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Pregnancy insulin, glucose, and BMI contribute to birth outcomes in nondiabetic mothers.

Ong KK, Diderholm B, Salzano G, Wingate D, Hughes IA, MacDougall J, Acerini CL, Dunger DB - Diabetes Care (2008)

Bottom Line: We investigated the effects of normal variations in maternal glycemia on birth size and other birth outcomes.In the retrospective study, within the nondiabetic range (2.1-7.8 mmol/l), each 1 mmol/l rise in the mother's 60-min glucose level was associated with a (mean +/- SEM) 2.1 +/- 0.8% (P = 0.006) rise in absolute risk of assisted vaginal delivery, a 3.4 +/- 0.8% (P < 0.0001) rise in emergency cesarean delivery, a 3.1 +/- 0.7% (P < 0.0001) rise in elective cesarean delivery, and a 46 +/- 8 g (P < 0.0001) increase in offspring birth weight.In the prospective study, fetal macrosomia (birth weight >90th centile) was independently related to the mother's fasting glucose (odds ratio 2.61 per +1 mmol/l [95% CI 1.15-5.93]) and prepregnancy BMI (1.10 per +1 kg/m(2) [1.04-1.18]).

View Article: PubMed Central - PubMed

Affiliation: MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK.

ABSTRACT

Objective: We investigated the effects of normal variations in maternal glycemia on birth size and other birth outcomes.

Research design and methods: Women in two unselected birth cohorts, one retrospective (n = 3,158) and one prospective (n = 668), underwent an oral glucose challenge at 28 weeks of gestation. In the retrospective study, glycemia was linked to routine birth records. In the prospective study, offspring adiposity was assessed by skinfold thickness from birth to age 24 months.

Results: In the retrospective study, within the nondiabetic range (2.1-7.8 mmol/l), each 1 mmol/l rise in the mother's 60-min glucose level was associated with a (mean +/- SEM) 2.1 +/- 0.8% (P = 0.006) rise in absolute risk of assisted vaginal delivery, a 3.4 +/- 0.8% (P < 0.0001) rise in emergency cesarean delivery, a 3.1 +/- 0.7% (P < 0.0001) rise in elective cesarean delivery, and a 46 +/- 8 g (P < 0.0001) increase in offspring birth weight. In the prospective study, fetal macrosomia (birth weight >90th centile) was independently related to the mother's fasting glucose (odds ratio 2.61 per +1 mmol/l [95% CI 1.15-5.93]) and prepregnancy BMI (1.10 per +1 kg/m(2) [1.04-1.18]). The mother's higher fasting glycemia (P = 0.004), lower insulin sensitivity (P = 0.01), and lower insulin secretion (P = 0.02) were independently related to greater offspring adiposity at birth. During postnatal follow-up, the correlation between the mother's glycemia and offspring adiposity disappeared by 3 months, whereas prepregnancy BMI was associated with offspring adiposity that was only apparent at 12 and 24 months (both P < 0.05).

Conclusions: Prepregnancy BMI, pregnancy glycemia, insulin sensitivity, and insulin secretion all contribute to offspring adiposity and macrosomia and may be separate targets for intervention to optimize birth outcomes and later offspring health.

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Distinct postnatal influences of the mother's prepregnancy BMI and gestational fasting glucose level on offspring skinfold thicknesses during infancy (birth to 24 months). Standardized correlation coefficients (β ± 95% CI) from multivariable models that included both BMI and fasting glucose as determinants are shown. *P < 0.05.
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f2: Distinct postnatal influences of the mother's prepregnancy BMI and gestational fasting glucose level on offspring skinfold thicknesses during infancy (birth to 24 months). Standardized correlation coefficients (β ± 95% CI) from multivariable models that included both BMI and fasting glucose as determinants are shown. *P < 0.05.

Mentions: In the prospective Cambridge Baby Growth Study, prepregnancy BMI correlated positively with offspring adiposity at ages 12 and 24 months (both P < 0.05). However, the correlation between the mother's glycemia and offspring adiposity, which had been apparent at birth, disappeared from age 3 months onward (Fig. 2). Accordingly, higher maternal fasting glucose levels were associated with a decline in offspring adiposity between birth to age 12 months (β = −0.218, P < 0.0001).


Pregnancy insulin, glucose, and BMI contribute to birth outcomes in nondiabetic mothers.

Ong KK, Diderholm B, Salzano G, Wingate D, Hughes IA, MacDougall J, Acerini CL, Dunger DB - Diabetes Care (2008)

Distinct postnatal influences of the mother's prepregnancy BMI and gestational fasting glucose level on offspring skinfold thicknesses during infancy (birth to 24 months). Standardized correlation coefficients (β ± 95% CI) from multivariable models that included both BMI and fasting glucose as determinants are shown. *P < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571044&req=5

f2: Distinct postnatal influences of the mother's prepregnancy BMI and gestational fasting glucose level on offspring skinfold thicknesses during infancy (birth to 24 months). Standardized correlation coefficients (β ± 95% CI) from multivariable models that included both BMI and fasting glucose as determinants are shown. *P < 0.05.
Mentions: In the prospective Cambridge Baby Growth Study, prepregnancy BMI correlated positively with offspring adiposity at ages 12 and 24 months (both P < 0.05). However, the correlation between the mother's glycemia and offspring adiposity, which had been apparent at birth, disappeared from age 3 months onward (Fig. 2). Accordingly, higher maternal fasting glucose levels were associated with a decline in offspring adiposity between birth to age 12 months (β = −0.218, P < 0.0001).

Bottom Line: We investigated the effects of normal variations in maternal glycemia on birth size and other birth outcomes.In the retrospective study, within the nondiabetic range (2.1-7.8 mmol/l), each 1 mmol/l rise in the mother's 60-min glucose level was associated with a (mean +/- SEM) 2.1 +/- 0.8% (P = 0.006) rise in absolute risk of assisted vaginal delivery, a 3.4 +/- 0.8% (P < 0.0001) rise in emergency cesarean delivery, a 3.1 +/- 0.7% (P < 0.0001) rise in elective cesarean delivery, and a 46 +/- 8 g (P < 0.0001) increase in offspring birth weight.In the prospective study, fetal macrosomia (birth weight >90th centile) was independently related to the mother's fasting glucose (odds ratio 2.61 per +1 mmol/l [95% CI 1.15-5.93]) and prepregnancy BMI (1.10 per +1 kg/m(2) [1.04-1.18]).

View Article: PubMed Central - PubMed

Affiliation: MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK.

ABSTRACT

Objective: We investigated the effects of normal variations in maternal glycemia on birth size and other birth outcomes.

Research design and methods: Women in two unselected birth cohorts, one retrospective (n = 3,158) and one prospective (n = 668), underwent an oral glucose challenge at 28 weeks of gestation. In the retrospective study, glycemia was linked to routine birth records. In the prospective study, offspring adiposity was assessed by skinfold thickness from birth to age 24 months.

Results: In the retrospective study, within the nondiabetic range (2.1-7.8 mmol/l), each 1 mmol/l rise in the mother's 60-min glucose level was associated with a (mean +/- SEM) 2.1 +/- 0.8% (P = 0.006) rise in absolute risk of assisted vaginal delivery, a 3.4 +/- 0.8% (P < 0.0001) rise in emergency cesarean delivery, a 3.1 +/- 0.7% (P < 0.0001) rise in elective cesarean delivery, and a 46 +/- 8 g (P < 0.0001) increase in offspring birth weight. In the prospective study, fetal macrosomia (birth weight >90th centile) was independently related to the mother's fasting glucose (odds ratio 2.61 per +1 mmol/l [95% CI 1.15-5.93]) and prepregnancy BMI (1.10 per +1 kg/m(2) [1.04-1.18]). The mother's higher fasting glycemia (P = 0.004), lower insulin sensitivity (P = 0.01), and lower insulin secretion (P = 0.02) were independently related to greater offspring adiposity at birth. During postnatal follow-up, the correlation between the mother's glycemia and offspring adiposity disappeared by 3 months, whereas prepregnancy BMI was associated with offspring adiposity that was only apparent at 12 and 24 months (both P < 0.05).

Conclusions: Prepregnancy BMI, pregnancy glycemia, insulin sensitivity, and insulin secretion all contribute to offspring adiposity and macrosomia and may be separate targets for intervention to optimize birth outcomes and later offspring health.

Show MeSH
Related in: MedlinePlus