Associations of serum D-dimer and glycosylated hemoglobin levels with third-trimester fetal growth restriction in gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism;GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development.AIM To investigate the associations of serum D-dimer(D-D)and glycosylated hemoglobin(HbA1c)levels with third-trimester fetal growth restriction(FGR)in GDM patients.METHODS The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively.Among these women,63 whose fetuses had FGR were included in the FGR group,and 101 women whose fetuses had normal body weights were included in the normal body weight group(normal group).Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis.The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis,and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression.RESULTS Serum fasting blood glucose,fasting insulin,D-D and HbA1c levels were significantly greater in the FGR group than in the normal group,while the homeostasis model assessment of insulin resistance values were lower(P<0.05).Regarding the diagnosis of FGR based on serum D-D and HbA1c levels,the areas under the curves(AUCs)were 0.826 and 0.848,the cutoff values were 3.04 mg/L and 5.80%,the sensitivities were 81.0%and 79.4%,and the specificities were 88.1%and 87.1%,respectively.The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928,and the sensitivity and specificity were 84.1%and 91.1%,respectively.High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients(P<0.05).CONCLUSION D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent,and their combination can be used as an important index for the early prediction of FGR.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

Maternal Obesity,Gestational Diabetes,and Fetal Macrosomia:An Incidental or a Mechanistic Relationship?

Gestational diabetes mellitus(GDM)is a well-established risk factor for fetal macrosomia.A significant number of patients with GDM also suffer from obesity,a factor associated with fetal macrosomia.An important question is whether GDM is independently associated with fetal macrosomia,or whether this relationship is merely the result of maternal obesity acting as a confounder.In this review of the literature,we attempt to further elucidate the relationship between GDM,maternal obesity,and fetal macrosomia.

The Impacts of Maternal Gestational Diabetes Mellitus (GDM) on Fetal Hearts

Objective To evaluate the fetal cardiac function in gestational diabetes mellitus （GDM） pregnancies under different maternal glycemic controls. Methods Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods （〈28, 28-34 and ≥34 weeks） and were divided into poorly-（DM1） and well-（DM2） controlled groups according to their glycemic control at examination. Seventy uncomplicated mothers were selected as controls. Parameters of fetal cardiac anatomy and function were measured and analyzed. Results GDM fetuses＇ cardiac ventricular walls were thicker than controls＇, and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls. In both GDM groups, the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones. GDM fetuses＇ left atrial shortening fraction was smaller than the controls＇ in the period of ≥34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses （r=-0.438 and -0.506）. The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of ≥34 weeks respectively. Tel index of both left and right ventricles increased in DM1 group after the period of 〈28 weeks and in DM2 group only in the period of ≥ 34 weeks, with no significant differences between DM1 and DM2 groups in this period. Conclusion Fetuses of GDM mothers showed cardiac function impairments. Good maternal glycemic control may delay the impairments, but cannot reduce the degree. Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.

Macrosomia in non-gestational diabetes pregnancy:glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.

Gestational heat stress alters skeletal muscle gene expression profiles and vascularity in fetal pigs in a sexually dimorphic manner

Background: There is evidence that sow heat stress(HS) during gestation affects fetal development with implications for impaired muscle growth. We have previously demonstrated that maternal HS during early to midgestation compromised muscle fibre hyperplasia in developing fetal pigs. Thus, we hypothesised these phenotypic changes are associated with a change in expression of genes regulating fetal skeletal muscle development and metabolism. To test this, at d 60 of gestation, RNA sequencing and immunohistochemistry were performed on fetal longissimus dorsi(LD) muscle biopsies collected from pregnant gilts that had experienced either thermoneutral control(CON, 20 ℃, n = 7 gilts, 18 LD samples) or controlled HS(cyclic 28 to 33 ℃, n = 8 gilts, 23 LD samples)conditions for 3 weeks.Results: A total of 282 genes were differentially expressed between the HS and CON groups in female LD muscles(false discovery rate(FDR) ≤ 0.05), whereas no differentially expressed genes were detected in male LD muscles between the two groups(FDR > 0.05). Gestational HS increased the expression of genes associated with transcription corepressor activity, adipogenesis cascades, negative regulation of angiogenesis and pro-inflammatory signalling in female LD muscles. Immunohistochemical analyses revealed a decreased muscle vascularity density in fetuses from HS group for both sexes compared to those from the CON group(P = 0.004).Conclusions: These results reveal gilt HS during early to mid-gestation altered gene expression profiles in fetal LD muscles in a sexually dimorphic manner. The molecular responses, including transcription and angiogenesis repressions and enhanced adipogenesis cascades, were exclusively observed in females. However, the associated reductions in muscle vascularity were observed independently of sexes. Collectively this may indicate female fetal pigs are more adaptive to gestational HS in terms of gene expression changes, and/or there may be sexually dimorphic differences with respect to the timing of muscle molecular responses to gestational HS.

Gestation-specific reference intervals for fetal cardiac Doppler indices from 12 to 40 weeks of gestation

We aimed to establish gestation age specific reference intervals for Doppler indices of fetal cardiac function from 12 to 40 weeks of pregnancy. In a cross-sectional observational study of singleton pregnancies, examinations were performed in 221 women evenly distributed across each week of pregnancy. Blood flow through the four cardiac valves was examined with Doppler. For the atrioventricular valves, velocity and duration of early (E) and atrial (A) waves and the interval (a) between E/A complexes was recorded. For the outflow valves, the duration (b), peak and average velocity of flow in systole was measured. Myocardial performance index (MPI) was calculated as (a - b)/b. Outlet valve diameters were measured and cardiac outputs were calculated. Gestation age specific ranges were constructed for all these parameters. We demonstrated that the cardiac output, peak systolic and time-averaged velocity increase with advancing gestation. However the MPI and E/A ratios show little change across gestation. Fetal cardiac physiology can be studied and Doppler indices reliably measured as early as the late first trimester of pregnancy. Establishing gestation age specific ranges for various cardiac indices throughout pregnancy will help the study of development of fetal cardiac function.

The Relation of Fetal Colon Diameter with Estimation of Gestational Age

Background: Conventional ultrasound dating is not very accurate after 34 weeks of gestation and has standard deviation of about 2 weeks. Objective: Verify whether fetal colon diameter can be used as a tool for estimating gestational age (GA) of fetuses between 34 to 40 weeks. Materials and Methods: This was a prospective cross-sectional study conducted at Obstetrics and Gynecology University Hospital, Damascus, Syria, during the period from September 2019-September 2020. The study enrolled 395 women with uncomplicated singleton pregnancies at 34 - 40 weeks of gestation. Fetal bi-parietal diameter, head circumference, abdominal circumference, and femoral lengths were assessed by ultrasound. In addition, descending colon diameter was assessed at the level of colonic haustra. The correlation between GA and colon diameter was assessed by the Pearson correlation test. Results: Significant correlation between fetal colon diameter and gestational age was observed P < 0.0001 (r = 0.852). In addition, a highly significant correlation between colon diameter and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. The correlation between gestational age at 3rd trimester and colon diameter was significantly stronger than the correlation between gestational age and bi-parietal diameter, head circumference, and abdominal circumference. Whereas, no significant difference was found when comparing colon diameter and femoral lengths (P = 0.089). Conclusion: The present study suggested that colon diameter can be used for predicting third trimester gestational age.

Unique Ultrastructural Alterations in the Placenta Associated With Macrosomia Induced by Gestational Diabetes Mellitus

Objective:To investigate the morphological and ultrastructural alterations in placentas from pregnancies with gestational diabetes mellitus(GDM)–induced macrosomia,term nondiabetic macrosomia,and normal pregnancies.Methods:Sixty full-term placentaswere collected,and clinical data alongwith informed consent were obtained from pregnant womenwho underwent regular visit checks and delivered their newborns in Northwest Women’s and Children’s Hospital between May and December 2022.Placentas were divided into three equal groups:normal pregnancy(control group),nondiabetic macrosomia group,and macrosomia complicated with GDM(diabetic macrosomia)group.Gross morphological data of placentas were recorded,and placental samples were processed for examination of ultrastructural and stereological changes using transmission electron microscopy.Analysis of variance and chi-squared test were used to examine the differences among the three groups for continuous and categorical variables,respectively.Results:The baseline characteristics of mothers and neonates did not differ across the three groups,except for a significantly higher birth weight in the diabetic macrosomia group(4172.00±151.20 g vs.3192.00±328.70 g,P<0.001)and nondiabetic macrosomia group(4138.00±115.20 g vs.3192.00±328.70 g,P<0.001)comparedwith control group.Examination of the placentas revealed that placental weight was also highest in the diabeticmacrosomia group comparedwith control group(810.00±15.81 g vs.490.00±51.48 g,P<0.001)and nondiabetic macrosomia group(810.00±15.81 g vs.684.00±62.69 g,P<0.001),but the ratio of neonatal birth weight to placental weight(BW/PW)was significantly lower in the diabetic macrosomia group compared with that in the control group(5.15±0.19 vs.6.54±0.63,P<0.001)and nondiabetic macrosomia group(5.15±0.19 vs.6.09±0.52,P<0.001)group.In contrast,the BW/PW ratio in nondiabetic macrosomia did not differ significantly from that in the control group.Distinct ultrastructural changes in terminal villi and stereological alterations in microvilli were observed in the diabetic macrosomia group,including changes in the appearance of cytoplasmic organelles and the fetal capillary endothelium and thickness of the vasculo-syncytial membrane and basal membrane.Conclusion:Significant ultrastructural and stereological alterations were discovered in the placentas from pregnant women with macrosomia induced by GDM.These alterationsmay be the response of the placenta to the hyperglycemia condition encountered during pregnancies complicated with GDM.

Effects of supplements differing in fatty acid profile to late gestational beef cows on cow performance,calf growth performance,and mRNA expression of genes associated with myogenesis and adipogenesis

Background:Maternal nutrition during gestation affects fetal development,which has long-term programming effects on offspring postnatal growth performance.With a critical role in protein and lipid metabolism,essential fatty acids can influence the development of muscle and adipose tissue.The experiment investigated the effects of late gestation supplements(77 d prepartum),either rich in saturated and monounsaturated fatty acids(CON;155 g/cow/d EnerGII)or polyunsaturated fatty acids(PUFA;80 g/cow/d Strata and 80 g/cow/d Prequel),on cow performance and subsequent calf growth performance as well as mRNA expression in longissimus muscle(LM)and subcutaneous adipose tissue at birth and weaning.Results:There was no difference(P≥0.34)in cow body weight(BW)or body condition score from presupplementation through weaning.Relative concentrations of C18:3n-3 and C20:4n-6 decreased(P≤0.05)to a greater extent from mid-supplementation to calving for PUFA compared with CON cows.Cow plasma C20:0,C20:5n-3,and C22:6n-3 were increased(P≤0.01)in PUFA during supplementation period.At birth,PUFA steers had greater(P=0.01)plasma C20:5n-3.No differences(P≥0.33)were detected in steer birth BW or dam milk production,however,CON steers tended(P=0.06)to have greater pre-weaning average daily gain and had greater(P=0.05)weaning BW compared with PUFA.For mRNA expression in steers:MYH7 and C/EBPβin LM increased(P≤0.04)to a greater extent from birth to weaning for PUFA compared with CON;MYF5 in LM and C/EBPβin adipose tissue tended(P≤0.08)to decrease more from birth to weaning for CON compared with PUFA;SCD in PUFA adipose tissue tended(P=0.08)to decrease to a greater extent from birth to weaning than CON.In addition,maternal PUFA supplementation tended(P=0.08)to decrease MYOG mRNA expression in LM and decreased(P=0.02)ZFP423 in adipose tissue during the pre-weaning stage.Conclusions:Late gestation PUFA supplementation decreased pre-weaning growth performance of the subsequent steer progeny compared with CON supplementation,which could have been a result of downregulated mRNA expression of myogenic genes during pre-weaning period.

Fetal Macrosomia in the Maternity Ward of the Community University Hospital: Risk Factors and Maternal-Fetal Prognosis

Introduction: Fetal macrosomia is a birth weight greater than or equal to 4000 grams. The aim of this study is to determine the frequency of macrosomia, to identify the risk factors, and to evaluate the maternal and perinatal prognosis in the obstetrics and gynaecology department of the Community University Hospital Centre (CHUC). Methodology: This was a retrospective case-control study over a period of 24 months in the maternity ward of the CHUC. Results: The frequency of delivery of macrosomic fetuses was 4.1%, and the average age of women with large fetuses was 29.5 years. In 65.7% of cases, they were not engaged in any income-generating activity. Most of them had at least secondary education (65.7%) and were mainly multiparous (78.8%). The risk factors found were maternal age greater than or equal to 35 years, multiparity, previous large fœtus, gestational diabetes, obesity and male sex. Maternal complications were dominated by uterine atony (52.2%), perineal tear (31.9%), and cervical tear (15.9%). In our series, macrosomic newborns were three times more likely to present with a neonatal complication than normal-weight newborns. Neonatal mortality was 2.1%. Conclusion: Reducing macrosomia requires a better understanding of the risk factors, early detection, correct management during vaginal delivery and close monitoring of labour with good control of obstetric manoeuvres.

Long-term effects of metformin use in gestational diabetes mellitus on offspring health

Metformin is the first-line drug for the treatment of type 2 diabetes mellitus,but its role in gestational diabetes mellitus(GDM)management is not clear.Recent evidence suggests a certain beneficial effect of metformin in the treatment of GDM,but a high treatment failure rate leads to the initiation of additional medications,such as insulin.Moreover,since metformin crosses the placental barrier and reaches a significant level in the fetus,it is likely to influence the fetal metabolic milieu.The evidence indicates the long-term safety in children exposed to metformin in utero except for mild adverse anthropometric profiles.Diligent follow-up of metformin-exposed offspring is warranted from the clinician’s point of view.

Nutritional Correlates of Women with a History of Gestational Diabetes and Insulin Resistance in the National Health and Nutrition Examination Survey (NHANES) 2000-2010

Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake, nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2000-2010. Data analysis was based on 290 women who reported a history of GDM compared to 4239 women who denied a GDM history. Insulin resistance [HOMA_IR = (fasting insulin in mU/mL × fasting glucose in mmol/L)/405] was calculated. Pearson correlation, Wilcoxon rank sum tests, Student’s t-tests, and chi-square analysis were used while linear regression assessed independent associations. Results: The median time-lapse from the diagnosis of GDM was 15 years. Women with a GDM history had significantly higher body mass index (BMI), other anthropometric measurements, diastolic blood pressures and insulin resistance. They were also more likely to be Hispanic, have delivered macrosomic infants, and delivered via cesarean. Previous GDM history compared to non-GDM subjects had significantly higher dietary intakes of energy calories, protein, total fat, saturated fatty acids, mono-saturated fatty acids, and cholesterol. Within the entire cohort, increasing insulin resistance was also associated with lower income, less college education, Hispanic or African American ethnicity, obesity, higher systolic and diastolic blood pressures, and with higher dietary cholesterol but lower intake of dietary fiber and micronutrients. Regression analyses showed that GDM history, Hispanic ethnicity, BMI, dietary intake of cholesterol and decreasing income were independently predictive of insulin resistance. Conclusion: The data confirm that even many years after a pregnancy associated with GDM, women with a history of GDM still report significantly higher dietary intakes of energy calories, protein, and fat with no corresponding increase in consumption of dietary fiber or minerals and vitamins. Consequently, the increased calorie and food consumption of women with previous GDM are associated with obesity, insulin resistance and higher blood pressures. These observations may suggest the need to target high-risk groups who may need more resources and awareness of the benefits of quality nutrition.

A Review on the Management of Gestational Diabetes Mellitus(GDM):Pharmacological and Non-Pharmacological Interventions

Gestational diabetes mellitus(GDM)is defined as any degree of glucose or carbohydrate intolerance mainly during pregnancy.About 10%to 15%of pregnancies are affected and complicated by gestational diabetes.Due to hormonal changes during pregnancy,the requirement for insulin increases,and thus the usual concentration of insulin previously catered for glycemic control is ineffective.In order to meet the body’s demand,the islet cells secrete a higher amount of insulin.GDM occurs when this higher concentration is also unable to control blood glucose.This increased resistance toward insulin is most noticeable during the third trimester of pregnancy,which gradually normalizes after the termination of pregnancy.Various complications do arise,which affect both the mother and her developing fetus.In the mother,miscarriages,delivery of baby via caesarian section,and other complications may result,whereas the fetus may be affected with congenital abnormalities,neonatal hypoglycemia,and even death.Treatment of GDM includes both non-pharmacological and pharmacological interventions.Pharmacological agents are employed when non-pharmacological interventions fail to achieve the desired target.Glyburide,insulin,and metformin are the commonly used pharmacological agents.

Automatic Fetal Segmentation Designed on Computer-Aided Detection with Ultrasound Images

In the present research,we describe a computer-aided detection(CAD)method aimed at automatic fetal head circumference(HC)measurement in 2D ultrasonography pictures during all trimesters of pregnancy.The HC might be utilized toward determining gestational age and tracking fetal development.This automated approach is particularly valuable in low-resource settings where access to trained sonographers is limited.The CAD system is divided into two steps:to begin,Haar-like characteristics were extracted from ultrasound pictures in order to train a classifier using random forests to find the fetal skull.We identified the HC using dynamic programming,an elliptical fit,and a Hough transform.The computer-aided detection(CAD)program was well-trained on 999 pictures(HC18 challenge data source),and then verified on 335 photos from all trimesters in an independent test set.A skilled sonographer and an expert in medicine personally marked the test set.We used the crown-rump length(CRL)measurement to calculate the reference gestational age(GA).In the first,second,and third trimesters,the median difference between the standard GA and the GA calculated by the skilled sonographer stayed at 0.7±2.7,0.0±4.5,and 2.0±12.0 days,respectively.The regular duration variance between the baseline GA and the health investigator’s GA remained 1.5±3.0,1.9±5.0,and 4.0±14 a couple of days.The mean variance between the standard GA and the CAD system’s GA remained between 0.5 and 5.0,with an additional variation of 2.9 to 12.5 days.The outcomes reveal that the computer-aided detection(CAD)program outperforms an expert sonographer.When paired with the classifications reported in the literature,the provided system achieves results that are comparable or even better.We have assessed and scheduled this computerized approach for HC evaluation,which includes information from all trimesters of gestation.

Establish a normal fetal lung gestational age grading model and explore the potential value of deep learning algorithms in fetal lung maturity evaluation

Background:Prenatal evaluation of fetal lung maturity(FLM)is a challenge,and an effective non-invasive method for prenatal assessment of FLM is needed.The study aimed to establish a normal fetal lung gestational age(GA)grading model based on deep learning(DL)algorithms,validate the effectiveness of the model,and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41+6 weeks were analyzed in this study.There were no pregnancy-related complications that affected fetal lung development,and all infants were born without neonatal respiratory diseases.The images were divided into three classes based on the gestational week:class I:20 to 29+6 weeks,class II:30 to 36+6 weeks,and class III:37 to 41+6 weeks.There were 3323,2142,and 1548 images in each class,respectively.First,we performed a pre-processing algorithm to remove irrelevant information from each image.Then,a convolutional neural network was designed to identify different categories of fetal lung ultrasound images.Finally,we used ten-fold cross-validation to validate the performance of our model.This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA.This was used to establish a grading model.The performance of the grading model was assessed using accuracy,sensitivity,specificity,and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated.The sensitivity of each class in the independent test set was 91.7%,69.8%,and 86.4%,respectively.The specificity of each class in the independent test set was 76.8%,90.0%,and 83.1%,respectively.The total accuracy was 83.8%.The area under the curve(AUC)of each class was 0.982,0.907,and 0.960,respectively.The micro-average AUC was 0.957,and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs,which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy.The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.

Updates in Long-term Maternal and Fetal Adverse Effects of Gestational Diabetes Mellitus

Gestational diabetes mellitus(GDM)is associated with long-term maternal and fetal adverse outcomes.Recent evidences suggest GDM increases long-term maternal cardiovascular disease,chronic kidney disease,and cancer risks.Maternal hyperglycemia is associated with offspring obesity,overweight,insulin resistance,and neurocognitive development.It remains unclear whether treating mild GDM would reduce long-term maternal and fetal adverse effects.

Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study

Background Fetal macrosomia,defined as birth weight equal or over 4000 g,is a major concern for both neonatal and maternal health.A rapid increasing trend in fetal macrosomia is observed in different regions of China.We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China.Methods All macrosomic live singletons (≥ 4000 g),and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu,Western China,in 2011 were included in the cohort study.Maternal demographics,obstetric factors,labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System.Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected.Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference.Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs.Results A total of 1767 infants were included in the analyses,of whom 714 were macrosomic.After controlling for maternal age,parity,gestational age and anemia at the first antenatal visit,pre-pregnancy BMI,gestational weight gain,gestational age at birth,baby age and sex,and breastfeeding practices at 6 months,the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight.The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age,respectively.Conclusion Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.

Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus

Background： Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test （OGTT） results on adverse perinatal outcomes. Methods： This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus （GDM） were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. Results： in total, 14,741 pregnant women were included in the study population, 2927 （19.86%） of whom had G DM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age （LGA）, macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia bad clear associations with macrosomia （odds ratios [ORs]：1.84, 95% confidence intervals [CIs]： 1.39-2.42, P 〈 0.001）, L（SA （OR： 1.70, 95% CI： 1.29-2.25. P 〈 0.001）, and cesarean delivery （OR： 1.33, 95% CI： 1.15-1.55, P 〈 0.001）. The associations were stronger as tasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth （OR： 1.50, 95% Cl： 1. 11-2.03, P 〈 0.01）. Conclusions： Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration ofGDM wiih hierarchical and individualized management according to OGTT characteristics is needed.

基于新生儿、孕妇临床特征构建新生儿呼吸窘迫综合征的预测模型

目的基于新生儿、孕妇临床特征构建新生儿呼吸窘迫综合征(NRDS)的预测模型。方法选取2020年1月—2023年1月收治的102例NRDS患儿纳入NRDS组,另择同期健康新生儿150例纳入无NRDS组,回顾性收集临床资料。分析2组新生儿情况、孕妇情况,采用多因素Logistic回归分析NRDS发生的危险因素,建立预测模型,并绘制受试者工作特征(ROC)曲线分析预测模型对NRDS的预测价值。结果与无NRDS组比较,NRDS组胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫、胎膜早破、酸中毒比例高(P<0.05,P<0.01)。与无NRDS组比较,NRDS组孕妇年龄≥35岁、初产、妊娠期高血压疾病、妊娠期糖尿病、合并生殖道感染、产前检查低于9次比例高,血清25-羟基维生素D(25-OH-D)水平低(P<0.05,P<0.01)。胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫,以及孕妇年龄≥35岁、妊娠期糖尿病、产前检查低于9次为NRDS发生的独立危险因素(P<0.05,P<0.01);孕妇血清25-OH-D水平升高为其保护因素(P<0.01)。根据上述结果构建预测模型,并绘制ROC曲线,结果显示,当Logit(P)>18.570时,预测NRDS发生的曲线下面积为0.893,诊断敏感度为81.37%、特异度为82.00%。结论胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫,以及孕妇年龄≥35岁、妊娠期糖尿病、产前检查低于9次为NRDS的独立危险因素,孕妇血清25-OH-D水平升高为其保护因素,据此构建预测模型对NRDS预测价值较高,可为筛选高危患儿、制订临床干预策略提供依据。