Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women.

Murphy, Helen R 
Smith, Gordon CS 

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OBJECTIVE: To determine whether fetal overgrowth precedes the diagnosis of gestational diabetes mellitus (GDM) and to quantify the interrelationships among fetal overgrowth, GDM, and maternal obesity. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study of unselected nulliparous women and performed ultrasonic measurement of the fetal abdominal circumference (AC) and head circumference (HC) at 20 and 28 weeks of gestational age (wkGA). Exposures were diagnosis of GDM ≥28 wkGA and maternal obesity. The risk of AC >90th and HC-to-AC ratio <10th percentile was modeled using log-binomial regression, adjusted for maternal characteristics. RESULTS: Of 4,069 women, 171 (4.2%) were diagnosed with GDM at ≥28 wkGA. There was no association between fetal biometry at 20 wkGA and subsequent maternal diagnosis of GDM. However, at 28 wkGA, there was an increased risk of AC >90th percentile (adjusted relative risk 2.05 [95% CI 1.37-3.07]) and HC-to-AC ratio <10th percentile (1.97 [1.30-2.99]). Maternal obesity showed similar associations at 28 wkGA (2.04 [1.62-2.56] and 1.46 [1.12-1.90], respectively). The combination of GDM and obesity was associated with an approximately fivefold risk of AC >90th (4.52 [2.98-6.85]) and approximately threefold risk of HC-to-AC ratio <10th percentile (2.80 [1.64-4.78]) at 28 wkGA. Fetal AC >90th percentile at 28 weeks was associated with an approximately fourfold risk of being large for gestational age at birth. CONCLUSIONS: Diagnosis of GDM is preceded by excessive growth of the fetal AC between 20 and 28 wkGA, and its effects on fetal growth are additive with the effects of maternal obesity.

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Adult, Cohort Studies, Diabetes, Gestational, Female, Fetal Development, Fetal Macrosomia, Fetus, Gestational Age, Head, Humans, Obesity, Parity, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Prospective Studies, Ultrasonography, Prenatal, Waist Circumference, Young Adult
Journal Title
Diabetes Care
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American Diabetes Association
Stillbirth and Neonatal Death Society (SANDS) (JE/DICT4/97771/14)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
TCC (None)
TCC (None)
The work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre (Women's Health theme) and SANDS (Stillbirth and neonatal death charity). GE donated two Voluson i ultrasound systems for this study. The study was also supported by the NIHR Cambridge Clinical Research Facility, where all research visits took place. HM is supported by a NIHR Career Development Fellowship Award (NIHR CDF 2013-06- 035). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health. None of the authors has a directly relevant competing interest. Two authors have commercial interests in other areas. Murphy sits on a scientific advisory board for Medtronic (insulin pump manufacturer). Smith receives/has received research support from GE (supply of two diagnostic ultrasound systems used in the present study). Other commercial interests, not directly relevant to the present study are: support from Roche (supply of equipment and reagents for biomarker studies, ~£600,000 in value) and from GSK (~£200,000) project to study effects of retosiban in human myometrium). Smith has been paid to attend advisory boards by GSK and 16 Roche. Smith has acted as a paid consultant to GSK. Smith is named inventor in a patent submitted by GSK (UK), for novel application of an existing GSK compound for the prevention of preterm birth (PCT/EP2014/062602). This work was presented as an oral communication at the Society for Maternal-Fetal Medicine, Atlanta GA, February 2016.