Family, anthropometric and biochemical factors affecting birth weight of infants born to GDM women
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(6) 3 4, 2 1. „Omnimed” Diabetes Outpatient Clinic Łódź, Poland Department of Diabetology and Metabolic Diseases, Łódź, Poland 3 Department of Structural Biology Medical University, Łódź, Poland 4 Chair and Department of Pharmacology, Poznań, Poland 2. Abstract Objectives: Gestational diabetes mellitus (GDM) affects up to 25% of all pregnancies worldwide. If untreated, GDM leads to increased complication rates both, in the mother and the fetus. Early diagnosis and adequate management of GDM are essential to avoid macrosomia. Nonetheless, neonates born to GDM mothers often have high birth weight. The aim of the study was to evaluate selected factors which can affect neonatal birth weight. Material and methods: The study included 152 women with GDM and 58 healthy pregnant controls. Anthropometric data of both parents, maternal biochemical parameters, and neonatal birth weight were collected. Results: The independent factors influencing neonatal birth weight were pregnancy duration, maternal smoking, as well as birth weight and current weight of the father. The risk of delivering a large for gestational age (LGA) infant increases with the diagnosis of GDM, higher maternal pre-pregnancy weight, and higher fasting glycaemia. No correlation between maternal fasting glycaemia, HbA1c, 1,5-AG, lipids and neonatal birth weight was found. Conclusions: Risk factors for LGA include gestational diabetes, high maternal pre-pregnancy weight, and current body weight of the father. Neither HbA1c nor 1,5-AG were reliable predictors of neonatal birth weight and occurrence of LGA in the studied population.. Key words:
(7) / / LGA / /. Correspondence address: Marcin Kosiński Department of Diabetology and Metabolic Diseases, Łódź, Polska 92-213 Łódź, ul. Pomorska 251, Polska tel.: +48 42 2014347, fax: +48 42 2014341 e-mail: cosa@mp.pl. Nr 7/2015. © Polskie Towarzystwo Ginekologiczne. Otrzymano: 18.12.2014 Zaakceptowano do druku: 26.02.2015. 499.
(8) P R A C E O R Y G I N A L N E poł ożn i ct wo. DOI: 10.17772/gp/652. Ginekol Pol. 2015, 86, 499-503. Patrycja Świerzewska et al. Family, anthropometric and biochemical factors affecting birth weight of infants born to GDM women.. Streszczenie Cel pracy: Cukrzyca ciążowa (Gestational Diabetes Mellitus – GDM) dotyczy do 25% ciąż na całym świecie. Nieleczona prowadzi do zwiększonej częstości powikłań zarówno u kobiet jak i noworodków. Wczesna diagnostyka i leczenie cukrzycy jest niezbędne do zapobieżenia makrosomii. Mimo tego noworodki kobiet z cukrzycą często mają zwiększoną masę urodzeniową. Celem tego badania była ocena wpływu wybranych czynników które mogą mieć wpływ na masę ciała noworodka. Materiał i metody: Badaniem objęto 152 kobiety z GDM oraz 58 zdrowych kobiet w ciąży. Zebrano dane antropometryczne obojga rodziców, parametry biochemiczne matek, oraz dane dotyczące masy ciała noworodków. Wyniki: Niezależnymi czynnikami które wpływają na masę urodzeniową noworodków są: czas trwania ciąży, palenie tytoniu przez matkę, jak również masa ciała ojca – zarówno aktualna jak I urodzeniowa. Ryzyko urodzenia dziecka z hipertrofią (LGA) wzrasta wraz z diagnozą cukrzycy ciążowej, wyższą masą ciała matki przed ciążą i wyższą glikemią na czczo. Nie stwierdzono korelacji pomiędzy matczyną glikemią na czczo, stężeniem HbA1c, 1,5-AG, i lipidów a masą ciała noworodka. Wnioski: Stwierdziliśmy, że czynnikami LGA są: cukrzyca ciążowa, wysoka masa ciała matki przed ciążą i aktualna masa ciała ojca. Ani HbA1c ani 1,5-AG nie były predykatorami masy ciała noworodka lub wystąpienia LGA w badanej populacji.. Słowa kluczowe: / /
(9) / LGA /. Introduction
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(898) /. 6. Stickle D, Turk J. A kinetic mass balance model for 1,5-anhydroglucitol: applications to monitoring of glycemic control. Am J Physiol. 1997, 273 (4Pt 1), E821-E830. 7. Dworacka M, Winiarska H, Szymanska M, [et al.]. 1,5-anhydro-D-glucitol: a novel marker of glucose excursions. Int J Clin Pract Suppl. 2002, 129, 40-44. 8. Dworacka M, Wender-Ozegowska E, Winiarska H, [et al.]. Plasma anhydro-D-glucitol (1,5-AG) as an indicator of hyperglycaemic excursions in pregnant women with diabetes. Diabet Med. 2006, 23, 171-175. 9. Christensen BL, Williams M. Assessing postprandial glucose using 1,5-anhydroglucitol: An integrative literature review. J Am Acad Nurse Pract. 2009, 21, 542-548. 10. Nowak N, Skupien J, Cyganek K, [et al.]. 1,5-Anhydroglucitol as a marker of maternal glycaemic control and predictor of neonatal birthweight in pregnancies complicated by type 1 diabetes mellitus. Diabetologia. 2013, 56, 709-713. 11. Voldner N, Qvigstad E, Froslie KF, [et al.]. Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose. J Matern Fetal Neonatal Med. 2010, 23, 74-81. 12. Heiskanen N, Raatikainen K, Heinonen S. Fetal macrosomia--a continuing obstetric challenge. Biol Neonate. 2006, 90, 98-103. 13. Owens LA, O’Sullivan EP, Kirwan B, [et al.]. ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women. Diabetes Care. 2010, 33, 577-579. 14. Gutaj P, Wender-Ożegowska E, Mantaj U, Zawiejska A, Brązert J: Maternal body mass index and their association with perinatal outcome in women with gestational diabetes. Ginekol Pol. 2011, 82, 827-833. 15. Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA. Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population. Obstet Gynecol. 2003, 102, 1022-1027. 16.. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. N Engl J Med. 1993, 329, 977-986.. 17. Stratton IM, Adler AI, Neil HA, [et al.]. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000, 321, 405-412. 18. O’Shea P, O’Connor C, Owens L, [et al.]. Trimester-specific reference intervals for IFCC standardised haemoglobin A(1c): new criterion to diagnose gestational diabetes mellitus (GDM)? Ir Med J. 2012, 105, 29-31. 19. Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes: a reappraisal of HBA1c as a screening test. Acta Obstet Gynecol Scand. 2005, 84, 1159-1163. 20. Yamanouchi T, Ogata N, Tagaya T, [et al.]. Clinical usefulness of serum 1,5-anhydroglucitol in monitoring glycaemic control. Lancet. 1996, 347, 1514-1518. 21. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005, 115, 485-491.. Oświadczenie autorów: 1. Patrycja Świerzewska – opracowanie koncepcji i założeń pracy, zebranie i opracowanie materiału, obliczenia statystyczne, współautor pracy, korekta i aktualizacja literatury. 2. Marcin Kosiński – przygotowanie manuskryptu i piśmiennictwa, tłumaczenie manuskryptu – autor zgłaszający i odpowiedzialny za manuskrypt. 3. Marzena Wójcik – wykonanie oznaczeń laboratoryjnych. 4. Marzena Dworacka – wykonanie oznaczeń laboratoryjnych. 5. Katarzyna Cypryk – autor koncepcji i założeń badań, nadzór merytoryczny i naukowy nad przebiegiem badań, współautor pracy, korekta i ostateczna akceptacja manuskryptu. Źródło finansowania: Praca finansowana ze środków na cele statutowe Kliniki. Konflikt interesów: Autorzy nie zgłaszają konfliktu interesów oraz nie otrzymali żadnego wynagrodzenia związanego z powstawaniem pracy.. 22. Cypryk K, Pertynska-Marczewska M, Szymczak W, [et al.]. [Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers]. Przegl Lek. 2005, 62, 38-41. 23. Moses RG, Mackay MT. Gestational diabetes: Is there a relationship between leg length and glucose tolerance? Diabetes Care. 2004, 27, 1033-1035. 24. Ogonowski J, Miazgowski T. Are short women at risk for gestational diabetes mellitus? Eur J Endocrinol. 2010, 162, 491-497. 25. Ben-Haroush A, Hadar E, Chen R, [et al.]. Maternal obesity is a major risk factor for large-forgestational-infants in pregnancies complicated by gestational diabetes. Arch Gynecol Obstet. 2009, 279, 539-543. 26. Jaipaul JV, Newburn-Cook CV, O’Brien B, Demianczuk N. Modifiable risk factors for term large for gestational age births. Health Care Women Int. 2009, 30, 802-823. 27. Kaymak O, Iskender CT, Ustunyurt E, [et al.]. Retrospective evaluation of perinatal outcome in women with mild gestational hyperglycemia. J Obstet Gynaecol Res. 2011, 37, 986-991. 28. Sarkar S, Watman J, Seigel WM, Schaeffer HA. A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al). J Perinatol. 2003, 23, 223-228. 29. Shah PS. Paternal factors and low birthweight, preterm, and small for gestational age births: a systematic review. Am J Obstet Gynecol. 2010, 202, 103-123. 30. Katon J, Williams MA, Reiber G, Miller E. Antepartum A1C, maternal diabetes outcomes, and selected offspring outcomes: an epidemiological review. Paediatr Perinat Epidemiol. 2011, 25, 265-276. 31. Mikkelsen MR, Nielsen SB, Stage E, [et al.]. High maternal HbA1c is associated with overweight in neonates. Dan Med Bull. 2011, 58, A4309. 32. Katon J, Reiber G, Williams MA, [et al.]. Antenatal haemoglobin A1c and risk of large-forgestational-age infants in a multi-ethnic cohort of women with gestational diabetes. Paediatr Perinat Epidemiol. 2012, 26, 208-217.. Refe re nc e s 1. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. WHO/ NMH/MND/13.2, WHO. 2013, 1-63. 2. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997, 20, 1183-1197.. 33. Lowe LP, Metzger BE, Dyer AR, [et al.]. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012, 35, 574-580.. 3. Boney CM, Verma A, Tucker R, Vohr BR: Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005, 115, e290-e296. 4. Lawlor DA, Lichtenstein P, Langstrom N. Association of maternal diabetes mellitus in pregnancy with offspring adiposity into early adulthood: sibling study in a prospective cohort of 280,866 men from 248,293 families. Circulation. 2011, 123, 258-265. 5. Rohlfing CL, Wiedmeyer HM, Little RR, [et al.]. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002, 25, 275-278.. Nr 7/2015. © Polskie Towarzystwo Ginekologiczne. 503.
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