Asymmetric Large-for-Gestational-Age Infants of Type 1 Diabetic Women: Morbidity and Abdominal Growth

Sureka Bollepalli; Lawrence M Dolan; Menachem Miodovnik; Maisa Feghali; Jane C Khoury

doi:10.1055/s-0030-1249362

American Journal of Perinatology, Table of Contents

Am J Perinatol 2010; 27(8): 603-610
DOI: 10.1055/s-0030-1249362

Asymmetric Large-for-Gestational-Age Infants of Type 1 Diabetic Women: Morbidity and Abdominal Growth

Sureka Bollepalli¹ , Lawrence M. Dolan¹ , Menachem Miodovnik² , Maisa Feghali² , Jane C. Khoury³

¹Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, Ohio
²Department of Obstetrics and Gynecology, Professor of Obstetrics and Gynecology, Georgetown University, Washington Hospital Center, Washington, DC
³Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, Ohio

Abstract

ABSTRACT

We sought to examine neonatal morbidity in four groups of offspring (asymmetric large for gestational age [LGA], symmetric LGA, asymmetric non-LGA, symmetric non-LGA) exposed in utero to maternal type 1 diabetes, and the association between rate of fetal abdominal circumference growth and asymmetric LGA. We performed a secondary analysis of 302 singleton pregnancies. Neonatal morbidity (respiratory distress syndrome, polycythemia, hypoglycemia, hyperbilirubinemia, acidosis, and composite morbidity [any of the five]) was assessed. Serial ultrasound examinations after 20 weeks' gestation were available for 35 fetuses. Logistic regression and general linear mixed modeling were used for analysis. Asymmetric LGA infants had 3.5-, 2.2-, and 3.2-fold greater odds of hypoglycemia, hyperbilirubinemia, and composite morbidity, respectively, compared with symmetric non-LGA infants. The rate of growth of the abdominal circumference in asymmetric LGA infants (1.11 cm/wk) was greater than for both the symmetric LGA infants (0.87 cm/wk, p = 0.09) and the symmetric non-LGA infants (0.87 cm/wk, p = 0.03). Asymmetric LGA infants are at higher risk for morbidity than symmetric LGA and non-LGA infants. Intrauterine growth rate of the abdominal circumference may potentially be used as a marker to identify the asymmetric LGA and thereby aid in the identification of newborns at greatest risk for perinatal complications.

KEYWORDS

Large for gestational age - type 1 diabetes - abdominal circumference - ultrasound

Full Text

References

REFERENCES

1 Evers I M, de Valk H W, Visser G H. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004; 328 915
2 Taylor R, Lee C, Kyne-Grzebalski D, Marshall S M, Davison J M. Clinical outcomes of pregnancy in women with type 1 diabetes(1). Obstet Gynecol. 2002; 99 537-541
3 Mondestin M A, Ananth C V, Smulian J C, Vintzileos A M. Birth weight and fetal death in the United States: the effect of maternal diabetes during pregnancy. Am J Obstet Gynecol. 2002; 187 922-926
4 Siddiqui F, James D. Fetal monitoring in type 1 diabetic pregnancies. Early Hum Dev. 2003; 72 1-13
5 Ballard J L, Rosenn B, Khoury J C, Miodovnik M. Diabetic fetal macrosomia: significance of disproportionate growth. J Pediatr. 1993; 122 115-119
6 Jährig D, Jährig K, Stiete S, Beyersdorff E, Poser H, Hopp H. Neonatal jaundice in infants of diabetic mothers. Acta Paediatr Scand Suppl. 1989; 360 101-107
7 Dupak J DL. Ultrasound surveillance in pregnancy complicated by diabetes. Diabetes Spectrum. 2007; 20 89-93
8 Landon M B. Prenatal diagnosis of macrosomia in pregnancy complicated by diabetes mellitus. J Matern Fetal Med. 2000; 9 52-54
9 Bernstein I M, Catalano P M. Influence of fetal fat on the ultrasound estimation of fetal weight in diabetic mothers. Obstet Gynecol. 1992; 79 561-563
10 Greco P, Vimercati A, Scioscia M, Rossi A C, Giorgino F, Selvaggi L. Timing of fetal growth acceleration in women with insulin-dependent diabetes. Fetal Diagn Ther. 2003; 18 437-441
11 Siddiqi T A, Miodovnik M, Mimouni F, Clark E A, Khoury J C, Tsang R C. Biphasic intrauterine growth in insulin-dependent diabetic pregnancies. J Am Coll Nutr. 1989; 8 225-234
12 Kaplan L A, Cline D, Gartside P, Burstein S, Sperling M, Stein E A. Hemoglobin A1 in hemolysates from healthy and insulin-dependent diabetic children, as determined with a temperature-controlled minicolumn assay. Clin Chem. 1982; 28 13-18
13 Campbell S, Newman G B. Growth of the fetal biparietal diameter during normal pregnancy. J Obstet Gynaecol Br Commonw. 1971; 78 513-519
14 Deter R L, Harrist R B, Hadlock F P, Carpenter R J. The use of ultrasound in the assessment of normal fetal growth: a review. J Clin Ultrasound. 1981; 9 481-493
15 Hadlock F P, Harrist R B, Sharman R S, Deter R L, Park S K. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol. 1985; 151 333-337
16 Campbell S, Wilkin D. Ultrasonic measurement of fetal abdomen circumference in the estimation of fetal weight. Br J Obstet Gynaecol. 1975; 82 689-697
17 Shepard M J, Richards V A, Berkowitz R L, Warsof S L, Hobbins J C. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol. 1982; 142 47-54
18 Djelmis J, Buković D, Pfeifer D, Ivanisević M. Ponderal index and disproportionate fetal growth in IDDM pregnancies. Coll Antropol. 1998; 22 491-495
19 Akcakus M, Koklu E, Kurtoglu S, Kula M, Koklu S S. The relationship among intrauterine growth, insulinlike growth factor I (IGF-I), IGF-binding protein-3, and bone mineral status in newborn infants. Am J Perinatol. 2006; 23 473-480
20 Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh). 1954; 16 330-342
21 Schaefer-Graf U M, Kjos S L, Bühling K J et al.. Amniotic fluid insulin levels and fetal abdominal circumference at time of amniocentesis in pregnancies with diabetes. Diabet Med. 2003; 20 349-354
22 Susa J B, Gruppuso P A, Widness J A et al.. Chronic hyperinsulinemia in the fetal rhesus monkey: effects of physiologic hyperinsulinemia on fetal substrates, hormones, and hepatic enzymes. Am J Obstet Gynecol. 1984; 150 415-420
23 Vela-Huerta M M, San Vicente-Santoscoy E U, Guizar-Mendoza J M, Amador-Licona N, Aldana-Valenzuela C, Hernnández J. Leptin, insulin, and glucose serum levels in large-for-gestational-age infants of diabetic and non-diabetic mothers. J Pediatr Endocrinol Metab. 2008; 21 17-22
24 Hay Jr W W. Recent observations on the regulation of fetal metabolism by glucose. J Physiol. 2006; 572(Pt 1) 17-24
25 Catalano P M, Thomas A, Huston-Presley L, Amini S B. Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol. 2003; 189 1698-1704
26 Chiesa C, Osborn J F, Haass C et al.. Ghrelin, leptin, IGF-1, IGFBP-3, and insulin concentrations at birth: is there a relationship with fetal growth and neonatal anthropometry?. Clin Chem. 2008; 54 550-558
27 Koklu E, Kurtoglu S, Akcakus M, Yikilmaz A, Gunes T. Serum insulin-like growth factor-I (IGF-I) IGF binding protein-3 (IGFBP-3) and leptin levels are related to abdominal aortic intima-media thickness in macrosomic newborns. Growth Horm IGF Res. 2007; 17 26-32
28 Lepercq J, Lahlou N, Timsit J, Girard J, Mouzon S H. Macrosomia revisited: ponderal index and leptin delineate subtypes of fetal overgrowth. Am J Obstet Gynecol. 1999; 181 621-625
29 Susa J B, Widness J A, Hintz R, Liu F, Sehgal P, Schwartz R. Somatomedins and insulin in diabetic pregnancies: effects on fetal macrosomia in the human and rhesus monkey. J Clin Endocrinol Metab. 1984; 58 1099-1105
30 Raychaudhuri K, Maresh M J. Glycemic control throughout pregnancy and fetal growth in insulin-dependent diabetes. Obstet Gynecol. 2000; 95 190-194
31 Ashworth M A, Leach F N, Milner R D. Development of insulin secretion in the human fetus. Arch Dis Child. 1973; 48 151-152
32 Buchanan T A, Kjos S L, Montoro M N et al.. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care. 1994; 17 275-283
33 Buchanan T A, Kjos S L, Schafer U et al.. Utility of fetal measurements in the management of gestational diabetes mellitus. Diabetes Care. 1998; 21(Suppl 2) B99-B106
34 Kjos S L, Schaefer-Graf U, Sardesi S et al.. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care. 2001; 24 1904-1910
35 Lande B, Andersen L F, Henriksen T et al.. Relations between high ponderal index at birth, feeding practices and body mass index in infancy. Eur J Clin Nutr. 2005; 59 1241-1249
36 Pietiläinen K H, Kaprio J, Räsänen M, Winter T, Rissanen A, Rose R J. Tracking of body size from birth to late adolescence: contributions of birth length, birth weight, duration of gestation, parents' body size, and twinship. Am J Epidemiol. 2001; 154 21-29

Sureka BollepalliM.D.

Division of Endocrinology, Clinical Fellow, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine

MLC 7012, 3333 Burnet Avenue, Cincinnati, OH 45208

Email: surekabollepalli@yahoo.com