Gestational Diabetes in Women with Fetal Spina Bifida Repair—Influence of Perioperative Management
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients and Study Design
2.2. Data Analysis
3. Results
3.1. Primary Outcomes
3.2. Changes in the Perioperative Protocol over the Years
3.3. Secondary Outcomes
4. Discussion
Strengths and Weaknesses
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Adzick, N.S. Fetal surgery for spina bifida: Past, present, future. Semin. Pediatr. Surg. 2013, 22, 10–17. [Google Scholar] [CrossRef]
- Copp, A.J.; Stanier, P.; Greene, N.D. Neural tube defects: Recent advances, unsolved questions, and controversies. Lancet Neurol. 2013, 12, 799–810. [Google Scholar] [CrossRef] [PubMed]
- Copp, A.J.; Adzick, N.S.; Chitty, L.S.; Fletcher, J.M.; Holmbeck, G.N.; Shaw, G.M. Spina bifida. Nat. Rev. Dis. Prim. 2015, 1, 15007. [Google Scholar] [CrossRef] [PubMed]
- Au, K.S.; Ashley-Koch, A.; Northrup, H. Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev. Disabil. Res. Rev. 2010, 16, 6–15. [Google Scholar] [CrossRef] [PubMed]
- Chitayat, D.; Matsui, D.; Amitai, Y.; Kennedy, D.; Vohra, S.; Rieder, M.; Koren, G. Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. J. Clin. Pharmacol. 2016, 56, 170–175. [Google Scholar] [CrossRef] [PubMed]
- Agopian, A.; Canfield, M.A.; Olney, R.S.; Lupo, P.J.; Ramadhani, T.; Mitchell, L.E.; Shaw, G.M.; Moore, C.A.; the National Birth Defects Prevention Study. Spina bifida subtypes and sub-phenotypes by maternal race/ethnicity in the National Birth Defects Prevention Study. Am. J. Med. Genet. A 2012, 158A, 109–115. [Google Scholar] [CrossRef]
- Matok, I.; Gorodischer, R.; Koren, G.; Landau, D.; Wiznitzer, A.; Levy, A. Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations. Br. J. Clin. Pharmacol. 2009, 68, 956–962. [Google Scholar] [CrossRef]
- Parker, S.E.; Yazdy, M.M.; Tinker, S.C.; Mitchell, A.A.; Werler, M.M. The impact of folic acid intake on the association among diabetes mellitus, obesity, and spina bifida. Am. J. Obstet. Gynecol. 2013, 209, 239.e231–239.e238. [Google Scholar] [CrossRef]
- Stothard, K.J.; Tennant, P.W.G.; Bell, R.; Rankin, J. Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA 2009, 301, 636–650. [Google Scholar] [CrossRef]
- Adzick, N.S.; Thom, E.A.; Spong, C.Y.; Brock, J.W.I.; Burrows, P.K.; Johnson, M.P.; Howell, L.J.; Farrell, J.A.; Dabrowiak, M.E.; Sutton, L.N.; et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N. Engl. J. Med. 2011, 364, 993–1004. [Google Scholar] [CrossRef]
- Möhrlen, U.; Ochsenbein-Kölble, N.; Mazzone, L.; Kraehenmann, F.; Hüsler, M.; Casanova, B.; Biro, P.; Wille, D.; Latal, B.; Scheer, I.; et al. Benchmarking against the MOMS Trial: Zurich Results of Open Fetal Surgery for Spina Bifida. Fetal Diagn. Ther. 2020, 47, 91–97. [Google Scholar] [CrossRef]
- Moehrlen, U.; Ochsenbein, N.; Vonzun, L.; Mazzone, L.; Horst, M.; Schauer, S.; Wille, D.A.; Hagmann, C.; Kottke, R.; Grehten, P.; et al. Fetal surgery for spina bifida in Zurich: Results from 150 cases. Pediatr. Surg. Int. 2021, 37, 311–316. [Google Scholar] [CrossRef] [PubMed]
- Sepulveda, W.; Cruz-Martinez, R.; Etchegaray, A.; Sanin-Blair, J.; Ventura, W.; Corral, E.; Marquez, R. Open intrauterine repair of spina bifida aperta: Historical aspects, current availability, and clinical outcomes from the Latin American Spina Bifida Consortium. Prenat. Diagn. 2021, 41, 933–941. [Google Scholar] [CrossRef]
- Winder, F.M.; Vonzun, L.; Meuli, M.; Moehrlen, U.; Mazzone, L.; Krähenmann, F.; Hüsler, M.; Zimmermann, R.; Ochsenbein-Kölble, N. Maternal Complications following Open Fetal Myelomeningocele Repair at the Zurich Center for Fetal Diagnosis and Therapy. Fetal Diagn. Ther. 2019, 46, 153–158. [Google Scholar] [CrossRef]
- Vonzun, L.; Kahr, M.; Noll, F.; Mazzone, L.; Moehrlen, U.; Meuli, M.; Hüsler, M.; Krähenmann, F.; Zimmermann, R.; Ochsenbein-Kölble, N. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair—Results from a large prospective cohort. BJOG 2021, 128, 1184–1191. [Google Scholar] [CrossRef] [PubMed]
- Paulo, M.S.; Abdo, N.M.; Bettencourt-Silva, R.; Al-Rifai, R.H. Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front. Endocrinol. 2021, 12, 691033. [Google Scholar] [CrossRef] [PubMed]
- Ye, W.; Luo, C.; Huang, J.; Li, C.; Liu, Z.; Liu, F. Gestational diabetes mellitus and adverse pregnancy outcomes: Systematic review and meta-analysis. BMJ 2022, 377, e067946. [Google Scholar] [CrossRef] [PubMed]
- Song, Z.; Cheng, Y.; Li, T.; Fan, Y.; Zhang, Q.; Cheng, H. Effects of obesity indices/GDM on the pregnancy outcomes in Chinese women: A retrospective cohort study. Front. Endocrinol. 2022, 13, 1029978. [Google Scholar] [CrossRef]
- 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. [Google Scholar] [CrossRef]
- Venkatesh, K.K.; Lynch, C.D.; Powe, C.E.; Costantine, M.M.; Thung, S.F.; Gabbe, S.G.; Grobman, W.A.; Landon, M.B. Risk of Adverse Pregnancy Outcomes among Pregnant Individuals with Gestational Diabetes by Race and Ethnicity in the United States, 2014–2020. JAMA 2022, 327, 1356–1367. [Google Scholar] [CrossRef]
- Anderson, J.L.; Waller, D.K.; Canfield, M.A.; Shaw, G.M.; Watkins, M.L.; Werler, M.M. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005, 16, 87–92. [Google Scholar] [CrossRef]
- Malaza, N.; Masete, M.; Adam, S.; Dias, S.; Nyawo, T.; Pheiffer, C. A Systematic Review to Compare Adverse Pregnancy Outcomes in Women with Pregestational Diabetes and Gestational Diabetes. Int. J. Environ. Res. Public Health 2022, 19, 10846. [Google Scholar] [CrossRef]
- Refuerzo, J.S.; Garg, A.; Rech, B.; Ramin, S.M.; Vidaeff, A.; Blackwell, S.C. Continuous glucose monitoring in diabetic women following antenatal corticosteroid therapy: A pilot study. Am. J. Perinatol. 2012, 29, 335–338. [Google Scholar] [CrossRef]
- Peterson, A.; Peterson, K.; Tongen, S.; Guzman, M.; Corbett, V.; Langer, O.; Mazze, R. Glucose intolerance as a consequence of oral terbutaline treatment for preterm labor. J. Fam. Pract. 1993, 36, 25–31. [Google Scholar]
- Regenstein, A.C.; Belluomini, J.; Katz, M. Terbutaline tocolysis and glucose intolerance. Obstet. Gynecol. 1993, 81, 739–741. [Google Scholar]
- Fisher, J.E.; Smith, R.S.; LaGrandeur, R.; Lorenz, R.P. Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery. Obstet. Gynecol. 1997, 90, 880–883. [Google Scholar] [CrossRef] [PubMed]
- Mijatovic-Vukas, J.; Capling, L.; Cheng, S.; Stamatakis, E.; Louie, J.; Cheung, N.W.; Markovic, T.; Ross, G.; Senior, A.; Brand-Miller, J.C.; et al. Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients 2018, 10, 698. [Google Scholar] [CrossRef] [PubMed]
- The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 650: Physical Activity and Exercise during Pregnancy and the Postpartum Period. Obstet. Gynecol. 2015, 126, e135–e142. [Google Scholar] [CrossRef] [PubMed]
- Dipietro, L.; Evenson, K.R.; Bloodgood, B.; Sprow, K.; Troiano, R.; Piercy, K.L.; Vaux-Bjerke, A.; Powell, K.E.; 2018 Physical Activity Guidelines Advisory Committee. Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review. Med. Sci. Sports Exerc. 2019, 51, 1292–1302. [Google Scholar] [CrossRef]
- Lautredou, M.; Pan-Petesch, B.; Dupré, P.-F.; Drugmanne, G.; Nowak, E.; Anouilh, F.; Briend, D.; Salomon, C.; Gourhant, L.; Le Moigne, E.; et al. Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: Results from a French cohort study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2022, 275, 31–36. [Google Scholar] [CrossRef]
- Ochsenbein-Kölble, N.; Krähenmann, F.; Hüsler, M.; Meuli, M.; Moehrlen, U.; Mazzone, L.; Biro, P.; Zimmermann, R. Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate. Fetal Diagn. Ther. 2018, 44, 59–64. [Google Scholar] [CrossRef]
- Moore, T.R.; Gale, S.; Benirschke, K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am. J. Obstet. Gynecol. 1990, 163, 907–912. [Google Scholar] [CrossRef] [PubMed]
- Hong, J.G.S.; Tan, P.C.; Kamarudin, M.; Omar, S.Z. Prophylactic metformin after antenatal corticosteroids (PROMAC): A double blind randomized controlled trial. BMC Pregnancy Childbirth 2021, 21, 138. [Google Scholar] [CrossRef] [PubMed]
- Barakat, M.N.; Youssef, R.M.; Al-Lawati, J.A. Pregnancy outcomes of diabetic women: Charting Oman’s progress towards the goals of the Saint Vincent Declaration. Ann. Saudi Med. 2010, 30, 265–270. [Google Scholar] [CrossRef] [PubMed]
- Stogianni, A.; Lendahls, L.; Landin-Olsson, M.; Thunander, M. Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden. BMC Pregnancy Childbirth 2019, 19, 159. [Google Scholar] [CrossRef]
- Kahr, M.K.; Winder, F.; Vonzun, L.; Meuli, M.; Mazzone, L.; Moehrlen, U.; Krähenmann, F.; Hüsler, M.; Zimmermann, R.; Ochsenbein-Kölble, N. Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort. Fetal Diagn. Ther. 2020, 47, 15–23. [Google Scholar] [CrossRef]
- Barakat, R.; Refoyo, I.; Coteron, J.; Franco, E. Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial. Braz. J. Phys. Ther. 2019, 23, 148–155. [Google Scholar] [CrossRef]
- Sanabria-Martinez, G.; Garcia-Hermoso, A.; Poyatos-Leon, R.; Alvarez-Bueno, C.; Sanchez-Lopez, M.; Martinez-Vizcaino, V. Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain: A meta-analysis. BJOG 2015, 122, 1167–1174. [Google Scholar] [CrossRef]
- Sosa, C.G.; Althabe, F.; Belizán, J.M.; Bergel, E. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst. Rev. 2015, 2015, CD003581. [Google Scholar] [CrossRef]
- Lauder, J.; Sciscione, A.; Biggio, J. Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management: (Replaces Consult Number 33, August 2014). Am. J. Obstet. Gynecol. 2020, 223, B2–B10. [Google Scholar] [CrossRef]
- Palacio, M.; Mottola, M.F. Activity Restriction and Hospitalization in Pregnancy: Can Bed-Rest Exercise Prevent Deconditioning? A Narrative Review. Int. J. Environ. Res. Public Health 2023, 20, 1454. [Google Scholar] [CrossRef] [PubMed]
- Meah, V.L.; Davies, G.A.; Davenport, M.H. Why can’t I exercise during pregnancy? Time to revisit medical ‘absolute’ and ‘relative’ contraindications: Systematic review of evidence of harm and a call to action. Br. J. Sports Med. 2020, 54, 1395–1404. [Google Scholar] [CrossRef] [PubMed]
Baseline Characteristics | N = 182 fSB Repair Cohort | N = 4755 Preterm Cohort | p-Value |
---|---|---|---|
Maternal age, [years] | 32.5 ± 4.8 | ||
BMI, [kg/m2] | 27.0 ± 5.3 | 23 ± 4.7 | <0.001 |
GA at surgery, [GWs, median (IQR)] | 25.3 (24.1–25.5) | - | - |
Administration of corticosteroids, N (%) | 168 (92) | 2486 (52) | <0.001 |
Administration of tocolytics, N (%) and duration [days, median (IQR) or mean ± SD]
| 163 (90), 6 (4–10) 132 (73), 19 ± 19 | 256 (5) 1011 (21) | <0.001 <0.001 |
Duration of hospitalization, [days, median (IQR)] | 18 (15–31) | 6 (4–18) | <0.001 |
GA at delivery, [GWs, median (IQR)] | 36.0 (34.0–37.0) | 36.4 (33.1–38.3) | 0.49 |
GD (N = 34) | No GD (N = 148) | p-Value | |
---|---|---|---|
BMI at surgery, [kg/m2] | 28 ± 7 | 27 ± 5 | 0.52 |
Corticosteroids for lung maturation, [N] (%) | 32 (94) | 136 (92) | 1.0 |
GA at at lung maturation, [GWs, mean ± SD] | 24.9 ± 0.9 | 24.8 ± 0.8 | 0.53 |
GA at surgery, [GWs, median (IQR)] | 25.3 (24.2–25.5) | 25.3 (24.1– 25.5) | 0.8 |
Total duration of tocolytics
| 8 (5–13) 29 ± 22 | 6 (4–9) 16 ± 17 | 0.01 0.002 |
GA at glucose tolerance test, [GWs, median (IQR)] | 27.1 (26.4–27.9) | 26.7 (26.0–27.4) | 0.04 |
Interval corticosteroid application to glucose tolerance test, [days, median (IQR)] | 16 (13–19) | 15 (12–18) | 0.18 |
Postoperative LOS, [days, median (IQR)] | 29 (17–55) | 17 (15–28) | <0.001 |
GA at delivery, [GWs, median (IQR)] | 35.4 (34.1–36.7) | 36.3 (35.0–37.4) | 0.01 |
Apgar score, [5 min, median (IQR)] | 9 (8–9) | 9 (8–9) | 0.57 |
Birth weight, [32] | 2556 ± 451 | 2563 ± 558 | 0.94 |
Percentile birthweight, [N] (%) <3. 3–9. 10–24. 25–74. 75–89. 90–97. >97. | 1 (3) 4 (12) 5 (15) 9 (26) 10 (29) 4 (12) 1 (3) | 2 (1) 8 (5) 35 (24) 49 (33) 45 (30) 5 (3) 1 (1) | 0.2 |
Pregnancy complications, [N] (%) Hypertension Preeclampsia | 0 (0) 1 (3) | 1 (1) 4 (3) | 0.8 |
1 2010–2017 N = 70 | 2 2018–2020 N = 81 | 3 2020–2022 N = 31 (early Mobilization) | p-Value | |
---|---|---|---|---|
Gestational diabetes [N] (%) | 16 (23) | 15 (19) | 3 (10) | 0.29 |
GA at surgery [GWs, median (IQR)] | 24.9 (24.4 -25.2) | 25 (24.4 -25.4) | 25.3 (24.1–25.5) | 0.41 |
Corticosteroid application [N] (%) | 57 (81) | 80 (99) | 31 (100) | <0.001 |
Duration of tocolytics
| 7 (4–11) 20 ± 18 | 6 (4–10) 21 ± 18 | 5 (4–9) 11 ± 9 | <0.001 0.007 |
LOS [days, median (IQR)] | 33.3 ± 22 | 25 ± 19 | 14 ± 6 | <0.001 |
GA at delivery [GWs, median (IQR)] | 36.2 (34.3–37.0) | 36.3 (33.0–37.6) | 37.1 (35.0–37.1) | 0.02 |
Early Mobilization (N = 31) | Bedrest for First 24 h (N = 151) | p-Value | |
---|---|---|---|
Gestational diabetes, [N] (%) | 3 (9.7) | 28 (18.5) | 0.16 |
GA at surgery, [GWs, median (IQR)] | 25.3 (24.1–25.5) | 25.2 (24.1–25.4) | 0.30 |
Corticosteroid application, [N] (%) | 31 (100) | 137 (90.7) | 0.13 |
Duration of tocolytics
| 5 (4–9) 11 ± 9 | 6 (4–10) 21 ± 20 | 0.54 0.03 |
LOS, [days, median (IQR)] | 14 ± 6 | 29 ± 20 | <0.001 |
GA at delivery, [GWs, median (IQR)] | 37.1 (35.0–37.1) | 36.2 (34.0–37.1) | 0.03 |
birth weight, [gram, mean ± SD] | 2586 ± 598 | 2557 ± 529 | 0.79 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Rüegg, L.; Vonzun, L.; Zepf, J.; Strübing, N.; Möhrlen, U.; Mazzone, L.; Meuli, M.; Spina Bifida Study Group; Ochsenbein-Kölble, N. Gestational Diabetes in Women with Fetal Spina Bifida Repair—Influence of Perioperative Management. J. Clin. Med. 2024, 13, 5029. https://doi.org/10.3390/jcm13175029
Rüegg L, Vonzun L, Zepf J, Strübing N, Möhrlen U, Mazzone L, Meuli M, Spina Bifida Study Group, Ochsenbein-Kölble N. Gestational Diabetes in Women with Fetal Spina Bifida Repair—Influence of Perioperative Management. Journal of Clinical Medicine. 2024; 13(17):5029. https://doi.org/10.3390/jcm13175029
Chicago/Turabian StyleRüegg, Ladina, Ladina Vonzun, Julia Zepf, Nele Strübing, Ueli Möhrlen, Luca Mazzone, Martin Meuli, Spina Bifida Study Group, and Nicole Ochsenbein-Kölble. 2024. "Gestational Diabetes in Women with Fetal Spina Bifida Repair—Influence of Perioperative Management" Journal of Clinical Medicine 13, no. 17: 5029. https://doi.org/10.3390/jcm13175029