Exploration of the shared pathophysiological mechanisms of gestational diabetes and large for gestational age offspring

Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.

Perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer:analysis of 9408 singleton newborns using propensity score analysis

Objective:Regarding frozen-thawed embryo transfer(FET),there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes.This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer(BT)and cleavage-stage embryo transfer(CT)in FET.Methods:A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022.Blastocyst-stage embryo transfers were performed in the BT group,and cleavage-stage embryo transfers were performed in the CT group.Multivariate logistic regression analyses were performed,as well as propensity score matching(PSM)to adjust for confounders.Results:After PSM,a higher risk of pre-term birth(PTB;odds ratio[OR]:1.23,95%confidence interval[CI]:1.00-1.50,P=0.048)and being large for gestational age(LGA;OR:1.16,95%CI:1.00-1.35,P=0.050)was observed in the BT group compared to that in the CT group.After stratified PSM,in the subgroup under 35 years of age,only an increased risk of LGA was observed in the BT group compared to the CT group.Perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group.However,in the subgroup beyond 35 years of age and the single embryo transfer subgroup,perinatal outcomes were not statistically different between the BT and CT groups(P>0.05).Conclusions:In FET,prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses.However,stratified analysis based on age and the number of transferred embryos yielded different results,necessitating further mechanistic studies.

巨大儿与单纯性肥胖症的相关性分析

[目的 ] 探讨巨大儿与婴幼儿、青少年单纯性肥胖的关系。 [方法 ] 对 6～ 14岁的 132例巨大儿、5 0 0例正常对照儿及其双亲作了身高和体重的人体测量学检查 ,并对以往超重肥胖情况采用了回顾性问卷调查 ;对婴儿期 5 0例巨大儿 ,15 0例对照儿于 1岁内作了身长体重测量的定期随访。 [结果 ] 6～ 14岁时巨大儿组肥胖率 16 .3% ,高于对照组的 8.6 % (P <0 .0 5 ) ,巨大儿组超重率 10 .9% ,略高于对照组的 9.8% ,且与遗传因素无明显的相关性。肥胖和超重在婴儿期最多 ,在学龄前期 ,随着年龄的增加 ,人数逐渐减少 ,但在各年龄段巨大儿组和对照组的肥胖和超重率差异均有显著性。 [结论 ] 胎儿期肥胖易导致婴幼儿期肥胖 。

Women Who Develop Diabetes Later in Life Have Diabetes-Associated Complications during Preceding Pregnancies

Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.

Macrosomia is associated with overweight in childhood:a follow-back of a cohort established in the early years of the obesity epidemic

Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.