Fetal Macrosomia
Pregnancy in Diabetics
Fetal Weight
Diabetes, Gestational
Birth Weight
Pregnancy
Gestational Age
Pregnancy Outcome
Ultrasonography, Prenatal
Roman World
Pregnancy Complications
Pre-conception diabetes care in insulin-dependent diabetes mellitus. (1/228)
Prospective studies of pre-conception diabetes care have confirmed its positive impact on the incidence of malformations by improving glycaemic control. Less information is available on the impact of pre-conception care on maternal and neonatal morbidity. This audit addresses its impact on timing and mode of delivery, incidence of macrosomia and rate of admission to neonatal unit care in addition to sociodemographic factors which may influence attendance at such a service. Attenders were more likely to be in a stable relationship and be non-smokers. They were more likely to book for antenatal care earlier and with a lower glycated haemoglobin. There were no early deliveries (i.e. < 30 weeks) or small for gestational age (SGA) babies in those who attended for pre-conception care and no neonatal deaths. Admission to NNU care was reduced by 50% in those who attended for pre-conception care. Although the rate of macrosomia was reduced, there was no impact on the Caesarian section rate. A pre-conception diabetes clinic may have a positive impact on neonatal morbidity. (+info)Effects of overexpression of human GLUT4 gene on maternal diabetes and fetal growth in spontaneous gestational diabetic C57BLKS/J Lepr(db/+) mice. (2/228)
During gestation, heterozygous C57BLKS/J-Lepr(db/+) mice develop spontaneous gestational diabetes mellitus (GDM), and the newborn fetuses are macrosomic compared with offspring from wild-type (+/+) mothers. To investigate the effects of the leptin receptor mutation on maternal metabolism and fetal growth during pregnancy, we studied +/+, db/+, and db/+ transgenic mice that overexpress the human GLUT4 gene two- to three-fold (db/+TG6). During pregnancy, fasting plasma glucose and hepatic glucose production were twofold greater in db/+ than +/+ mice, despite similar insulin levels. In skeletal muscle, insulin-stimulated tyrosine phosphorylation was decreased in pregnant +/+ mice, and even more so in db/+ mice: insulin receptor beta (IR-beta), +/+ 34%, db/+ 57% decrease, P<0.05; insulin receptor substrate 1 (IRS-1), +/+ 44%, db/+ 61% decrease, P<0.05; and phosphoinositol (PI) 3-kinase (p85alpha), +/+ 33%, db/+ 65% decrease, P<0.05. Overexpression of GLUT4 in db/+TG6 mice markedly improved glucose-stimulated insulin secretion, by 250%, and increased IRbeta, IRS-1, and p85alpha phosphorylation twofold, despite no change in concentration of these proteins. Plasma leptin concentration increased 40-fold during pregnancy, from 2.2+/-0.5 to 92+/-11 ng/ml and 3.6+/-0.1 to 178+/-34 ng/ml in +/+ and db/+ mice, respectively (P<0.01), but was increased to only 23+/-3 ng/ml in pregnant db/+TG6 mice (P<0.001). Maternal fat mass and energy intake were greater in db/+ mice, and fat mass was reduced by GLUT4 overexpression, independent of food intake. Fetal body weight was increased by 8.1 and 7.9% in db/+ and db/+TG6 mothers, respectively (P<0.05), regardless of fetal genotype, whereas fetuses from db/+TG8 mothers (four- to fivefold overexpression) weighed significantly less compared with pups from +/+ or db/+ mothers (P<0.05). These results suggest that the single mutant db allele effects susceptibility to GDM through abnormalities in insulin receptor signaling, defective insulin secretion, and greater nutrient availability. GLUT4 overexpression markedly improves insulin-signaling in GDM, resulting in increased insulin secretion and improved glycemic control. However, maternal hyperglycemia appears not to be the sole cause of fetal macrosomia. These data suggest that GDM is associated with defects in insulin receptor signaling in maternal skeletal muscle, and this may be an important factor provoking maternal and fetal perinatal complications. (+info)Human placental nitric oxide synthase activity is not altered in diabetes. (3/228)
Endothelial nitric oxide synthase (NOS) protein and mRNA have been identified and calcium-dependent NOS activity has been measured in human placentae during normal pregnancy. Recently, mRNA and protein for the inducible isoform of NOS have been detected in placentae of women with gestational diabetes. The aim of this study was to determine whether calcium-independent (ciNOS) and/or total (tNOS) NOS activities were increased in placentae obtained after vaginal delivery or Caesarean section from women assigned to the following groups according to standard obstetric criteria: gestational diabetes, diabetes before pregnancy and non-diabetic controls. tNOS and ciNOS were assessed by measuring the conversion of [3H]L-arginine to [3H]L-citrulline in the three groups. Michaelis-Menten constants (Km) and maximum velocities of reaction (Vmax) were calculated using Lineweaver-Burk analysis for tNOS. There were no significant differences in either ciNOS, Vmax or Km values between any of the three groups (normal, ciNOS 12.7+/-1.6%, Vmax 16.6+/-3.3 pmol.min-1.mg-1 protein, Km 15.30+/-2.6 micromol/l; gestational diabetes, ciNOS 15.4+/-1.4%, Vmax 14.8+/-5.2 pmol.min-1. mg-1 protein, Km 10.5+/-1.7 micromol/l; diabetes before pregnancy, ciNOS 13.4+/-1.1%, Vmax 14.9+/-3.4 pmol.min-1.mg-1 protein, Km 17. 7+/-2.2 micromol/l). The presence of macrosomia did not affect tNOS activity in those with diabetes before pregnancy, and glycosylated haemoglobin levels measured between weeks 27 and 39 were not correlated with ciNOS activity. The results from the present study do not provide evidence for increased placental tNOS or ciNOS activities in pregnancies complicated by gestational diabetes or diabetes present before pregnancy. (+info)Screening efficacy of the subcutaneous tissue width/femur length ratio for fetal macrosomia in the non-diabetic pregnancy. (4/228)
BACKGROUND: Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non-diabetic population at term. STUDY DESIGN: Intrapartum sonographic measurements were performed in 178 well-dated gravidas at 37-41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut-off points of the examined parameters or estimated fetal weights. RESULTS: Macrosomia occurred in 27 newborns (15.1%). The SCT/FL ratio was independent of gestational age (r = -0.017). Maternal age, gravidity, parity, gestational age and the ratio of male-to-female infants were similar in pregnancies resulting in appropriate-for-gestational-age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (theta) revealed that the abdominal circumference had the best sensitivity-specificity trade-off (theta = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (theta = 0.8773; p < 0.0005), the Shepard formula (theta = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (theta = 0.6872; p < 0.01) and the SCT/FL ratio (theta = 0.6303). CONCLUSIONS: We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non-diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters. (+info)Early postpartum metabolic assessment in women with prior gestational diabetes. (5/228)
OBJECTIVE: To present the results of early postpartum metabolic assessment in women with gestational diabetes mellitus (GDM), to determine predictive factors for subsequent diabetes, and to investigate the association of postpartum glucose tolerance with other components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: A total of 788 women were evaluated 3-6 months after a GDM pregnancy. A 75-g oral glucose tolerance test (OGTT) was performed. Cholesterol, HDL cholesterol, triglycerides, blood pressure, BMI, and body fat distribution were assessed. Clinical and obstetric history, baseline variables at the diagnosis of GDM, metabolic control during pregnancy, and index pregnancy outcome were compared in women with diabetes and women without diabetes (American Diabetes Association [ADA] criteria) after pregnancy. Multivariate logistic regression analysis was used to ascertain independent predictors of subsequent diabetes. Correlation coefficients were assessed between postpartum glucose tolerance and lipid levels, blood pressure, BMI, and body fat distribution. RESULTS: According to ADA criteria, 588 (74.6%) women were normal, 46 (5.8%) had impaired fasting glucose, 82 (10.4%) had impaired glucose tolerance, 29 (3.7%) had both impaired fasting glucose and impaired glucose tolerance, and 43 (5.4%) had diabetes. Prepregnancy obesity, recurrence of GDM, gestational age at diagnosis of GDM, glucose values in the 100-g OGTT, number of abnormal values in the 100-g OGTT, fasting C-peptide levels in pregnancy, C-peptide/glucose score in pregnancy, insulin requirement in pregnancy, 3rd trimester HbA1c levels, and macrosomia differed significantly in women with subsequent diabetes. Independent predictors of postpartum diabetes were prepregnancy obesity, C-peptide/glucose score during pregnancy, and the number of abnormal values in the 100-g diagnostic OGTT. The area under the postpartum glucose curve was positively associated with BMI, waist circumference, waist-to-hip ratio, triglycerides, and systolic and diastolic blood pressures. CONCLUSIONS: Low C-peptide/glucose score during pregnancy together with prepregnancy obesity and severity of GDM (number of abnormal values in the 100-g diagnostic OGTT) are independent predictors of subsequent diabetes. Our data suggest that regardless of obesity and severity of GDM, a beta-cell defect increases the risk of postpartum diabetes. The association of postpartum glucose tolerance with triglyceride levels, blood pressure, obesity, and regional distribution of body fat suggests that postpartum glucose intolerance anticipates a high-risk cardiovascular profile that comprises other risk factors besides diabetes. (+info)What is the significance of macrosomia? (6/228)
This commentary/review briefly considers the diverse criteria recommended for classification of overweight infants. Macrosomia continues to be a vexing problem for both obstetricians and pediatricians. Among the various techniques possible for use in assessing body composition, none are more practical than body weight relative to gestational age. The criteria for normative data from large populations are reviewed. The stringent definition, i.e., exceeding +2 SD of an appropriate normative population, is reaffirmed. Using these criteria, infants of diabetic mothers showed a significant relationship of body weight to fetal hyperinsulinemia. (+info)Are conventional targets for metabolic control sufficient to prevent fetal macrosomia during diabetic pregnancy? (7/228)
We report the case of a 26 year-old woman, with an uncomplicated type 1 IDDM of 17 yr duration followed for her first pregnancy. At conception, HbA1c (measured by HPLC) was 6.5% and fructosamine was 280 u.mol.l (normal range below 285). During the follow-up, 15-days-interval frutosamine never exceeded the normal range and HbA1c values were under 6.5% excepted in the third trimester (7.0 +/- 0.8%) coinciding with a bad control of the 2 hours post-prandial blood glucose. A fetal macrosomy was discovered at 34 weeks of gestation and a heavy-for-date 4680 g baby was delivered by caesarean section at 38 weeks of gestation. Our case report outlines again the need to achieve the recommended target of metabolic control for the diabetic pregnant woman (blood preprandial glucose: 3.9-5.6 mM; post-prandial 2 h < 6.7 mM) specially during the third trimester of pregnancy. The use of computer databases might be helpful for precise monitoring during this narrow window period. (+info)Time course of changes in serum glucose, insulin, lipids and tissue lipase activities in macrosomic offspring of rats with streptozotocin-induced diabetes. (8/228)
The aim of this investigation was to determine the time course of changes in serum glucose, insulin and lipid levels, as well as lipid and protein content and lipolytic activities in insulin target organs (liver, adipose tissue and muscle), in macrosomic offspring of streptozotocin-induced mildly hyperglycaemic rats. Food intake and nutritional efficiency were also evaluated. Mild hyperglycaemia in pregnant rats was induced by intraperitoneal injection of streptozotocin (40 mg/kg body weight) on day 5 of gestation. Control pregnant rats were injected with citrate buffer. At birth, macrosomic pups (birth weight >1.7 S.D. greater than the mean value for the control pups) had higher serum insulin, glucose and lipid levels than control pups. These macrosomic rats maintained accelerated postnatal growth combined with high adipose tissue weight up to 12 weeks of age. These rats were not hyperphagic; however, they had higher food efficiency and fat storage capacity with higher adipocyte lipoprotein lipase activity, which contributed to persisting obesity. Hepatic lipase activity was increased in macrosomic rats at all ages. Moreover, macrosomia was associated with metabolic disturbances that varied according to age and sex. After 1 month, several alterations observed at birth had disappeared. Serum glucose, insulin and lipid levels in male and female macrosomic rats became similar to those of their respective controls. At 2 months of age, hepatic and serum triacylglycerol levels were higher in macrosomic females than in controls. By 3 months, macrosomic rats (both males and females) had developed insulin resistance with hyperinsulinaemia, hyperglycaemia, and higher serum and hepatic lipids. In conclusion, macrosomia was associated with alterations in glucose and lipid metabolism through to adulthood. It should be considered as an important potential risk factor for obesity and its metabolic complications. (+info)Fetal macrosomia is a medical condition where the fetus in the womb is significantly larger than normal. While there is no consensus on an exact weight that defines macrosomia, it is generally defined as a fetus with an estimated weight of 4,000 grams (8 pounds 13 ounces) or more at birth.
Fetal macrosomia can be caused by several factors, including maternal diabetes, post-term pregnancy, excessive weight gain during pregnancy, and prior history of macrosomic infants. Macrosomic infants are at an increased risk for complications during labor and delivery, such as shoulder dystocia, birth injuries, and hypoglycemia.
It is important for healthcare providers to monitor fetal growth carefully during pregnancy, particularly in women who have risk factors for macrosomia. Regular prenatal care, including ultrasound measurements of the fetus, can help identify cases of fetal macrosomia and allow for appropriate management and delivery planning.
'Pregnancy in Diabetics' refers to the condition where an individual with pre-existing diabetes mellitus becomes pregnant. This can be further categorized into two types:
1. Pre-gestational diabetes: This is when a woman is diagnosed with diabetes before she becomes pregnant. It includes both Type 1 and Type 2 diabetes. Proper control of blood sugar levels prior to conception and during pregnancy is crucial to reduce the risk of complications for both the mother and the baby.
2. Gestational diabetes: This is when a woman develops high blood sugar levels during pregnancy, typically in the second or third trimester. While it usually resolves after delivery, women with gestational diabetes have a higher risk of developing Type 2 diabetes later in life. Proper management of gestational diabetes is essential to ensure a healthy pregnancy and reduce the risk of complications for both the mother and the baby.
Fetal weight is the calculated weight of a fetus during pregnancy, typically estimated through ultrasound measurements. It is a crucial indicator of fetal growth and development throughout pregnancy. The weight is determined by measuring various parameters such as the head circumference, abdominal circumference, and femur length, which are then used in conjunction with specific formulas to estimate the fetal weight. Regular monitoring of fetal weight helps healthcare providers assess fetal health, identify potential growth restrictions or abnormalities, and determine appropriate delivery timing. Low fetal weight can indicate intrauterine growth restriction (IUGR), while high fetal weight might suggest macrosomia, both of which may require specialized care and management.
Gestational diabetes is a type of diabetes that occurs during pregnancy. It is characterized by an increase in blood sugar levels that begins or is first recognized during pregnancy. The condition usually develops around the 24th week of gestation and is caused by the body's inability to produce enough insulin to meet the increased demands of pregnancy.
Gestational diabetes typically resolves after delivery, but women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life. It is important for women with gestational diabetes to manage their blood sugar levels during pregnancy to reduce the risk of complications for both the mother and the baby.
Management of gestational diabetes may include lifestyle modifications such as dietary changes and exercise, as well as monitoring blood sugar levels and potentially using insulin or other medications to control blood sugar levels. Regular prenatal care is essential for women with gestational diabetes to ensure that their blood sugar levels are properly managed and to monitor the growth and development of the fetus.
Birth weight refers to the first weight of a newborn infant, usually taken immediately after birth. It is a critical vital sign that indicates the baby's health status and is used as a predictor for various short-term and long-term health outcomes.
Typically, a full-term newborn's weight ranges from 5.5 to 8.8 pounds (2.5 to 4 kg), although normal birth weights can vary significantly based on factors such as gestational age, genetics, maternal health, and nutrition. Low birth weight is defined as less than 5.5 pounds (2.5 kg), while high birth weight is greater than 8.8 pounds (4 kg).
Low birth weight babies are at a higher risk for various medical complications, including respiratory distress syndrome, jaundice, infections, and developmental delays. High birth weight babies may face challenges with delivery, increased risk of obesity, and potential metabolic issues later in life. Regular prenatal care is essential to monitor fetal growth and ensure a healthy pregnancy and optimal birth weight for the baby.
Pregnancy is a physiological state or condition where a fertilized egg (zygote) successfully implants and grows in the uterus of a woman, leading to the development of an embryo and finally a fetus. This process typically spans approximately 40 weeks, divided into three trimesters, and culminates in childbirth. Throughout this period, numerous hormonal and physical changes occur to support the growing offspring, including uterine enlargement, breast development, and various maternal adaptations to ensure the fetus's optimal growth and well-being.
A Cesarean section, often referred to as a C-section, is a surgical procedure used to deliver a baby. It involves making an incision through the mother's abdomen and uterus to remove the baby. This procedure may be necessary when a vaginal delivery would put the mother or the baby at risk.
There are several reasons why a C-section might be recommended, including:
* The baby is in a breech position (feet first) or a transverse position (sideways) and cannot be turned to a normal head-down position.
* The baby is too large to safely pass through the mother's birth canal.
* The mother has a medical condition, such as heart disease or high blood pressure, that could make vaginal delivery risky.
* The mother has an infection, such as HIV or herpes, that could be passed to the baby during a vaginal delivery.
* The labor is not progressing and there are concerns about the health of the mother or the baby.
C-sections are generally safe for both the mother and the baby, but like any surgery, they do carry some risks. These can include infection, bleeding, blood clots, and injury to nearby organs. In addition, women who have a C-section are more likely to experience complications in future pregnancies, such as placenta previa or uterine rupture.
If you have questions about whether a C-section is necessary for your delivery, it's important to discuss your options with your healthcare provider.
Gestational age is the length of time that has passed since the first day of the last menstrual period (LMP) in pregnant women. It is the standard unit used to estimate the age of a pregnancy and is typically expressed in weeks. This measure is used because the exact date of conception is often not known, but the start of the last menstrual period is usually easier to recall.
It's important to note that since ovulation typically occurs around two weeks after the start of the LMP, gestational age is approximately two weeks longer than fetal age, which is the actual time elapsed since conception. Medical professionals use both gestational and fetal age to track the development and growth of the fetus during pregnancy.
A newborn infant is a baby who is within the first 28 days of life. This period is also referred to as the neonatal period. Newborns require specialized care and attention due to their immature bodily systems and increased vulnerability to various health issues. They are closely monitored for signs of well-being, growth, and development during this critical time.
Pregnancy outcome refers to the final result or status of a pregnancy, including both the health of the mother and the newborn baby. It can be categorized into various types such as:
1. Live birth: The delivery of one or more babies who show signs of life after separation from their mother.
2. Stillbirth: The delivery of a baby who has died in the womb after 20 weeks of pregnancy.
3. Miscarriage: The spontaneous loss of a pregnancy before the 20th week.
4. Abortion: The intentional termination of a pregnancy before the fetus can survive outside the uterus.
5. Ectopic pregnancy: A pregnancy that develops outside the uterus, usually in the fallopian tube, which is not viable and requires medical attention.
6. Preterm birth: The delivery of a baby before 37 weeks of gestation, which can lead to various health issues for the newborn.
7. Full-term birth: The delivery of a baby between 37 and 42 weeks of gestation.
8. Post-term pregnancy: The delivery of a baby after 42 weeks of gestation, which may increase the risk of complications for both mother and baby.
The pregnancy outcome is influenced by various factors such as maternal age, health status, lifestyle habits, genetic factors, and access to quality prenatal care.
Prenatal ultrasonography, also known as obstetric ultrasound, is a medical diagnostic procedure that uses high-frequency sound waves to create images of the developing fetus, placenta, and amniotic fluid inside the uterus. It is a non-invasive and painless test that is widely used during pregnancy to monitor the growth and development of the fetus, detect any potential abnormalities or complications, and determine the due date.
During the procedure, a transducer (a small handheld device) is placed on the mother's abdomen and moved around to capture images from different angles. The sound waves travel through the mother's body and bounce back off the fetus, producing echoes that are then converted into electrical signals and displayed as images on a screen.
Prenatal ultrasonography can be performed at various stages of pregnancy, including early pregnancy to confirm the pregnancy and detect the number of fetuses, mid-pregnancy to assess the growth and development of the fetus, and late pregnancy to evaluate the position of the fetus and determine if it is head down or breech. It can also be used to guide invasive procedures such as amniocentesis or chorionic villus sampling.
Overall, prenatal ultrasonography is a valuable tool in modern obstetrics that helps ensure the health and well-being of both the mother and the developing fetus.
I'm sorry for any confusion, but "Roman World" is not a medical term. It may refer to the geographical area, culture, or time period associated with the ancient Roman Empire. If you have any questions about medical terminology or concepts, I would be happy to help answer those!
Pregnancy complications refer to any health problems that arise during pregnancy which can put both the mother and the baby at risk. These complications may occur at any point during the pregnancy, from conception until childbirth. Some common pregnancy complications include:
1. Gestational diabetes: a type of diabetes that develops during pregnancy in women who did not have diabetes before becoming pregnant.
2. Preeclampsia: a pregnancy complication characterized by high blood pressure and damage to organs such as the liver or kidneys.
3. Placenta previa: a condition where the placenta covers the cervix, which can cause bleeding and may require delivery via cesarean section.
4. Preterm labor: when labor begins before 37 weeks of gestation, which can lead to premature birth and other complications.
5. Intrauterine growth restriction (IUGR): a condition where the fetus does not grow at a normal rate inside the womb.
6. Multiple pregnancies: carrying more than one baby, such as twins or triplets, which can increase the risk of premature labor and other complications.
7. Rh incompatibility: a condition where the mother's blood type is different from the baby's, which can cause anemia and jaundice in the newborn.
8. Pregnancy loss: including miscarriage, stillbirth, or ectopic pregnancy, which can be emotionally devastating for the parents.
It is important to monitor pregnancy closely and seek medical attention promptly if any concerning symptoms arise. With proper care and management, many pregnancy complications can be treated effectively, reducing the risk of harm to both the mother and the baby.
The third trimester of pregnancy is the final stage of pregnancy that lasts from week 29 until birth, which typically occurs around the 40th week. During this period, the fetus continues to grow and mature, gaining weight rapidly. The mother's body also prepares for childbirth by dilating the cervix and producing milk in preparation for breastfeeding. Regular prenatal care is crucial during this time to monitor the health of both the mother and the developing fetus, as well as to prepare for delivery.