Galanin in pregnancy: Is there an association with birth weight and gestational diabetes?

Objective: To review the actions of galanin during pregnancy and to examine the existence of an association between galanin and birthweight as well as with gestational diabetes mellitus (GDM).

Results: Galanin concentrations in maternal circulation are similar in pregnant and nonpregnant status and have been correlated with body mass index (BMI). There is evidence of an association between birthweight and galanin concentrations in amniotic fluid during second trimester and galanin concentrations in umbilical cord at term. Moreover, there is a positive correlation between maternal galanin concentrations and existence of GDM. However, galanin concentrations in fetal circulation have not been correlated with neonatal fat mass. Neonatal galanin concentrations do not differ among uncomplicated pregnancies and those complicated by GDM or intrauterine growth retardation (IUGR).

Conclusions: There is evidence for an association between galanin during pregnancy with birth weight and metabolic processes. Further studies are required in order to elucidate this role. Galanin could serve as a predictor of neonatal body weight, alternations of which contribute to the development of diseases during adulthood.     

Can shortened midtrimester cervical length predict very early spontaneous preterm birth?

OBJECTIVE: The study was undertaken to test the hypothesis that shortened midtrimester cervical length is more predictive of early (<26 weeks) than later (26-34 weeks) spontaneous preterm birth. STUDY DESIGN: This is a secondary analysis of a blinded, multicenter observational study of 183 women with a prior preterm birth. Vaginal sonography was begun at 16 to18 weeks' gestation and scheduled every 2 weeks (maximum 4 scans per patient). Cervical length and any observed dynamic shortening were recorded at each visit to determine the shortest observed cervical length from 16 to 24 weeks' gestation. The shortest cervical length measurements were categorized as less than 25 mm, 25 to 29 mm and 30 mm or greater. The initial cervical length was also compared with the shortest cervical length to categorize patients on the basis of the timing of cervical shortening 30 mm or less. Contingency table, linear regression, and survival analysis were used to analyze the relationship between cervical length groups and spontaneous preterm birth. RESULTS: In both the less than 25 mm and 25 to 29 mm groups, the incidence of spontaneous midtrimester birth (<26 weeks) was higher than the incidence of later (26-34 weeks) preterm birth (<25 mm group: 37% vs 19%; 25-29 mm group: 16% vs 3%, respectively) as compared with women with a shortest cervical length 30 mm or greater, who had rates of 1% and 9% respectively (P <.0001). Similarly, women who had an initial cervical length 30 mm or less and those who shortened their cervix to 30 mm or less before 22 weeks were also more likely to experience a midtrimester than later preterm birth, whereas women who shortened their cervix 30 mm or less later (22-24 weeks) or who maintained a cervical length greater than 30 mm had lower rates of midtrimester than later preterm birth (P <.0001). CONCLUSION: Shortened cervical length in the midtrimester preferentially predicts early, as opposed to later, spontaneous preterm birth in high-risk women.     

Can discordance in CRL at the first trimester predict birth weight discordance in twin pregnancies?

Abstract Objective: To examine the correlation between measurements of crown rump length (CRL), nuchal translucency (NT), and birth weight in dichorionic (DC) and monochorionic (MC) twin pregnancies. Methods: A retrospective analysis was performed on all twin term pregnancies delivered between 2001 and 2007 at the McGill University Health Center. Data collected included maternal age, CRL and NT measurement, results of glucose challenge test, birth weight and length, gestational age at delivery, and fetal gender. Results: The study population comprised 792 fetuses: 94 MC/DA and 698 DC/DA. Maternal age, gestational age at delivery, birth weight, and birth length were all significantly higher for the DC group. Male fetuses had significantly higher NT and higher birth weight than female fetuses. Discordance in CRL was found to correlate with discordance in birth weight in the entire study population (P<0.0001, R=0.25), in the DC twins (P<0.0001, R=0.275), but not in MC twins (R=0.10, P=0.33). CRL discordance above the 90th percentile (>12%) predicted 14/40 pregnancies with birth weight discordance above the 90th percentile (>24%) [P<0.001, LR=4.1 (2.6-6.2)]. CRL discordance above the 95th percentile (>16%) predicted 5/21 pregnancies with birth weight discordance above the 95th percentile (>30%) [P<0.001, LR=5.5 (2.6-10.4)]. NT discordance was correlated with CRL discordance (R=0.15, P<0.0001), but not with birth weight, regardless of chorionicity or gender. Conclusion: In twin pregnancies, CRL discordance in first trimester can predict discordance of more than 25% in neonatal birth weight.     

Can ultrasound fetal biometry predict fetal hyperinsulinaemia at delivery in pregnancy complicated by maternal diabetes?

OBJECTIVE: The aim of this study was to determine whether there is an association between ultrasound fetal biometry and amniotic fluid insulin levels at delivery in women with pre-existing diabetes or impaired glucose tolerance in pregnancy. STUDY DESIGN: This retrospective cohort study identified 93 women who had amniotic fluid insulin levels measured at time of delivery. Standardised estimated fetal weight and fetal growth velocity were calculated from serial third trimester fetal ultrasound measurements. RESULTS: Women with pre-existing diabetes had significantly greater mean growth velocity [1.39 (95% CI: 0.43-2.23) versus 0.39 (95% CI: -01.7-0.95); p=0.04], significantly greater mean estimated fetal weight (EFW) Z score prior to delivery [2.36 (95% CI: 1.82-2.9) versus 1.38 (95% CI: 1.02-1.74); p=0.002] and greater mean birthweight centile [82 (95% CI: 0.74-0.89) versus 67 (95% CI: 58-76); p=0.02] than those with GDM/IGT. Amniotic fluid insulin levels demonstrated a similar significant difference between the pre-existing and GDM/IGT groups [20.5 (95% CI: 12.9-28.1) versus 8.5 (95% CI: 5.4-11.7); p=0.001]. An association between fetal growth and size and amniotic fluid insulin was observed in women with pre-existing diabetes. Positive likelihood ratios were 1.67 and 2.08, respectively, for the prediction of liquor insulin greater than the 95th centile in women with pre-existing diabetes. CONCLUSION: Ultrasound measures of fetal size and growth used in this study are not sufficiently accurate to predict those infants likely to be at risk from the adverse effects of fetal hyperinsulinaemia.     

How does early ultrasound scan estimation of gestational age lead to higher rates of preterm birth?

OBJECTIVE: Early ultrasound scanning estimation of gestational age is known to increase the reported preterm delivery rate (<37 completed weeks) compared with estimation by date of the last normal menstrual period, but it is unclear how this systematic difference arises. STUDY DESIGN: This study was a hospital-based study of 44,623 women who delivered a live-born or stillborn infant between January 1, 1978, and March 31, 1996, and who had both last normal menstrual period-based and early (usually at 16-18 weeks) ultrasound scan-based gestational age estimates. Cross-classification of the 2 estimates by completed weeks was used to examine the direction and magnitude of the differences between them and to compare the resulting classifications of preterm birth. RESULTS: The early ultrasound scan-based gestational age distribution was shifted uniformly to the left (ie, lower gestational age) relative to the last normal menstrual period gestational age distribution; the early ultrasound scan-based preterm delivery rate was 9.1%, which was 19.5% (n = 659 births) higher than the 7.6% rate by last normal menstrual period (P <.0001). The last normal menstrual period estimate exceeded the early ultrasound scan estimate far more often than the reverse, up to and including early ultrasound scan estimates of 40 weeks. No concentration of 4-week discrepancies was observed in either direction, as would be expected with random or systematic errors in recall of the last normal menstrual period. The absolute number of births at 37 to 39 weeks of gestation (by last normal menstrual period) that were reclassified as preterm (n = 1206 births) was much higher than the number of preterm births at 34 to 36 weeks of gestation that were reclassified as term (n = 581 births). The net increase of 625 preterm births (from 581 to 1206 births) that resulted from reclassification of births at 37 to 39 last normal menstrual period weeks accounted for 95% of the total 659-birth increase in early ultrasound scan-based preterm births at all last normal menstrual period gestational ages. CONCLUSION: Early ultrasound scanning reduces the gestational age estimate across the entire gestational age range; early ultrasound scan-based reclassification of gestational age results in a substantial increase in the prevalence of preterm births. Small downward reclassifications exceed upward reclassifications of similar magnitude, which is consistent with previous reports that delayed (>14 days) ovulation is more frequent than early (<14 days) ovulation.     

Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes?

Objective: To determine the ability to predict the need for pharmacological treatment in gestational diabetes mellitus (GDM).

Method: A retrospective cohort study. Data were collected from medical records of 1324 GDM patients including demographic data, family history of diabetes, obstetrical history, laboratory results, treatment modality and level of glycemic control. Patients who were identified as pre-gestational diabetes were excluded.

Results: Overall, 143 (10.8%) GDM patients required pharmacological therapy. Of women who had GDM in their previous pregnancy; only 11.65% achieved desired glycemic control solely by diet treatment. Moreover, 62.5% of patients requiring pharmacological therapy in their previous pregnancy achieved desired level of glycemic control only by diet. Of patients who achieved desired level of glycemic control on diet until the second antenatal visit, 95% continued to maintain desired level glycemic control throughout pregnancy. Pre-pregnancy BMI?>30, fasting plasma glucose >95?mg/dL and maternal age above 30 were associated with increase need for pharmacological treatment. One abnormal value in the OGTT and GCT result >2?mg/dL did not predict the need for pharmacological therapy. Primigravida and family history of GDM were not found to be predictors for treatment modality.

Conclusion: Using clinical and demographical data can predict the need for pharmacological treatment for GDM.     

Can first trimester maternal serum follistatin like 3 levels predict developing gestational diabetes mellitus?

Purpose: The purpose of this study is to determine whether the first trimester maternal serum levels of follistatin like 3 (FSTL3) are altered in patients who develop gestational diabetes mellitus (GDM).

Methods: This is a prospective nested case-control study that included 170 singleton pregnant women recruited in their first trimester. All women were followed up until the delivery and 144 of them completed the study. The maternal serum levels of FSTL3 were measured at 11–14 weeks of gestation. The GDM-affected women (n?=?19) were compared with the GDM-free control women (n?=?125) for potential serum biomarkers including the FSTL3 levels.

Results: There were no significant differences in maternal age, maternal pre-pregnancy body mass index, and neonatal birth weight between the GDM group and the GDM-free control group. Women with GDM had significantly greater weight gain during pregnancy than the women without GDM. Serum concentration of glycosylated hemoglobin was significantly higher in women with GDM. There were no significant differences in serum FSTL3 levels (p?=?0.578) between the GDM group and the GDM-free control group.

Conclusions: Our results suggest that the first trimester maternal serum FSTL3 levels are not altered in women who develop GDM and thus do not support the use of serum FSTL3 levels for early prediction of GDM.     

Is low pre-pregnancy body mass index a risk factor for preterm birth and low neonatal birth weight?

OBJECTIVES: A pregnant woman's weight is an extremely important factor in the course of pregnancy and delivery. Not only obesity but also being underweight may lead to complications in pregnancy such as: preterm delivery and low neonatal birth weight. DESIGN: The aim of this study was to analyze the relationship between a low BMI and outcome of pregnancy, birth weight and general well being of the neonates. MATERIAL AND METHODS: 415 patients who were hospitalized in the Department of Obstetrics and Reproduction Wroc?aw Medical University between 1996-2005 was done. The patients were divided into 3 groups I--Underweight (BMI <19,8), II--Appropriate weight (BMI 19,8-26,0) and III--Overweight (BMI>26,0). RESULTS: The frequency of preterm deliveries as well as low neonatal birth weight <2500g, in underweight mothers was higher than in other groups. CONCLUSIONS: Low pre-pregnancy BMI is an important factor risk factor in preterm deliveries. There was no correlation between BMI and the general well being of the neonates.     

Can we predict delivery date with obstetric ultrasound?

Abstract

Objective: The long-term prediction of delivery date with obstetric ultrasound.

Method: The cervical length (CL) and the fetal vertebral, middle cerebral and umbilical resistance indices were measured in 317 pregnancies between 30 and 37 weeks. Subsequently, multivariate analysis was applied to calculate the best model for the prediction of delivery date.

Results: The best model included the examinations of the CL and the middle cerebral artery resistance index. In comparison with estimated delivery date (EDD) based on the last menstrual period, a small improvement was detected, particularly in earlier deliveries, however 34% of predictions still had an error of more than 5 days.

Conclusions: Long-term sonographic prediction of delivery date depends mainly on the CL and improves the prediction of the EDD. However, it is still too inaccurate for clinical use.     

Effect of pre-gestational weight and gestational weight gain in women with gestational diabetes controlled with medication on pregnancy outcomes – is recommended weight gain too liberal?

This is a retrospective cohort study of women with GDM treated with glucose-lowering agents that were followed and gave birth between 2005 and 2015 in the Assaf Harofeh medical center, Israel. Classification and regression tree method identified four groups according to adverse outcomes, consisted of 74 women with pre-gestational BMI below 25, 98 women with BMI 25–31, 90 women 31–39 and 18 women above 39. Respectively, median GWG was 12?kg (8–16), 11?kg (8–15), 7.5?kg (3.75–11) and 5?kg (–1.5 to 11.5) (p?<?.001). The risk for composite adverse outcomes was higher in the groups of BMI 25–31 (73.5%) and 31–39 (83.3%) in comparison to BMI <25 (51.4%) and 39?<?(55.6%), p?<?.001. In women with pre-gestational BMI of <25, GWG of more than the median resulted in odds ratio of 2.75 (1.07–7.08, p?=?.036) for adverse pregnancy outcomes compared with participants who gained less than the median. Maternal obesity is related to adverse pregnancy outcomes. Women with GDM with normal pre-gestational BMI who gained weight according to IOM recommendations still experienced adverse outcomes.     

Is there any association between periodontitis and preterm low birth weight?

Objective.?To estimate the association between periodontitis (PD) and preterm low birth weight (LBW).

Study design.?Observational study in a University clinical setting on a population of 120 pregnant women.

Results.?One specialist in periodontics examined all the patients. Two thresholds for definition of PD were used, which detected respectively 29 women (24%) and 4 (3%) as affected by the pathology. Six patients were lost to follow-up. Out of the remaining 114, 1 had an abortion, while 20 (17%) delivered pre-term. Eleven per cent of all women delivered low-weight babies. Ten women (9%) delivered preterm LBW babies. No association was detected between any of the two definitions of PD and any of the adverse pregnancy outcomes.

Conclusion.?This study was unable to provide evidence of association between PD and preterm LBW.