Risk of Large-for-Gestational-Age Newborns in Women With Gestational Diabetes by Race and Ethnicity and Body Mass Index Categories
TL;DR: African American women with GDM have a greater risk of LGA newborns at a lower BMI than other racial and ethnic groups, and Clinicians should be aware that among women withGDM, there may be significantracial and ethnic differences in the risk of large-for-gestational-age newborns by BMI threshold.
About: This article is published in Obstetrics & Gynecology.The article was published on 2013-06-01 and is currently open access. It has received 53 citations till now. The article focuses on the topics: Gestational diabetes & Body mass index.
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TL;DR: Pregnancies following HRC-FET are associated with higher risks of HDPs and placenta accreta and a lower risk of GDM, and the association between the endometrium preparation method and obstetrical complication merits further attention.
Abstract: Study question What were the risks with regard to the pregnancy outcomes of patients who conceived by frozen-thawed embryo transfer (FET) during a hormone replacement cycle (HRC-FET)? Summary answer The patients who conceived by HRC-FET had increased risks of hypertensive disorders of pregnancy (HDP) and placenta accreta and a reduced risk of gestational diabetes mellitus (GDM) in comparison to those who conceived by FET during a natural ovulatory cycle (NC-FET) What is known already Previous studies have shown that pregnancy and live-birth rates after HRC-FET and NC-FET are comparable Little has been clarified regarding the association between endometrium preparation and other pregnancy outcomes Study design, size, duration A retrospective cohort study of patients who conceived after HRC-FET and those who conceived after NC-FET was performed based on the Japanese assisted reproductive technology registry in 2014 Participants/materials, setting, methods The pregnancy outcomes were compared between NC-FET (n = 29 760) and HRC-FET (n = 75 474) cycles Multiple logistic regression analyses were performed to investigate the potential confounding factors Main results and the role of chance The pregnancy rate (321% vs 361%) and the live birth rate among pregnancies (671% vs 719%) in HRC-FET cycles were significantly lower than those in NC-FET cycles A multiple logistic regression analysis showed that pregnancies after HRC-FET had increased odds of HDPs [adjusted odds ratio, 143; 95% confidence interval (CI), 114-180] and placenta accreta (adjusted odds ratio, 691; 95% CI, 287-1666) and decreased odds for GDM (adjusted odds ratio, 052; 95% CI, 040-068) in comparison to pregnancies after NC-FET Limitations, reasons for caution Our study was retrospective in nature, and some cases were excluded due to missing data The implication of bias and residual confounding factors such as body mass index, alcohol consumption, and smoking habits should be considered in other observational studies Wider implications of the findings Pregnancies following HRC-FET are associated with higher risks of HDPs and placenta accreta and a lower risk of GDM The association between the endometrium preparation method and obstetrical complication merits further attention Study funding/competing interest(s) No funding was obtained for this work The authors declare no conflicts of interest in association with the present study Trial registration number Not applicable
135 citations
TL;DR: Evidence supports a direct causal role for exposure to maternal diabetes in utero in determining offspring long-term greater adiposity and adverse cardiometabolic health.
Abstract: In this review, we critically assess recent evidence from human studies regarding the potential implications of exposure to maternal diabetes in-utero for long-term adiposity, cardiometabolic outcomes, and cognitive ability of the offspring. Evidence supports a direct causal role for exposure to maternal diabetes in utero in determining offspring long-term greater adiposity and adverse cardiometabolic health. Although a majority of observational studies report associations of exposure to maternal pregnancy diabetes with lower cognitive ability, there is also evidence supporting an opposite ‘protective’ intrauterine effect of exposure to maternal pregnancy diabetes on offspring cognitive ability. Epigenetic modification has been suggested as a mediator on the pathways from maternal pregnancy diabetes to long-term offspring outcomes and several recent studies that are reviewed here lend some support to this notion, but research in this area is still too novel to be conclusive.
116 citations
TL;DR: The evidence that determinants of childhood obesity act at many levels and at different stages of childhood is of policy relevance to those planning early health promotion and primary prevention programs as it suggests the need to address the individual, the family, the physical environment, the social environment, and social policy.
Abstract: The prevalence of childhood obesity has increased globally over the past three decades, with evidence of recent leveling off in developed countries. Reduction in the, currently high, prevalence of obesity will require a full understanding of the biological and social pathways to obesity in order to develop appropriately targeted prevention strategies in early life. Determinants of childhood obesity include individual level factors, including biological, social, and behavioral risks, acting within the influence of the child's family environment, which is, in turn, imbedded in the context of the community environment. These influences act across childhood, with suggestions of early critical periods of biological and behavioral plasticity. There is evidence of sex and gender differences in the responses of boys and girls to their environments. The evidence that determinants of childhood obesity act at many levels and at different stages of childhood is of policy relevance to those planning early health promotion and primary prevention programs as it suggests the need to address the individual, the family, the physical environment, the social environment, and social policy. The purpose of this narrative review is to summarize current, and emerging, literature in a multilevel, life course framework.
112 citations
Cites background from "Risk of Large-for-Gestational-Age N..."
...Risk factors for large infant birth weight for gestational age include maternal obesity and maternal gestational diabetes (64,65) with African-American women exhibiting risk at lower maternal BMI thresholds (66)....
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TL;DR: Following intrauterine exposure to meetformin for treatment of maternal GDM, neonates are significantly smaller than neonates whose mothers were treated with insulin during pregnancy, and metformin-exposed children appear to experience accelerated postnatal growth, resulting in heavier infants and higher BMI by mid-childhood compared to children whosemothers were treatment with insulin.
Abstract: Background Metformin is increasingly offered as an acceptable and economic alternative to insulin for treatment of gestational diabetes mellitus (GDM) in many countries. However, the impact of maternal metformin treatment on the trajectory of fetal, infant, and childhood growth is unknown. Methods and findings PubMed, Ovid Embase, Medline, Web of Science, ClinicalTrials.gov, and the Cochrane database were systematically searched (from database inception to 26 February 2019). Outcomes of GDM-affected pregnancies randomised to treatment with metformin versus insulin were included (randomised controlled trials and prospective randomised controlled studies) from cohorts including European, American, Asian, Australian, and African women. Studies including pregnant women with pre-existing diabetes or non-diabetic women were excluded, as were trials comparing metformin treatment with oral glucose-lowering agents other than insulin. Two reviewers independently assessed articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Outcome measures were parameters of fetal, infant, and childhood growth, including weight, height, BMI, and body composition. In total, 28 studies (n = 3,976 participants) met eligibility criteria and were included in the meta-analysis. No studies reported fetal growth parameters; 19 studies (n = 3,723 neonates) reported measures of neonatal growth. Neonates born to metformin-treated mothers had lower birth weights (mean difference −107.7 g, 95% CI −182.3 to −32.7, I2 = 83%, p = 0.005) and lower ponderal indices (mean difference −0.13 kg/m3, 95% CI −0.26 to 0.00, I2 = 0%, p = 0.04) than neonates of insulin-treated mothers. The odds of macrosomia (odds ratio [OR] 0.59, 95% CI 0.46 to 0.77, p < 0.001) and large for gestational age (OR 0.78, 95% CI 0.62 to 0.99, p = 0.04) were lower following maternal treatment with metformin compared to insulin. There was no difference in neonatal height or incidence of small for gestational age between groups. Two studies (n = 411 infants) reported measures of infant growth (18–24 months of age). In contrast to the neonatal phase, metformin-exposed infants were significantly heavier than those in the insulin-exposed group (mean difference 440 g, 95% CI 50 to 830, I2 = 4%, p = 0.03). Three studies (n = 520 children) reported mid-childhood growth parameters (5–9 years). In mid-childhood, BMI was significantly higher (mean difference 0.78 kg/m2, 95% CI 0.23 to 1.33, I2 = 7%, p = 0.005) following metformin exposure than following insulin exposure, although the difference in absolute weights between the groups was not significantly different (p = 0.09). Limited evidence (1 study with data treated as 2 cohorts) suggested that adiposity indices (abdominal [p = 0.02] and visceral [p = 0.03] fat volumes) may be higher in children born to metformin-treated compared to insulin-treated mothers. Study limitations include heterogeneity in metformin dosing, heterogeneity in diagnostic criteria for GDM, and the scarcity of reporting of childhood outcomes. Conclusions Following intrauterine exposure to metformin for treatment of maternal GDM, neonates are significantly smaller than neonates whose mothers were treated with insulin during pregnancy. Despite lower average birth weight, metformin-exposed children appear to experience accelerated postnatal growth, resulting in heavier infants and higher BMI by mid-childhood compared to children whose mothers were treated with insulin. Such patterns of low birth weight and postnatal catch-up growth have been reported to be associated with adverse long-term cardio-metabolic outcomes. This suggests a need for further studies examining longitudinal perinatal and childhood outcomes following intrauterine metformin exposure. This review protocol was registered with PROSPERO under registration number CRD42018117503.
109 citations
TL;DR: Maternal fasting glucose and HDL-cholesterol were predictors of offspring’s birth weight, and fasting and 2-hour glucose were predictor of neonatal sum of skinfolds, independently of weight gain, which was higher in non-Europeans than in Europeans.
Abstract: Maternal glucose and lipid levels are associated with neonatal anthropometry of the offspring, also independently of maternal body mass index (BMI). Gestational weight gain, however, is often not accounted for. The objective was to explore whether the effects of maternal glucose and lipid levels on offspring’s birth weight and subcutaneous fat were independent of early pregnancy BMI and mid-gestational weight gain. In a population-based, multi-ethnic, prospective cohort of 699 women and their offspring, maternal anthropometrics were collected in gestational week 15 and 28. Maternal fasting plasma lipids, fasting and 2-hour glucose post 75 g glucose load, were collected in gestational week 28. Maternal risk factors were standardized using z-scores. Outcomes were neonatal birth weight and sum of skinfolds in four different regions. Mean (standard deviation) birth weight was 3491 ± 498 g and mean sum of skinfolds was 18.2 ± 3.9 mm. Maternal fasting glucose and HDL-cholesterol were predictors of birth weight, and fasting and 2-hour glucose were predictors of neonatal sum of skinfolds, independently of weight gain as well as early pregnancy BMI, gestational week at inclusion, maternal age, parity, smoking status, ethnic origin, gestational age and offspring’s sex. However, weight gain was the strongest independent predictor of both birth weight and neonatal sum of skinfolds, with a 0.21 kg/week increased weight gain giving a 110.7 (95% confidence interval 76.6-144.9) g heavier neonate, and with 0.72 (0.38-1.06) mm larger sum of skinfolds. The effect size of mother’s early pregnancy BMI on birth weight was higher in non-Europeans than in Europeans. Maternal fasting glucose and HDL-cholesterol were predictors of offspring’s birth weight, and fasting and 2-hour glucose were predictors of neonatal sum of skinfolds, independently of weight gain. Mid-gestational weight gain was a stronger predictor of both birth weight and neonatal sum of skinfolds than early pregnancy BMI, maternal glucose and lipid levels.
40 citations
Cites result from "Risk of Large-for-Gestational-Age N..."
...Our finding that BMI had a different effect on birth weight in nonEuropeans than in Europeans, is supported by other studies who also found interactions between ethnicity and BMI in relation to prevalence of diabetes [18], gestational diabetes [33] as well as the risk of offspring born large for gestational age in women with gestational diabetes [34]....
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References
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TL;DR: It is confirmed that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States.
Abstract: ContextAtrial fibrillation is the most common arrhythmia in elderly persons
and a potent risk factor for stroke. However, recent prevalence and projected
future numbers of persons with atrial fibrillation are not well described.ObjectiveTo estimate prevalence of atrial fibrillation and US national projections
of the numbers of persons with atrial fibrillation through the year 2050.Design, Setting, and PatientsCross-sectional study of adults aged 20 years or older who were enrolled
in a large health maintenance organization in California and who had atrial
fibrillation diagnosed between July 1, 1996, and December 31, 1997.Main Outcome MeasuresPrevalence of atrial fibrillation in the study population of 1.89 million;
projected number of persons in the United States with atrial fibrillation
between 1995-2050.ResultsA total of 17 974 adults with diagnosed atrial fibrillation were
identified during the study period; 45% were aged 75 years or older. The prevalence
of atrial fibrillation was 0.95% (95% confidence interval, 0.94%-0.96%). Atrial
fibrillation was more common in men than in women (1.1% vs 0.8%; P<.001). Prevalence increased from 0.1% among adults younger than
55 years to 9.0% in persons aged 80 years or older. Among persons aged 50
years or older, prevalence of atrial fibrillation was higher in whites than
in blacks (2.2% vs 1.5%; P<.001). We estimate
approximately 2.3 million US adults currently have atrial fibrillation. We
project that this will increase to more than 5.6 million (lower bound, 5.0;
upper bound, 6.3) by the year 2050, with more than 50% of affected individuals
aged 80 years or older.ConclusionsOur study confirms that atrial fibrillation is common among older adults
and provides a contemporary basis for estimates of prevalence in the United
States. The number of patients with atrial fibrillation is likely to increase
2.5-fold during the next 50 years, reflecting the growing proportion of elderly
individuals. Coordinated efforts are needed to face the increasing challenge
of optimal stroke prevention and rhythm management in patients with atrial
fibrillation.
6,054 citations
"Risk of Large-for-Gestational-Age N..." refers background in this paper
...The demographic, racial and ethnic, and socioeconomic make-up of the Kaiser Permanente Northern California membership is well-representative of the population residing in the same geographic area, except that the very poor and the very wealthy are under-represented.(12,13) Women with GDM were identified through the Kaiser Permanente Northern California Gestational Diabetes Registry, which previously has been described in detail....
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TL;DR: Obesity has increased at an alarming rate in the United States over the past three decades and the associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic.
Abstract: This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m) 2 ) cutpoints of 25 and 30, respectively; childhood ‘‘at risk for overweight’’ and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.
2,780 citations
"Risk of Large-for-Gestational-Age N..." refers background in this paper
...Gestational diabetes mellitus (GDM), defined ascarbohydrate intolerance with onset or first recognition during pregnancy, affects approximately 7% of all pregnancies in the United States.1,2 It is associated with short-term and long-term health implications for the mother and her newborn, including cesarean delivery and subsequent type 2 diabetes for the mother and macrosomia, being large for gestational age (LGA), and subsequent childhood obesity for the newborn.3 The prevalence of GDM has increased by 35% in recent years and varies significantly by racial and ethnic groups; it is highest in Asian and Hispanic women and lowest in white and African American women.2,4 These racial and ethnic disparities are surprising given that obesity is the strongest known risk factor for GDM, and the prevalence of obesity is highest in African Americans and lowest in Asians.5 It is less clear whether there are also racial and ethnic disparities in the risk of complications most commonly associated with GDM....
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...These racial and ethnic disparities are surprising given that obesity is the strongest known risk factor for GDM, and the prevalence of obesity is highest in African Americans and lowest in Asians.(5) It is less clear whether there are also racial and ethnic disparities in the risk of complications most commonly associated with GDM....
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TL;DR: Test results suggest that thresholds for further testing be lowered from 143 to 135 mg/dl of plasma glucose, where further testing is required.
1,733 citations
"Risk of Large-for-Gestational-Age N..." refers methods in this paper
...Gestational diabetes was defined as having at least two plasma glucose values on the 100-g, 3-hour OGTT meeting or exceeding the Carpenter-Coustan thresholds (fasting, 95 mg/dL; 1-hour, 180 mg/dL; 2-hour, 155 mg/dL; 3-hour, 140 mg/dL).(15) As a surrogate measure of severity of GDM, we used the fasting value from the OGTT because previous research has shown it to be the most predictive of risk of having an LGA newborn....
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TL;DR: This census-based methodology offers a valid and useful approach to overcoming the absence of socioeconomic data in most US medical records.
Abstract: BACKGROUND. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million), with the link provided by each individual's residential address. Among a subset of 14,420 Black and White members, comparisons were made of the association of individual, census tract, and census block-group socioeconomic measures with hypertension, height, smoking, and reproductive history. RESULTS. Census-level and individual-level socioeconomic measures were similarly associated with the selected health outcomes. Census data permitted assessing response bias due to missing individual-level socioeconomic data and also contextual effects involving the interactio...
1,666 citations
"Risk of Large-for-Gestational-Age N..." refers background in this paper
...The demographic, racial and ethnic, and socioeconomic make-up of the Kaiser Permanente Northern California membership is well-representative of the population residing in the same geographic area, except that the very poor and the very wealthy are under-represented.(12,13) Women with GDM were identified through the Kaiser Permanente Northern California Gestational Diabetes Registry, which previously has been described in detail....
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TL;DR: Comparisons in anthropometry show that Asians had more subcutaneous fat than did whites and had different fat distributions from whites, and the magnitude of differences between the two races was greater in females than in males.
822 citations
Additional excerpts
...VOL. 121, NO. 6, JUNE 2013 Sridhar et al Race, BMI, and LGA Risk in Women With GDM 1259 BMI.23 Dornhorst et al24 found that more Asian women with GDM delivered LGA newborn compared with white women with GDM....
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...Finally, missing data on height and weight resulted in the loss of a large number of patients; however, missing cases were similar in demographics to those with information on BMI....
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...BMI.(23) Dornhorst et al(24) found that more Asian women with GDM delivered LGA newborn compared with white women with GDM....
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...Another study found that African American women with pregnancy-impaired glucose tolerance (a hyperglycemic condition not severe enough to be classified as GDM) had higher rates of newborns with macrosomia and LGA compared with white women with impaired glucose tolerance during pregnancy.20 Less research has been performed assessing the effect of GDM on birth weight by race and ethnicity and BMI....
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...056); therefore, we decided to perform the fully adjusted model stratified by each of the five racial and ethnic groups to further estimate differences in risk of having an LGA newborn by race and ethnicity and BMI....
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