424 Screening for geatational diabetes in the subsequent pregnancy: Is it worthwhile
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S196 SMFM Abstracts 423 ULTRASOUND FETAL SUBCUTANEOUS THICKNESS MEASUREMENT AS A PREDICTOR OF FETAL BODY FAT STORES IN DIABETIC PREG- NANCY YOKO IKEDAt, ICHIRO YASUHIt, TADAYUKI ISHIMARU1, 1Nagasaki University School of Medicine, Obstetrics and Gynecology, Nagasaki, Nagasaki OBJECTIVE: 1) To test our hypothesis that, in appropriate-fot~gestational- age (AGA) infants, neonatal adiposity is greater in infants of diabetic mother (IDM) compared with ini~mts of non-diabetic mothers (INDM); and 2) To demonstrate whether sonographic measurement of fetal subcutaneous thickness (FST) is a better predictor of neonatal adiposity than conventional fetal measures. STUDY DESIGN: As well as standard fetal measures including abdominal circumference (AC), biparietal diameter (BPD), and fenmr length (FL), we measured the sum of four FST (abdomen, subscapular, thigh, and upper arm) by ultrasound within 72 hours before delivery in AGA fetuses in diabetic (n - 25) and non-diabetic (n = 29) pregnancies. We also measured the sum of four neonatal skinfold thicknesses (NSFT) at the same sites with calipers within 24 hours of birth, RESULTS: IDM showed greater FST and NSFT cmnpared with INDM, although gestational age (GA), birth weight, and standard fetal measures did not differ between the groups. In all subjects, FST significantly correlated with NSFT (r = 0.62, P < .000l). in the nmltiple regression model including FST, AC, BPD, and FL as predictive variables, FST was the only significant predictor (P = .0002) of NSFF after controlling for GA, sex, and presence or absence of maternal diabetes. CONCLUSION: IDM has greater body fat stores compared with INDM even in AGA infants. FST is a better predictor of the fetal adiposity than conventional fetal measurement~s. Table IDM 1NDM PVALUE Gestational age at delivery (wks) 39.2 + 1.1 39.1 + 1.4 .68 Birth weight (grams) 3,140 +_ 350 3,010 +_ 300 .14 NSFF (ram) 16.3 _+1.9 14.1 + 3.0 .003 FST (ram) 34.3 + 3.8 28.9 + 4.4 <.0001 BPD (mm) 93 _+ 3 93 + 3 .92 AC (ram) 333 +_ 21 329 _+15 .44 FL (ram) 71 + 4 70 _+ 4 .35 425 December 2001 AmJ Obstet Gynecol DIFFERENCES BETWEEN SONOGRAPHIC ESTIMATED FETAL SUBCU- TANEOUS TISSUE AND MECHANICAL MEASURED FETAL SKINFOLD RATIOS IN DIABETIC AND NON-DIABETIC PREGNANCIES INES KEM- PER l, KAI BUHLING2, WOLFGANG HENRICH 3, PATRICK CATALANO 4, MARTIN BRAUER2, JOACHIM W DUDENHAUSEN5:ICharit6 Humboldt University, Clinic of Obstetrics, Berlin; 2Charit6, Humboldt University, Clinic of Obstetrics, Berlin: 3Charit6, Humboldt-University, Clinic of Obstetrics, Berlin; 4Case Western Reserve University, Reproductive Biology, Cleveland, OH; 5Humboldt-Universitat zu Berlin, Clinic of Obstetrics, Berlin OBJECTIVE: To test the difference between sonographic estimated tissue and mechanical measured postpartum skinfold in diabetic and non-diabetic pregnant women. STUDY DESIGN: In this prospective study we included singleton preg- nancies after 37th completed weeks of gestational age (GA). Fetal biometry and measurenlent of subcutaneous tissue (abdomen at filet planum and feulur at middle of femoral length) was performed. Mechanical measurement (60 sec.) of subcutaneous skinfolds was done within 72h post partum at left superior anterior iliac spine and in the middle above the left quadriceps femoris using a Holtain-Caliper. We calculated the following ratios: 1. Biparital diameter (BPD)/Transversal abdonfinal diameter (AQ) 2. Sono skinfold abdomen/Sono skinfold fenmr 3. Skinfold abd./Skinfold tiem. Patient were divided into two groups: A. Non-diabetic patients (ND; negative 50g-screening or negative oral glucose tolerance test), B. Patients with type 1 diabetes mellitus or gestational diabetes (DM). RESULTS: 45 (56.3%) women were recruited as ND, 5 (6,2%) women with Type 1 Diabetes, and 30 (37.5%) with Gestational Diabetes as study group (DM). There were no significant ditterences between the groups in GA and time difference between both measurements. 1. The BPD/AQ ratio for ND showed a mean of lag vs.l.12 for DM (P = .006). 2. The ratio of the sono- graphic measured Skinfold abdomen/fenmr was 0.99 -+ 0.334 for ND and 1.12 _+ 0.399 for DM (P = .016) 3. The mechanical measurement also showed a significant difference between the groups in Skinfold abdominal/Skintbld femur with 0.84 -+0.272 vs. 0.925 _+ 0.326 (P= .017). CONCLUSION: Truncal obesity is well known sign for diabetic fetopathy. The sonographic and mechanical estimated skinfold ratios were shown to be better qualified to diagnose carbohydrate intolerance as compared with BPD/AQ. Further studies are necessary to evaluate the clinical value. 424 SCREENING FOR GESTATIONAL DIABETES IN THE SUBSEQUENT PREGNANCY: IS IT WORTHWHILE GEORGE LU 1, ANGELA LUCCHESE l, VICTORIA CHAPMAN1, SUE CLIVERl, DWIGHT ROUSE 1, tUniversity of Alabama at girnfingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: To determine the likelihood of developing gestational diabetes (GDM) in the subsequent pregnancy, and the associated risk factors, among women without evidence of GDM during their first pregnancy. STUDY DESIGN: A retrospective cohort study from 1991 to 1999 of women with no evidence of GDM in their first pregnancy (<2 abnormal results on ?,-hour 100-gin glucose tolerance test). RESULTS: Of the 3,710 eligible women, one percent (N = 37) were subsequently diagnosed with GDM in their second pregnancy. These women, when compared (by means) to women without GDM in their second pregnancy, were more likely to be older (age 21 yrs vs. 19 yrs), obese (first visit BMI 28 kg/m2 vs. 25 kg/m2), have a higher inter-pregnancy weight gain of>5 kg (93% vs. 49%), and have a greater inte~:pregnancy interval (33 months vs. 24 months). None of the women with an inte~pregnancy weight gain of < 4.7 kg developed GDM in the next pregnancy. Regression analysis revealed that, during the first pregnancy, a first visit BIVII >29 kg/m2 (OR, 95%CI 4.7, 2.1- 10.5), serum glucose screen > 101 mg/dl (OR, 95%CI 7.4, 2.2-25.0), age > 21 years (OR, 95%CI 2.8, 1.2-6.5), and an inter-pregnancy weight gain of >5 kg (OR, 95%CI 11.2, 2.6-48.2) were significantly associated with developing GDM in the second pregnancy. All women who snbsequently developed GDM had at least one of these risk factors. CONCLUSION: Among women without GDM in the first pregnancy and who do not have risk factors for this condition, the risk of GDM in a second pregnancy is negligible. Screening of such women in the second pregnancy may not be justified. 426 IS THERE A DIFFERENCE IN BODY COMPOSITION OF LARGE FOR GESTATIONAL AGE INFANTS OF GESTATIONAL DIABETICS VERSUS CONTROLS? CELESTE DU~ALD l, PATRICK CATALANO'-', LARRAINE HUSTON PRESLEY'-': 1CWRU/MetroHealth Medical Center, Obstetrics and Gynecology, Maternal Fetal Medicine, Cleveland, OH; 2CWRU/MetroHealth Medical Centel, Obstetrics and Gynecology, Cleveland, OH OBJECTIVE: To determine if there is a difference in body composidon and factors associated with fat mass (FM) in large for gestational age infants (LGA) of gestational diabetics (GDM) compared with women with normal glucose tolerance (CTL). STUDY DESIGN: LGA was defined as weight >90th percentile fbr gesta- tional age (EGA), race and sex based on our population's normative data. Body composition was estimated using TOBEC and/or anthropometry. Mann- Whimey U test was used to evaluate birth weight (BW), FM, % body fat (%BF) and lean body mass (LBM). Stepwise regression analysis was used to deternfine factors correlating with FM. RESULTS: 50 GDM and 52 CTL were evaluated. There was a significant difference in EGA, pre-pregnancy weight, maternal age, race and smoking history between groups. There was a significant difference in %BE FM, and LBM between groups. There was no significant difference in BW. Stepwise regression on all 102 women showed EGA and GDM correlated with FM (R2 = 0.11, P- .001) and GDM alone correlated wida %BF (R2 = 0.12, P= .0005). For GDM, both FM and %BF correlated with EGA and fasting value of the OGTT (FBS) (R2 = 0.33, P = .0009 and R2 = 0.26, P = .005, respectively). For CTL, both FM and %BF were correlated with maternal weight gain (R2 = 0.12, P = .01 and R2 = 0.12, P= .01). CONCLUSION: LGA infants of GDM have increased BF compared with CTL. The presence of GDM had the strongest correlation with FM in both groups. In GDM, EGA and FBS correlated best with body fat. In CTL, EGA correlated best with body fat. Table Mean +-standard deviation GDM CTL P BW (kg) 4.06 + 0.38 4.12 + 0.35 NS FM (g) 662 _+163 563 + 206 .02 %BF (%) 16.24 _+3.27 13.54 + 4.54 .002 LBM (kg) 3.40 _+ 0.31 3.56 + 0.31 .0009
Transcript of 424 Screening for geatational diabetes in the subsequent pregnancy: Is it worthwhile
S196 SMFM Abstracts
423 ULTRASOUND FETAL SUBCUTANEOUS THICKNESS MEASUREMENT AS A PREDICTOR OF FETAL BODY FAT STORES IN DIABETIC PREG- NANCY YOKO IKEDA t, ICHIRO YASUHI t, TADAYUKI ISHIMARU 1, 1Nagasaki University School of Medicine, Obstetrics and Gynecology, Nagasaki, Nagasaki
OBJECTIVE: 1) To test our hypothesis that, in appropriate-fot~gestational- age (AGA) infants, neonatal adiposity is greater in infants of diabetic mother (IDM) compared with ini~mts of non-diabetic mothers (INDM); and 2) To demonstrate whether sonographic measurement of fetal subcutaneous thickness (FST) is a better predictor of neonatal adiposity than conventional fetal measures.
STUDY DESIGN: As well as standard fetal measures including abdominal circumference (AC), biparietal diameter (BPD), and fenmr length (FL), we measured the sum of four FST (abdomen, subscapular, thigh, and upper arm) by ultrasound within 72 hours before delivery in AGA fetuses in diabetic (n - 25) and non-diabetic (n = 29) pregnancies. We also measured the sum of four neonatal skinfold thicknesses (NSFT) at the same sites with calipers within 24 hours of birth,
RESULTS: IDM showed greater FST and NSFT cmnpared with INDM, although gestational age (GA), birth weight, and standard fetal measures did not differ between the groups. In all subjects, FST significantly correlated with NSFT (r = 0.62, P < .000l). in the nmltiple regression model including FST, AC, BPD, and FL as predictive variables, FST was the only significant predictor (P = .0002) of NSFF after controlling for GA, sex, and presence or absence of maternal diabetes.
CONCLUSION: IDM has greater body fat stores compared with INDM even in AGA infants. FST is a better predictor of the fetal adiposity than conventional fetal measurement~s.
Table
IDM 1NDM PVALUE
Gestational age at delivery (wks) 39.2 + 1.1 39.1 + 1.4 .68 Birth weight (grams) 3,140 +_ 350 3,010 +_ 300 .14 NSFF (ram) 16.3 _+ 1.9 14.1 + 3.0 .003 FST (ram) 34.3 + 3.8 28.9 + 4.4 <.0001 BPD (mm) 93 _+ 3 93 + 3 .92 AC (ram) 333 +_ 21 329 _+ 15 .44 FL (ram) 71 + 4 70 _+ 4 .35
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December 2001 AmJ Obstet Gynecol
DIFFERENCES BETWEEN SONOGRAPHIC ESTIMATED FETAL SUBCU- TANEOUS TISSUE AND MECHANICAL MEASURED FETAL SKINFOLD RATIOS IN DIABETIC AND NON-DIABETIC PREGNANCIES INES KEM- PER l, KAI BUHLING 2, WOLFGANG HENRICH 3, PATRICK CATALANO 4, MARTIN BRAUER 2, JOACHIM W DUDENHAUSEN5:ICharit6 Humboldt University, Clinic of Obstetrics, Berlin; 2Charit6, Humboldt University, Clinic of Obstetrics, Berlin: 3Charit6, Humboldt-University, Clinic of Obstetrics, Berlin; 4Case Western Reserve University, Reproductive Biology, Cleveland, OH; 5Humboldt-Universitat zu Berlin, Clinic of Obstetrics, Berlin
OBJECTIVE: To test the difference between sonographic estimated tissue and mechanical measured postpartum skinfold in diabetic and non-diabetic pregnant women.
STUDY DESIGN: In this prospective study we included singleton preg- nancies after 37th completed weeks of gestational age (GA). Fetal biometry and measurenlent of subcutaneous tissue (abdomen at filet planum and feulur at middle of femoral length) was performed. Mechanical measurement (60 sec.) of subcutaneous skinfolds was done within 72h post partum at left superior anterior iliac spine and in the middle above the left quadriceps femoris using a Holtain-Caliper. We calculated the following ratios: 1. Biparital diameter (BPD)/Transversal abdonfinal diameter (AQ) 2. Sono skinfold abdomen/Sono skinfold fenmr 3. Skinfold abd./Skinfold tiem. Patient were divided into two groups: A. Non-diabetic patients (ND; negative 50g-screening or negative oral glucose tolerance test), B. Patients with type 1 diabetes mellitus or gestational diabetes (DM).
RESULTS: 45 (56.3%) women were recruited as ND, 5 (6,2%) women with Type 1 Diabetes, and 30 (37.5%) with Gestational Diabetes as study group (DM). There were no significant ditterences between the groups in GA and time difference between both measurements. 1. The BPD/AQ ratio for ND showed a mean of l a g vs.l.12 for DM (P = .006). 2. The ratio of the sono- graphic measured Skinfold abdomen/ fenmr was 0.99 -+ 0.334 for ND and 1.12 _+ 0.399 for DM (P = .016) 3. The mechanical measurement also showed a significant difference between the groups in Skinfold abdominal/Skintbld femur with 0.84 -+ 0.272 vs. 0.925 _+ 0.326 (P= .017).
CONCLUSION: Truncal obesity is well known sign for diabetic fetopathy. The sonographic and mechanical estimated skinfold ratios were shown to be better qualified to diagnose carbohydrate intolerance as compared with BPD/AQ. Further studies are necessary to evaluate the clinical value.
424 SCREENING FOR GESTATIONAL DIABETES IN THE SUBSEQUENT PREGNANCY: IS IT WORTHWHILE GEORGE LU 1, ANGELA LUCCHESE l, VICTORIA CHAPMAN 1, SUE CLIVER l, DWIGHT ROUSE 1, tUniversity of Alabama at girnfingham, Obstetrics/Gynecology, Birmingham, AL
OBJECTIVE: To determine the likelihood of developing gestational diabetes (GDM) in the subsequent pregnancy, and the associated risk factors, among women without evidence of GDM during their first pregnancy.
STUDY DESIGN: A retrospective cohort study from 1991 to 1999 of women with no evidence of GDM in their first pregnancy (<2 abnormal results on ?,-hour 100-gin glucose tolerance test).
RESULTS: Of the 3,710 eligible women, one percent (N = 37) were subsequently diagnosed with GDM in their second pregnancy. These women, when compared (by means) to women without GDM in their second pregnancy, were more likely to be older (age 21 yrs vs. 19 yrs), obese (first visit BMI 28 kg /m2 vs. 25 kg/m2), have a higher inter-pregnancy weight gain of>5 kg (93% vs. 49%), and have a greater inte~:pregnancy interval (33 months vs. 24 months). None of the women with an inte~pregnancy weight gain of < 4.7 kg developed GDM in the next pregnancy. Regression analysis revealed that, during the first pregnancy, a first visit BIVII >29 kg /m2 (OR, 95%CI 4.7, 2.1- 10.5), serum glucose screen > 101 mg/dl (OR, 95%CI 7.4, 2.2-25.0), age > 21 years (OR, 95%CI 2.8, 1.2-6.5), and an inter-pregnancy weight gain of >5 kg (OR, 95%CI 11.2, 2.6-48.2) were significantly associated with developing GDM in the second pregnancy. All women who snbsequently developed GDM had at least one of these risk factors.
CONCLUSION: Among women without GDM in the first pregnancy and who do not have risk factors for this condition, the risk of GDM in a second pregnancy is negligible. Screening of such women in the second pregnancy may not be justified.
426 IS THERE A DIFFERENCE IN BODY COMPOSITION OF LARGE FOR GESTATIONAL AGE INFANTS OF GESTATIONAL DIABETICS VERSUS CONTROLS? CELESTE D U ~ A L D l, PATRICK CATALANO'-', LARRAINE HUSTON PRESLEY'-': 1CWRU/MetroHealth Medical Center, Obstetrics and Gynecology, Maternal Fetal Medicine, Cleveland, OH; 2CWRU/MetroHealth Medical Centel, Obstetrics and Gynecology, Cleveland, OH
OBJECTIVE: To determine if there is a difference in body composidon and factors associated with fat mass (FM) in large for gestational age infants (LGA) of gestational diabetics (GDM) compared with women with normal glucose tolerance (CTL).
STUDY DESIGN: LGA was defined as weight >90th percentile fbr gesta- tional age (EGA), race and sex based on our population's normative data. Body composition was estimated using TOBEC and /o r anthropometry. Mann- Whimey U test was used to evaluate birth weight (BW), FM, % body fat (%BF) and lean body mass (LBM). Stepwise regression analysis was used to deternfine factors correlating with FM.
RESULTS: 50 GDM and 52 CTL were evaluated. There was a significant difference in EGA, pre-pregnancy weight, maternal age, race and smoking history between groups. There was a significant difference in %BE FM, and LBM between groups. There was no significant difference in BW. Stepwise regression on all 102 women showed EGA and GDM correlated with FM (R2 = 0.11, P - .001) and GDM alone correlated wida %BF (R2 = 0.12, P= .0005). For GDM, both FM and %BF correlated with EGA and fasting value of the OGTT (FBS) (R2 = 0.33, P = .0009 and R2 = 0.26, P = .005, respectively). For CTL, both FM and %BF were correlated with maternal weight gain (R2 = 0.12, P = .01 and R2 = 0.12, P= .01).
CONCLUSION: LGA infants of GDM have increased BF compared with CTL. The presence of GDM had the strongest correlation with FM in both groups. In GDM, EGA and FBS correlated best with body fat. In CTL, EGA correlated best with body fat.
Table Mean +- standard deviation
GDM CTL P
BW (kg) 4.06 + 0.38 4.12 + 0.35 NS FM (g) 662 _+ 163 563 + 206 .02 %BF (%) 16.24 _+ 3.27 13.54 + 4.54 .002 LBM (kg) 3.40 _+ 0.31 3.56 + 0.31 .0009
