Fetal Growth and Neonatal Outcomes in Pregestational Diabetes Mellitus in a Population with a High Prevalence of Diabetes
Abstract
:1. Introduction
2. Methods
- Pregnancy outcomes—gestational age at childbirth (GA); hospital stay; mode of delivery (spontaneous vaginal delivery or caesarean section).
- Diseases of pregnancy and fetal pathologies—threatened abortion (vaginal bleeding and symptoms that suggest that a woman is at an increased risk of miscarriage. Threatened preterm labor is the progression of cervical dilatation and ripening caused by regular uterine contractions occurring before 37 weeks of pregnancy, which may result in preterm birth); gestational hypertension; preeclampsia and HELLP syndrome; placental abruption; pathology of amniotic fluid (oligohydramnios and polydramnios); premature rupture of membranes (PROM) and preterm rupture of membranes (P-PROM); macrosomia; fetal growth restriction (FGR); morphological abnormalities diagnosed on ultrasound.
- Neonatal outcomes—weight at birth compared to those expected for the gestational age (in percentiles), and then classification within one of the classes of appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age (LGA). For this study we used the definition of the Royal College of Obstetricians and Gynaecologists (RCOG) [12] which informs UK clinical practice, based on sonographic estimated fetal weight (EFW) measurement < 10th percentile to describe a fetus that has not reached its target weight. Patients were divided in three groups for comparison; fetuses with EFW < 10th percentile for gestational age (SGA), fetuses with EFW > 10th percentile for gestation (AGA) and fetuses > 90th percentile for gestation (LGA) according to the Alexander growth standard [13]; Apgar at the first minute and fifth minute; number of hospitalization days and at which intensity of care (nursery, neonatology or NICU); recognition of respiratory diseases at birth such as respiratory distress syndrome (RDS), transient tachycardia of the newborn (TTN) or apnea crisis, and if there has been any intubation; blood glucose at the third hour; hypoglycemia status and glucose supplementation; neonatal jaundice, treated or not with phototherapy; morphological abnormalities found at birth.
3. Results
3.1. Pregnancy Disorders
3.2. Fetal Disorders
3.3. Pregnancy Outcomes
3.4. Neonatal Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Controls (n = 116) | PGDM (n = 58) | DM1 (n = 42) | DM2 (n = 14) | p Value (Controls x PGDM) | p Value (Controls x DM1) | p Value (Controls x DM2) | |
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Median (IQR) pregestational weight, kg | 57 (50.5–63) | 61 (55.5–72.5) | 60 (55–68) | 76 (55.5–83.5) | 0.003 | ns | 0.009 |
Median (IQR) pregestational BMI, kg/m2 | 22 (19.8–24) | 23.7 (20.8–28) | 23.7 (20.8–25.9) | 28.2 (21.2–32.9) | 0.005 | 0.01 | 0.03 |
Normal weight, n (%) | 93 (80.2) | 25 (52.1) | 20 (58.8) | 3 (25.0) | <0.0001 | 0.02 | <0.0001 |
Underweight, n (%) | 7 (6.0) | 2 (4.2) | 0 (0.0) | 2 (16.7) | ns | ns | ns |
Overweight, n (%) | 14 (12.1) | 10 (20.8) | 8 (23.5) | 2 (16.7) | ns | ns | ns |
Obese, n (%) | 3 (2.6) | 8 (16.7) | 3 (8.8) | 5 (41.7) | 0.001 | ns | <0.0001 |
Median (IQR) weight increase, kg | 12 (10–14) | 11 (7.5–14) | 11.5 (9–13) | 11 (6–15.5) | ns | ns | ns |
Excessive weight increase (>12 kg), n (%) | 44 (37.9) | 19 (39.6) | 14 (41.2) | 4 (33.3) | ns | ns | ns |
Median (IQR) weight at delivery, kg | 70 (63–75) | 74 (65–85) | 73 (65–80) | 84.5 (65.0–92.5) | ns | ns | 0.02 |
Median (IQR) BMI at delivery, kg/m2 | 26.6 (24.8–28.8) | 27.9 (25.7–32.2) | 27.8 (25.8–30.1) | 30.6 (25.1–37.1) | ns | ns | ns |
Controls (n = 116) | PGDM (n = 58) | DM1 (n = 42) | DM2 (n = 14) | p Value (Controls x PGDM) | p Value (Controls x DM1) | p Value (Controls x DM2) | |
---|---|---|---|---|---|---|---|
Fetus appropriate for gestational age (AGA), n (%) | 96 (82.8) | 27 (46.6) | 17 (40.5) | 8 (57.1) | <0.0001 | <0.0001 | 0.04 |
Fetus small for gestational age (SGA), n (%) | 12 (10.3) | 4 (6.9) | 1 (2.4) | 3 (21.4) | ns | ns | ns |
Fetus large for gestational age (LGA), n (%) | 8 (6.9) | 27 (46.5) | 24 (57.1) | 3 (21.4) | <0.0001 | <0.0001 | ns |
Respiratory disorders, n (%) | 11 (9.5) | 18 (31.0) | 15 (35.7) | 3 (21.4) | <0.0001 | <0.0001 | ns |
RDS (respiratory distress syndrome), n (%) | 6 (5.2) | 17 (29.3) | 14 (33.3) | 3 (21.4) | <0.0001 | <0.0001 | ns |
TTN (neonatal transient tachypnea), n (%) | 2 (1.7) | 2 (3.5) | 2 (4.8) | 0 (0.0) | ns | ns | ns |
Neonatal intubation, n (%) | 4 (3.5) | 6 (10.3) | 6 (14.3) | 0 (0.0) | ns | 0.02 | ns |
Median (IQR) glycemia at 3 h, mg/dL | 66.5 (60–73.5) | 58.5 (37–72) | 58 (37–76) | 53 (37–67) | 0.003 | 0.02 | 0.003 |
Median (IQR) lower glycemia, mg/dL | 61.9 (14.2) | 40.3 (17.0) | 40.2 (18.1) | 41.1 (13.4) | <0.0001 | <0.0001 | <0.0001 |
Neonatal hypoglycemia, n (%) | 6 (5.2) | 38 (65.5) | 28 (66.7) | 9 (64.3) | <0.0001 | <0.0001 | <0.0001 |
Neonatal jaundice, n (%) | 29 (25.0) | 43 (74.1) | 43 (74.1) | 9 (64.3) | <0.0001 | <0.0001 | 0.002 |
Phototherapy, n (%) | 14 (12.1) | 26 (44.8) | 26 (44.8) | 4 (28.6) | <0.0001 | <0.0001 | ns |
Morphological anomalies, n (%) | 16 (13.8) | 19 (32.8) | 16 (38.1) | 2 (14.3) | 0.003 | 0.001 | ns |
PGDM n = 19 (32.8%) |
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Cardiovascular System |
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Urogenital apparatus |
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Other anomalies |
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Controls n = 16 (13.8%) |
Cardiovascular system |
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Musculoskeletal system |
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Central nervous system |
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Urogenital apparatus |
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Genetic defects |
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Other anomalies |
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Capobianco, G.; Gulotta, A.; Tupponi, G.; Dessole, F.; Virdis, G.; Cherchi, C.; De Vita, D.; Petrillo, M.; Olzai, G.; Antonucci, R.; et al. Fetal Growth and Neonatal Outcomes in Pregestational Diabetes Mellitus in a Population with a High Prevalence of Diabetes. J. Pers. Med. 2022, 12, 1320. https://doi.org/10.3390/jpm12081320
Capobianco G, Gulotta A, Tupponi G, Dessole F, Virdis G, Cherchi C, De Vita D, Petrillo M, Olzai G, Antonucci R, et al. Fetal Growth and Neonatal Outcomes in Pregestational Diabetes Mellitus in a Population with a High Prevalence of Diabetes. Journal of Personalized Medicine. 2022; 12(8):1320. https://doi.org/10.3390/jpm12081320
Chicago/Turabian StyleCapobianco, Giampiero, Alessandra Gulotta, Giulio Tupponi, Francesco Dessole, Giuseppe Virdis, Claudio Cherchi, Davide De Vita, Marco Petrillo, Giorgio Olzai, Roberto Antonucci, and et al. 2022. "Fetal Growth and Neonatal Outcomes in Pregestational Diabetes Mellitus in a Population with a High Prevalence of Diabetes" Journal of Personalized Medicine 12, no. 8: 1320. https://doi.org/10.3390/jpm12081320