Large- and Small-for-Gestational-Age Neonates Born by Women with Gestational Diabetes Mellitus Diagnosed by the New IADPSG Criteria: a Case-Control Study of 289 Patients and 1 108 Controls

E. Kintiraki; D. G. Goulis; S Mameletzi; S. Kasmas; A. Athanasiadis; E. Assimakopoulos; A. Tsapas; K. Dinas; B. C. Tarlatzis

doi:10.1055/s-0033-1334907

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2013; 121(05): 262-265
DOI: 10.1055/s-0033-1334907

Article

Large- and Small-for-Gestational-Age Neonates Born by Women with Gestational Diabetes Mellitus Diagnosed by the New IADPSG Criteria: a Case-Control Study of 289 Patients and 1 108 Controls

Authors

E. Kintiraki

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
D. G. Goulis

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
S Mameletzi

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
S. Kasmas

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
A. Athanasiadis

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
E. Assimakopoulos

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
A. Tsapas

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
K. Dinas

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece
B. C. Tarlatzis

¹Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, “Papageorgiou” General Hospital, Medical School, Aristotle University of Thessaloniki, Greece

Abstract

Background:

The primary aim of this case-control study was to compare women whose pregnancy was complicated with gestational diabetes mellitus (GDM), diagnosed by the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, with a control group of healthy, pregnant women in terms of incidence of large- (LGA) and small-for-gestational-age (SGA) neonates. Our secondary aim was to compare intrauterine growth of fetuses between the same 2 populations.

Patients and Methods:

The study included 289 women diagnosed as having GDM in the current pregnancy and 1 108 pregnant controls. Women were followed-up every 2 (GDM group) or 4 weeks (control group). The main metabolic parameters recorded were body mass index, fasting plasma glucose, home blood glucose and glycated hemoglobin A_1c. The main ultrasonographic parameters were estimated fetal weight (EFW), head (HC) and abdominal circumferences (AC). Decisions on treatment modification in the GDM group were based on both metabolic and ultrasonographic parameters.

Results:

There was no evidence for a difference in the incidence of LGA (9.9 vs. 9.2%, Chi-square, p=0.745) or SGA (10.5 vs. 9.0%, p=0.524) in GDM and in control group, respectively. No significant differences were found in EFW or AC between GDM and control groups during the second and third trimester.

Conclusions:

Incidence of LGA and SGA neonates is similar among healthy pregnant women and women with GDM, diagnosed by the new IADPSG criteria and treated according to both metabolic and ultrasonographic parameters.

Key words

diabetes in pregnancy - neonatal complications - fetal ultrasonography

Full Text

References

References
1 International Association of Diabetes and Pregnancy Study Groups Consensus Panel . International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
2 American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34: S62-S69
3 Blackwell SC, Rouse DJ. Gestational diabetes: Staying with old or marrying new guidelines. Am J Obstet Gynecol 2011; 204: 371-372
4 Metzger BE, Lowe LP, Dyer AR et al. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002
5 Crowther CA, Hiller JE, Moss JR et al. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477-2486
6 Landon MB, Spong CY, Thom E et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339-1348
7 Abuhamad AZ. ACOG Practice Bulletin, clinical management guidelines for obstetrician-gynecologists. Ultrasonography in pregnancy. Obstet Gynecol 2008; 112: 951-961
8 Landon MB, Mintz MC, Gabbe SG. Sonographic evaluation of fetal abdominal growth: predictor of the large-for-gestational-age infant in pregnancies complicated by diabetes mellitus. Am J Obstet Gynecol 1989; 160: 115-121
9 Reece EA, Winn HN, Smikle C et al. Sonographic assessment of growth of the fetal head in diabetic pregnancies compared with normal gestations. Am J Perinatol 1990; 7: 18-22
10 Kehl RJ, Krew MA, Thomas A et al. Fetal growth and body composition in infants of women with diabetes mellitus during pregnancy. J Matern Fetal Med 1990; 5: 273-280
11 Combs CA, Rosenn B, Miodovnik M et al. Sonographic EFW and macrosomia: is there an optimum formula to predict diabetic fetal macrosomia?. J Matern Fetal Med 2000; 9: 55-61
12 Chauhan SP, Grobman WA, Gherman RA et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 2005; 193: 332-346
13 Owen P, Ogston S. Conditional centiles for the quantification of fetal growth. Ultrasound Obstet Gynecol 1998; 11: 110-117
14 Kwik M, Seeho SK, Smith C et al. Outcomes of pregnancies affected by impaired glucose tolerance. Diabetes Res Clin Pract 2007; 77: 263-268
15 Garner P, Okun N, Keely E et al. A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study. Am J Obstet Gynecol 1997; 177: 190-195
16 O’Sullivan EP, Avalos G, O’Reilly M et al. Atlantic DIP collaborators . Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 2011; 54: 1670-1675
17 Kjos SL, Schaefer-Graf UM. Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care 2007; 30 (Suppl. 02) S200-S205
18 Seki Y, Williams L, Vuguin PM et al. Minireview: epigenetic programming of diabetes and obesity: animal models. Endocrinology 2012; 153: 1031-1038
19 Ben-Haroush A, Chen R, Hadar E et al. Accuracy of a single fetal weight estimation at 29–34 weeks in diabetic pregnancies: can it predict large-for-gestational-age infants at term?. Am J Obstet Gynecol 2007; 197: 497.e1-497.e6
20 Schaefer-Graf UM, Kjos SL, Fauzan OH et al. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. Diabetes Care 2004; 27: 297-302
21 Bonomo M, Cetin I, Pisoni MP et al. Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: a controlled randomized clinical trial. Diabetes Metab 2004; 30: 237-244
22 Buchanan TA, Kjos SL, Montoro MN et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care 1994; 17: 275-283
23 Kjos SL, Schaefer-Graf U, Sardesi S et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001; 24: 1904-1910
24 Lampl M, Jeanty P. Exposure to maternal diabetes is associated with altered fetal growth patterns: A hypothesis regarding metabolic allocation to growth under hyperglycemic-hypoxemic conditions. Am J Hum Biol 2004; 16: 237-263