. A higher macrosomia grade is related to a worse neonatal outcome. Further studies on other risk factors of macrosomia are needed.

Impact of induction of labor in fetal macrosomia: comparative series from 256 cases

The management of fetal macrosomia remains controversial. A protocol for induction of labor in the case of a suspected macrosomic fetus has been in place in our maternity hospital since 2016. We studied the impact of this protocol by analyzing the mode of delivery. We then studied its safety in terms of maternal and fetal morbidity and mortality and the risk factors of macrosomia. Retrospective, comparative, single-center study including 256 patients between 2016 and 2020 in a type 3 maternity hospital in France. We compared 114 patients induced at 39weeks of gestation (fetal weight ≥ 95th p; group 1) with 142 patients who after 37weeks of gestation delivered a macrosomic newborn (≥ 95th p according to Audipog; group 2) not diagnosed antenatally. The rate of vaginal delivery in the group 1 was 78.9% vs 83.8% in group 2 (p = 0.318). The rate of neonatal acidosis in group 1 was statistically lower than in group 2 (5.2% vs 16.9%; p = 0.004). The other maternal and neonatal outcomes were not significantly different in the two groups. A previous macrosomic newborn appeared to be a risk factor for macrosomia (p = 0.02). The establishment of a protocol for the induction of labor in the case of macrosomia in our maternity hospital did not increase the rate of vaginal delivery, but has a neonatal benefit, by significantly reducing neonatal acidosis.

Nomogram-based risk prediction of macrosomia: a case-control study.

BackgroundMacrosomia is closely associated with poor maternal and fetal outcome. But there is short of studies on the risk of macrosomia in early pregnancy. The purpose of this study is to establish a nomogram for predicting macrosomia in the first trimester.MethodsA case-control study involving 1549 pregnant women was performed. According to the birth weight of newborn, the subjects were divided into macrosomia group and non-macrosomia group. The risk factors for macrosomia in early pregnancy were analyzed by multivariate logistic regression. A nomogram was used to predict the risk of macrosomia.ResultsThe prevalence of macrosomia was 6.13% (95/1549) in our hospital. Multivariate logistic regression analysis showed that prepregnancy overweight (OR: 2.13 95% CI: 1.18–3.83)/obesity (OR: 3.54, 95% CI: 1.56–8.04), multiparity (OR:1.88, 95% CI: 1.16–3.04), the history of macrosomia (OR: 36.97, 95% CI: 19.90–68.67), the history of GDM/DM (OR: 2.29, 95% CI: 1.31–3.98), the high levels of HbA1c (OR: 1.76, 95% CI: 1.00–3.10) and TC (OR: 1.36, 95% CI: 1.00–1.84) in the first trimester were the risk factors of macrosomia. The area under ROC (the receiver operating characteristic) curve of the nomogram model was 0.807 (95% CI: 0.755–0.859). The sensitivity and specificity of the model were 0.716 and 0.777, respectively.ConclusionThe nomogram model provides an effective mothed for clinicians to predict macrosomia in the first trimester.

Reducing rate of macrosomia in Iceland in relation to changes in the labor induction rate

Diabetes and prolonged pregnancy are risk factors of macrosomia. The aim was to explore the relationship between the increased rate of labor induction and macrosomia in Iceland. Changes in the incidence proportion of macrosomia was estimated by gestational age. Further, the association between labor induction and macrosomia was estimated in reference to expectant management. Data from the Iceland birth registry on 92,424 singleton births from 1997 to 2018 was used in this cohort study. Macrosomia was defined as birth weight more than 4.5 kg. The incidence proportion during three periods, 1997-2004, 2005-2011, 2012-2018, was calculated and stratified by gestational age. The relative risk reduction of macrosomia over time was calculated with log-binomial regression, using the first period as reference. The risk and relative risk of macrosomia compared with expectant management was estimated and adjusted for diabetes. The total number of macrosomic infants was 5110 and of those only 313 had a mother with diabetes. The incidence proportion of macrosomia was 6.5% during the period 1997-2004, but 4.6% during 2012-2018. A relative risk reduction of macrosomia over time was seen for deliveries after estimated due date. Labor induction decreased the risk of macrosomia, but the association persisted after adjustment for diabetes. The rate of macrosomia decreased in Iceland during the last two decades, but only a small proportion of macrosomic infants had a mother with diabetes. Labor induction decreased the risk of macrosomia, an association which seemed independent of diabetes.

Macrosomia predictors and pregnancy outcomes in Gestational Diabetes patients: An observational study from Ha'il, Saudi Arabia.

Objectives:To determine the prevalence, risk factors for macrosomia and pregnancy outcome in women with gestational diabetes (GDM).Methods:In this prospective observational study, we included the data of 161 pregnant females diagnosed with GDM. The study was conducted from December 1st, 2020 to June 30, 2021, at the Maternity and Children Hospital (MCH) of Hail, Saudi Arabia. The data regarding risk factors of macrosomia was obtained from each patient. The patients were followed till the delivery of the baby. The data regarding the prevalence of fetal macrosomia and its associated outcomes was noted.Results:The prevalence of fetal macrosomia was 19.8%. Maternal obesity (OR 4.87), poorly controlled diabetes (OR 3.3), previous history of good-sized baby (OR 2.30), previous history of congenital abnormalities (OR 7.2) were the significant risk factors of fetal macrosomia. The prevalence of maternal and fetal complications was high among pregnancies complicated by fetal macrosomia. The prevalence of fetal macrosomia and other fetal complications was high in poorly controlled GDM patients in comparison to optimal control GDM patients.Conclusion:Fetal macrosomia is a common complication among GDM patients. Maternal obesity and poorly controlled diabetes are the common modifiable maternal factors contributing to macrosomia.

Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake

BackgroundIodine plays an important role in pregnancy. How to maintain adequate iodine intake amongst pregnant women in each trimester of pregnancy to prevent adverse birth outcomes in central China is a challenge for clinical practice.Methods870 pregnant women and their infants were enrolled in the study. Urinary iodine concentration (UIC) was measured using an inductively coupled plasma mass spectrometry (ICP-MS). Maternal and newborn information were obtained during follow-up. Multinomial logistic regression models were established.ResultsMedian UIC of pregnant women was 172 ± 135 μg/L which is currently considered to be sufficient. Multivitamin supplements containing iodine, iodized salt intake and frequent milk intake were significantly associated with higher UIC. Multivariate logistic regression analysis showed that multivitamin supplements containing iodine and milk consumption were risk factors for more than adequate iodine (UIC ≥ 250 μg/L). Iodine-rich diet was significantly related to heavier birthweight, larger head circumference and longer femur length of the newborns while more than adequate iodine intake (UIC ≥ 250 μg/L) was a risk factor for macrosomia. Logistic regression models based on potential risk factors involving iodine containing supplements and iodine-rich diet were established to predict and screen pregnant women with high risk of more than adequate iodine intake among local pregnant women in different trimesters and guide them to supplement iodine reasonably to prevent the risk.ConclusionsMultivitamin supplements containing iodine and milk consumption were risk factors for maternal UIC ≥ 250 μg/L which was a risk factor for macrosomia. Iodine monitoring models were established to provide guidance for pregnant women to reduce the risk of more than adequate iodine intake, thereby contributing to reduce the risk of having a macrosomia.

Gestational obesity and subclinical inflammation: The pathway from simple assessment to complex outcome (STROBE-compliant article).

Maternal obesity and excessive gestational weight gain (GWG) are associated with pregnancy-related complications, poor birth outcomes, and increased birth weight (BW).The aims of this study were to assess the relationship between excessive GWG and gestational inflammatory status in terms of blood parameters, as well as its influence on newborn's outcomes.We performed a prospective study on 176 pregnant women divided into 2 groups depending on the GWG: group 1—normal GWG, 80 cases; and group 2—high GWG, 96 cases. The statistical analysis was performed using the GraphPad Prism program, trial variant. We performed a thorough anamnesis and clinical examination in all mothers and their newborns, as well as an assessment of multiple laboratory parameters.The levels of both platelets and triglycerides were significantly higher in pregnant women from high GWG group (P = .0165/P = .0247). The newborns whose mothers presented an excessive GWG were found with a significantly higher BW as compared to those with normal GWG mothers (P = .0023). We obtained a positive correlation between the mothers’ and newborns’ values for hemoglobin, high-density lipoprotein, leucocytes, and platelets/lymphocytes ratio (P = .0002/P = .0313/P = .0137). Moreover, a significant positive correlation was found between GWG and BW (r = 0.2049, 95% CI: 0.0588–0.3425, P = .0064).Our findings sustain the hypothesis that maternal obesity is a risk factor for macrosomia and childhood obesity since we found a positive correlation between GWG and BW. Women with high GWG expressed significantly higher levels of platelets and triglycerides suggesting a subclinical inflammation associated to excessive fat accumulation. The inflammation transfer from mother to fetus in our study was suggested by the positive correlations between maternal and neonatal leukocytes and platelets/lymphocytes ratio.

The factors affecting the physical development of neonates in pregnant women with or without gestational diabetes mellitus.

ObjectivesTo explore the factors affecting neonatal physical development in pregnant women with or without gestational diabetes mellitus (GDM).MethodsThe subjects were selected from the pregnant woman giving birth in 2nd Affiliated Hospital of Zhengzhou University, from November 2015 to May 2016. The age, occupation, education level, gestational age, body weight before pregnancy, body weight at delivery, body height, delivery pattern, GDM status of pregnant women and neonatal gender, birth weight (BW), chest circumference (CC), head circumference (HC) and birth length (BL) were collected through medical records and questionnaires. The clinical data were retrospectively analyzed and studied.ResultsThe significant differences were found between women with GDM and without GDM in following neonatal variables (P<0.05): BW, CC, and HC. GDM status increased the incidence of macrosomia (OR = 2.241, 95% CI: 1.406–3.573), large CC (OR = 2.470, 95% CI: 1.687–3.6153). Gestational weight gain (GWG) above IOM guideline was risk factor for macrosomia (OR = 1.763, 95% CI:1.098–2.833), large HC (OR = 1,584, 95% CI: 1.093–2.296) and large CC (OR = 1.707, 95% CI:1.163–2.506). Underweight was risk factor for short BL (OR = 2.543, 95% CI:1.161–5.571) and small CC (OR = 1.901, 95% CI:1.064–3.394). Female neonate was prone to appear short BL(OR = 2.831, 95% CI: 1.478–5.422) and small HC (OR = 2.750, 95% CI: 1.413–5.350), and not likely to macrosomia (OR = 0.538, 95% CI: 0.343–0.843), longer BL (OR = 0.584, 95% CI: 0.401–0.850), large HC (OR = 0.501, 95% CI: 0.352–0.713), and (OR = 0.640, 95% CI: 0.446–0.917). For women with GDM, gestational age was an risk factor of neonatal BW (low BW: OR = 0.207, 95% CI: 0.085–0.503; macrosomia: OR = 1.637, 95% CI: 1.177–2.276), BL (short BL: OR = 0.376, 95% CI: 0.241–0.585; long BL: OR = 1.422, 95% CI: 1.054–1.919), HC (small HC: OR = 0.343, 95% CI: 0.202–0.583; large HC: OR = 1.399, 95% CI: 1.063–1.842) and CC (small CC: OR = 0.524, 95% CI: 0.374–0.733; large CC: OR = 1.485, 95% CI: 1.138–1.936).ConclusionsIn our study, gestational age, GDM status, neonatal gender, GWG and pre-pregnancy body mass index (BMI) are associated the abnormal physical development of neonates. In women with GDM, gestational age was correlate with neonatal abnormal physical developments.

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay.

ObjectiveTo evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG).MethodsWe performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression.ResultsMean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24; CI 1.07–1.44), overweight women at the end of pregnancy (OR 1.66; CI 1.46–1.87), obese women at the end of pregnancy (OR 2.21; CI 1.90–2.58), women with EGWG (OR 1.78; CI 1.59–1.98), pregestational diabetes (OR 1.75; CI 1.15–2.69), gestational diabetes (OR 1.39; CI 1.25–1.53), prolonged pregnancy (OR 2.67; CI 2.28–3.12), multiparity (OR 1.24; CI 1.04–1.48), and male newborn (OR 1.89; CI 1.72–2.08).ConclusionMaternal overweight, obesity, EGWG, and gestational diabetes are prevalent in Uruguay, increasing the risk of macrosomia. Efforts to implement strategies to decrease the prevalence of overweight and obesity among women of reproductive age are essential to improve maternal and neonatal outcomes.

Serum markers in quadruple screening associated with adverse pregnancy outcomes: A case–control study in China

BackgroundWe assessed whether the results of quadruple screening during pregnancy are associated with an increased risk of adverse pregnancy outcomes. MethodsWe measured serum marker concentrations using quadruple screening in the second trimester of pregnancy and analyzed the relationship between adverse perinatal outcomes and serum markers in 12,124 pregnant women. A multivariate logistic regression analysis was used to evaluate the relative risk of quadruple screening and adverse pregnancy outcomes. ResultsCompared with the control group, increased concentrations of alpha-fetoprotein (AFP) and inhibin A were risk factors for preeclampsia and preterm delivery; low concentrations of unconjugated estriol and high inhibin A were risk factors for pregnancy hypertension; an increased concentration of human chorionic gonadotropin (hCG) was a risk factor for gestational diabetes mellitus; high AFP, low hCG, and high inhibin A were risk factors for low birth weight; and low AFP and high hCG were risk factors for macrosomia. ConclusionsQuadruple screening in the second trimester of pregnancy can provide early warning signs for maternal and fetal adverse pregnancy outcomes.

Effect of pre-pregnancy weight and gestational weight gain on neonatal birth weight:a prospective cohort study in Chongqing City

To explore the effect of pre-pregnancy weight and gestational weight gain in Chongqing City on birth weight of newborns. Pregnant women were volunteered for the cohort study in 6 Maternal and Child Centers in Chongqing from January 2016 to June 2017, who were planning to be pregnant in latest 3 months. The basic information included height and weight of prepregnancy, first trimester, mid-trimester and third trimester of pregnancy, and pregnancy outcome were collected. ANOVA, chi square test and multi factor unconditional logistic regression model were used to analyze the data. In pre-pregnancy the major BMI of women were &lt;18. 5(46. 74%, 1119/2394) and 18. 5≤BMI≤29. 99(47. 12%, 1128/2394), in first trimester of pregnancy, the figures were &lt;18. 5(34. 46%, 825/2394) and 18. 5≤BMI≤29. 99(57. 77%, 1383/2394). The distribution BMI in above stages were statistically different(χ~2=74. 95, P&lt;0. 01). The incidence of the low birth weight and macrosomia were 4. 51%(108/2394) and 6. 89%(165/2394). The average of neonatal birth weight, the low birth weight and macrosomia were statistically different(F=24. 18, P&lt;0. 01) and(χ~2=66. 44, P&lt;0. 01) comparisons among all prepregnancy BMI groups. The average birth weight of newborns, the low birth weight of the newborn and macrosomia were statistically different(F=11. 27, P&lt;0. 01), and(χ~2=89. 53, P&lt;0. 01) comparisons among all IOM groups of three stages of pregnancy. Low weight in pregnancy is the risk factor for low birth weight infants(RR=1. 90(95%CI 1. 27-2. 86)), while excessive gestational weight gain is the protective factor(RR=0. 66(95%CI 0. 46-0. 96)). Prepregnancy obesity(RR=3. 06(95%CI 1. 77-5. 31)) and excessive weight gain during pregnancy(RR=3. 60(95%CI 2. 48-5. 22)) were the risk factors for macrosomia. The above two factors, prepregnancy obesity and excessive weight gain during pregnancy interacted multiply. The figures of pre-pregnancy BMI are not equal to the BMI in first trimester of pregnancy. Low weight in pre-pregnancy is the risk factor for low birth weight infants, while excessive weight gain during pregnancy is the protective factor. Prepregnancy obesity and excessive weight gain during pregnancy are the risk factors for macrosomia. Prepregnancy obesity and excessive weight gain during pregnancy interacted multiply.

The combination of symphysis-fundal height and abdominal circumference as a novel predictor of macrosomia in GDM and normal pregnancy

BackgroundMacrosomia is a major adverse pregnancy outcome of gestational diabetes mellitus (GDM). Although BMI, symphysis-fundal height (SFH) and abdominal circumference (AC) are associated with foetal weight, there are some limitations to their use, especially for the prediction of macrosomia. This study aimed to identify a novel predictive methodology to improve the prediction of high-risk macrosomia.MethodsClinical information was collected from 3730 patients. The association between the ISFHAC (index of the SFH algorithm multiplied by the square of AC) and foetal weight was determined and validated. A new index, the ISFHAC, was evaluated by area under the curve (AUC) analysis.ResultsA total of 1087 GDM and 657 normal singleton pregnancies were analysed. The ISFHAC was positively correlated with foetal weight in GDM pregnancies and normal pregnancies (NPs). The AUCs of the ISFHAC were 0.815 in the GDM group and 0.804 in the NP group, which were higher than those of BMI, SFH, AC and GA. The ISFHAC cut-off points were 41.7 and 37 in the GDM and NP groups, respectively. The sensitivity values for the prediction of macrosomia with high ISFHAC values were 75.9 and 81.3% in the GDM and NP groups, respectively, which were higher than those with BMI. Regarding the validation data, the sensitivity values for prediction with high ISFHAC values were 78.9% (559 GDM pregnancies) and 78.3% (1427 NPs).ConclusionsThe ISFHAC can be regarded as a new predictor of and risk factor for macrosomia in GDM pregnancy and NP.

Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications

BackgroundThe potential effects of pre-pregnancy body mass (BMI) and gestational weight gain (GWG) on pregnancy outcomes remain unclear. Thus, we investigated socio-demographic characteristics that affect pre-pregnancy BMIs and GWG and the effects of pre-pregnancy BMI and GWG on Chinese maternal and infant complications.Methods3172 women were enrolled in the Chinese Pregnant Women Cohort Study-Peking Union Medical College from July 25, 2017 to July 24, 2018, whose babies were delivered before December 31, 2018. Regression analysis was employed to evaluate the socio-demographic characteristics affecting pre-pregnancy BMI and GWG values and their effects on adverse maternal and infant complications.ResultsMultivariate logistic regression analysis revealed that age groups < 20 years (OR: 1.97), 25–30 years (OR: 1.66), 30–35 years (OR: 2.24), 35–40 years (OR: 3.90) and ≥ 40 years (OR: 3.33) as well as elementary school or education below (OR: 3.53), middle school (OR: 1.53), high school (OR: 1.40), and living in the north (OR: 1.37) were risk factors in maintaining a normal pre-pregnancy BMI. An age range of 30–35 years (OR: 0.76), living in the north (OR: 1.32) and race of ethnic minorities (OR: 1.51) were factors affecting GWG. Overweight (OR: 2.01) and inadequate GWG (OR: 1.60) were risk factors for gestational diabetes mellitus (GDM). Overweight (OR: 2.80) and obesity (OR: 5.42) were risk factors for gestational hypertension (GHp). Overweight (OR: 1.92), obesity (OR: 2.48) and excessive GWG (OR: 1.95) were risk factors for macrosomia. Overweight and excessive GWG were risk factors for a large gestational age (LGA) and inadequate GWG was a risk factor for low birth weights.ConclusionsOverweight and obesity before pregnancy and an excessive GWG are associated with a greater risk of developing GDM, GHp, macrosomia and LGA. The control of body weight before and during the course of pregnancy is recommended to decrease adverse pregnancy outcomes, especially in pregnant women aged < 20 or > 25 years old educated below university and college levels, for ethnic minorities and those women who live in the north of China.Trial registrationRegistered at Clinical Trials (NCT03403543), September 29, 2017.

Are serum levels of inhibin A in second trimester predictors of adverse pregnancy outcome?

ObjectiveDuring pregnancy, inhibin A is mainly derived from the placenta and regulates the implantation and differentiation of embryos. Our aim was to assess whether second trimester serum inhibin A was associated with an increased risk of adverse pregnancy outcomes.MethodsWe investigated the serum levels of Inhibin A during the second trimester in pregnancy, and analyzed associations between the Inhibin A and the risk of adverse pregnancy outcome. 12,124 pregnant women were enrolled in this study between January 2017 and July 2019 at the Obstetrics & Gynecology Hospital of Fudan University. Multivariate logistic regression analysis was conducted to estimate the relative risk between Inhibin A and adverse pregnancy outcome.ResultsCompared with the group without adverse pregnancy outcome, during the second trimester of pregnancy, age and Inhibin A were risk factors for pre-eclampsia, gestational diabetes mellitus and preterm delivery; Inhibin A was risk factors for low birth weight. Gravidity and Inhibin A were risk factors for macrosomia; while parity was a protective factor against pre-eclampsia, gestational hypertension and low birth weight.ConclusionElevated Inhibin A levels in pregnancy are significantly associated with pre-eclampsia, GDM, macrosomia, low birth weight and preterm delivery.

Risk of macrosomia and low birthweight among immigrants in Belgium, a perfect mirror?

Abstract Background Both low birthweight (LBW) and macrosomia are associated with increased risk health conditions but risk factors of macrosomia among immigrant are understudied. One hypothesis is that some migrant groups at high risk for LBW have correspondingly low risk for macrosomia, and vice-versa. Our objective was to analyze LBW and macrosomia among immigrants according to naturalization, time since naturalization and socioeconomic status in Belgium. Methods The data came from the linkage between the Brussels birth and death registers, the national register of migrant trajectories and the social security register for the years 2004-2010. We used logistic regression to estimate the odds ratios of the associations between LBW and macrosomia according to maternal nationality and time since naturalization, taking into account socioeconomic status (SES), parity and maternal age. Results Data relate to all singleton births among Belgian, Maghrebi, Sub-Saharan African and Turkish women (n = 76 312). Compared to Belgians, we observed lower risk of LBW but higher risk of macrosomia among Maghrebi women (p &amp;lt; 0.0001). Among Turkish and Sub-Saharan African mothers the risk of LBW is higher than the Belgian (p &amp;lt; 0.001) but the risk of macrosomia is similar to Belgian mother. The results show a U-shaped increase of LBW and decrease of macrosomia with time since naturalization for all migrant groups. Results did not change after adjustment with maternal characteristics and SES. In parallel, we observe an improvement of SES among all migrant groups. Conclusions Our results show an increase of LBW rates and a decrease of macrosomia among Maghrebi, Sub-Saharan African and Turkish women with time since naturalization. The risk of macrosomia completely mirrors the risk of LBW for Maghrebi mother but not for Sub-Saharan African and Turkish women. Further studies would help to better explain risk factor and social determinants of macrosomia among immigrant. Key messages We observed an increase of LBW but a decrease of macrosomia with time since naturalization among immigrants. Patterns of macrosomia do not completely mirror those of LBW among different migrant groups.

Association of insulin resistance and β-cell function with macrosomia among pregnant women with gestational diabetes mellitus

Objective To investigate the associations of insulin resistance and β-cell function with macrosomia among pregnant women with gestational diabetes mellitus (GDM). Methods Totally 165 women with GDM were enrolled from January 2017 to June 2017 in the Nutrition Clinic of Beijing Obstetrics and Gynecology Hospitals of Capital Medical University, and they were followed-up until delivery. These GDM women were divided into macrosomia group (birth weight≥4 000 g) and control group (birth weight 2 500-3 999 g) according to their infants′ birth weight. Homeostasis model assessment of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) were estimated. Multivariable logistic regression was conducted to analyze the risk factors of macrosomia. Results Compared to control group, macrosomia group had higher gestational weeks and body mass index (BMI) before pregnancy, gestational weight gain, fasting plasma glucose levels during both 24-28 and 28-32 weeks of gestation, and HOMA-IR. Multivariable logistic regression showed that the risk of macrosomia was associated with BMI before pregnancy (OR=1.41, 95%CI 1.14-1.75, P<0.01), gestational weight gain (OR=1.50, 95%CI 1.26-1.79, P<0.01) and fasting blood glucose during the 28-32 week period of gestation (OR=6.56, 95%CI 1.15-37.27, P<0.05). In addition, BMI before pregnancy was positively correlated to birth weight (r=0.21, P<0.01), HOMA-IR(r=0.46, P<0.01), and HOMA-β(r=0.26, P<0.01). Conclusion Fasting plasma glucose levels during 28-32 weeks of gestation are associated with the risk of giving birth to macrosomia in pregnant women with GDM independent of maternal BMI before pregnancy as well as gestational weight gain. Key words: Gestational diabetes mellitus; Insulin resistance; Islet β-cell function; Macrosomia

Abstract P073: A Novel Epigenetic Link Between Gestational Diabetes Mellitus and Macrosomia

Background: Gestational diabetes mellitus (GDM) is a known risk factor for macrosomia, with recent estimates suggesting that between 15-45% of newborns of mothers with GDM are macrosomic (vs. 12% in non-GDM mothers). This study’s objectives were to explore associations between both maternal GDM and children’s macrosomia and DNA methylation of eight genes selected based on a literature review of candidates potentially involved in GDM and obesogenic pathways ( IGF1 , IGF2 , H19 , ARHGRF11 , MEST , NR3C1 , Adiponectin , and RETN ). Methods: Data were taken from the Tianjin GDM Observational study, in the 4th-largest city in China; subjects were ages 24-49 and diagnosed with GDM between 2005-2009. Baseline surveys were completed from 2009-2011 for 580 enrolled women-child pairs; an additional 580 women-child pairs without GDM and frequency matched on child sex and birth date were enrolled. We examined 572 GDM cases vs. 573 non-GDM controls; of these 177 children were born with macrosomia (114 to women with GDM, p&lt;0.001). Anthropometric measurements of all enrolled women were completed as part of usual prenatal care; blood draws for DNA methylation analysis (using the Illumina 850K array) were collected from children (median age 5.9 years, range 3.1-10.0). We used logistic regression for all analyses and adjusted for maternal height, age, smoking status, pre-pregnancy overweight/obesity, weight gain during pregnancy, parity, and hypertensive disorders of pregnancy as well as child sex and gestational age at delivery. FDR adjustment was used to correct all candidate gene CpG analyses for multiple testing, with FDR-adjusted P&lt;0.05 considered statistically significant. Results: After analysis of 345 CpGs in eight target genes, one CpG was associated with macrosomia (cg14428359) and one with GDM (cg19466922) at FDR &lt; 0.05; both CpGs were located in the gene MEST (3’ and 5’ untranslated regions, respectively). One additional CpG site in the promoter region of MEST (cg05862114) was associated with both GDM and macrosomia before FDR adjustment. All three CpGs were hypomethylated in both children of GDM mothers and macrosomia cases. Conclusions: MEST is a paternally imprinted gene that is highly expressed in fetal and placental tissue, and believed to play an important role in fetal development. It has also been found to have elevated expression in adipose tissue; epigenetic regulation of MEST may play an important role in the link between GDM and macrosomia.

Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus

Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18–45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44–80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.