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Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus.
Diabet Med. 2013 Sep; 30(9):1040-6.DM

Abstract

AIM

To identify predictors of large and small for gestational age in women with gestational diabetes mellitus.

METHODS

A retrospective audit of clinical data analysed for singleton births in women diagnosed with gestational diabetes by Australasian Diabetes in Pregnancy Society guidelines from 1994 to 2009. Exclusions were: incomplete data, delivered at < 36 weeks gestation and/or last recorded weight > 4 weeks pre-delivery. We assessed: pre-pregnancy BMI, ethnicity, total maternal weight gain, weight gain before and after treatment initiation for gestational diabetes, HbA(1c) at gestational diabetes presentation and treatment modality (diet or insulin) and smoking. Birthweight was assessed using customized percentile charts (large for gestational age > 90th; small for gestational age < 10th percentile). Multiple regression analyses were undertaken; statistical significance was p < 0.05.

RESULTS

There were 1695 women first seen at (mean ± sd) 28.1 ± 5.3 weeks gestation (range 6-39). Ethnic mix was South-East Asian 36.7%, Middle Eastern 27.6%, European 22.4%, Indian/Pakistani 8.6%, Samoan 1.9%, African 1.5% and Maori 1.1%. Therapy was diet 69.1% and insulin 30.9%. Mean total weight gain was 12.3 ± 6.1 kg, the majority (10.6 ± 6.0 kg), gained before dietary intervention. There were 7.9% small for gestational age and 15.2% large for gestational age births. Significant independent large for gestational age predictors were: weight gain before intervention, pre-pregnancy BMI, weight gain after intervention and treatment type, but not HbA1c or smoking. Significant small for gestational age predictors were: weight gain before intervention, weight gain after intervention, but not pre-pregnancy BMI, HbA(1c) or smoking.

CONCLUSION

Conventional treatment for gestational diabetes mellitus concentrates on management of blood glucose levels. The trends identified here emphasize the need to also address pregnancy weight gain stratified by pre-pregnancy BMI.

Authors+Show Affiliations

Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, NSW, Australia. Robyn.Barnes@sswahs.nsw.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23551273

Citation

Barnes, R A., et al. "Predictors of Large and Small for Gestational Age Birthweight in Offspring of Women With Gestational Diabetes Mellitus." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 30, no. 9, 2013, pp. 1040-6.
Barnes RA, Edghill N, Mackenzie J, et al. Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. Diabet Med. 2013;30(9):1040-6.
Barnes, R. A., Edghill, N., Mackenzie, J., Holters, G., Ross, G. P., Jalaludin, B. B., & Flack, J. R. (2013). Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. Diabetic Medicine : a Journal of the British Diabetic Association, 30(9), 1040-6. https://doi.org/10.1111/dme.12207
Barnes RA, et al. Predictors of Large and Small for Gestational Age Birthweight in Offspring of Women With Gestational Diabetes Mellitus. Diabet Med. 2013;30(9):1040-6. PubMed PMID: 23551273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus. AU - Barnes,R A, AU - Edghill,N, AU - Mackenzie,J, AU - Holters,G, AU - Ross,G P, AU - Jalaludin,B B, AU - Flack,J R, Y1 - 2013/05/15/ PY - 2012/07/12/received PY - 2012/12/20/revised PY - 2013/03/22/accepted PY - 2013/4/5/entrez PY - 2013/4/5/pubmed PY - 2014/3/22/medline SP - 1040 EP - 6 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 30 IS - 9 N2 - AIM: To identify predictors of large and small for gestational age in women with gestational diabetes mellitus. METHODS: A retrospective audit of clinical data analysed for singleton births in women diagnosed with gestational diabetes by Australasian Diabetes in Pregnancy Society guidelines from 1994 to 2009. Exclusions were: incomplete data, delivered at < 36 weeks gestation and/or last recorded weight > 4 weeks pre-delivery. We assessed: pre-pregnancy BMI, ethnicity, total maternal weight gain, weight gain before and after treatment initiation for gestational diabetes, HbA(1c) at gestational diabetes presentation and treatment modality (diet or insulin) and smoking. Birthweight was assessed using customized percentile charts (large for gestational age > 90th; small for gestational age < 10th percentile). Multiple regression analyses were undertaken; statistical significance was p < 0.05. RESULTS: There were 1695 women first seen at (mean ± sd) 28.1 ± 5.3 weeks gestation (range 6-39). Ethnic mix was South-East Asian 36.7%, Middle Eastern 27.6%, European 22.4%, Indian/Pakistani 8.6%, Samoan 1.9%, African 1.5% and Maori 1.1%. Therapy was diet 69.1% and insulin 30.9%. Mean total weight gain was 12.3 ± 6.1 kg, the majority (10.6 ± 6.0 kg), gained before dietary intervention. There were 7.9% small for gestational age and 15.2% large for gestational age births. Significant independent large for gestational age predictors were: weight gain before intervention, pre-pregnancy BMI, weight gain after intervention and treatment type, but not HbA1c or smoking. Significant small for gestational age predictors were: weight gain before intervention, weight gain after intervention, but not pre-pregnancy BMI, HbA(1c) or smoking. CONCLUSION: Conventional treatment for gestational diabetes mellitus concentrates on management of blood glucose levels. The trends identified here emphasize the need to also address pregnancy weight gain stratified by pre-pregnancy BMI. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/23551273/Predictors_of_large_and_small_for_gestational_age_birthweight_in_offspring_of_women_with_gestational_diabetes_mellitus_ L2 - https://doi.org/10.1111/dme.12207 DB - PRIME DP - Unbound Medicine ER -