Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus
It’s been reported that fetal abdominal obesity (FAO) gets affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. There is less knowledge to conclude whether appropriate treatment of GDM could prevent the risk of fetal obesity and pregnancy outcome in this high-risk population. Wonjin Kim and colleagues published a study in the Diabetes and Metabolism Journal under the title “Fetal Abdominal Obesity Detected at 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus”. The summary of the findings is given below:
To evaluate whether the management of GDM ameliorates FAO in GDM subjects near term.
Medical records of singleton pregnant women delivering at CHA Gangnam Medical Center were considered for review. A total of 7,099 records were reviewed. A 100-g oral glucose tolerance test was used for GDM diagnosis post 50-g glucose challenge test based on Carpenter–Coustan criteria. According to maternal age and obesity, GDM subjects were divided into 4 study groups. In the study, FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively.
The study reports that FAORs and odds ratios for FAO in the GDM subjects were significantly elevated near term as compared with normal glucose tolerance (NGT) subjects. Additionally, fetal abdominal overgrowth assessed at 24 to 28 weeks of gestation in the obese and/or old GDM patients continues until near term. As compare to GDM subjects without FAO at diagnosis, the prevalence of FAO near term and being large for gestational age (LGA) at birth were more than threefold higher in GDM subjects with FAO, despite GDM treatment.
Findings add that the routine diagnosis and management of GDM at 24 to 28 weeks of gestation is suggested for GDM patients without FAO during 24 to 28 weeks gestation. On the other hand, it may be hard to prevent near-term FAO and improve pregnancy outcomes for GDM patients who are already affected by FAO at 24 to 28 weeks of gestation. While the additive effect of obesity on GDM was not significant, the continuous near-term FAO in GDM subjects despite treatment might be due to maternal old age with or without obesity. Additionally, even if infants of women with GDM have average weight for gestational age (GA), they have increased body fat.
As compared to other studies, the overall prevalence of LGA and macrosomia was low in this study. Hence, efforts to decrease FAO are thought to matter a lot in preventing metabolically affected infants. The study reports a prevalence of neonatal macrosomia and a positive correlation between blood glucose level and HbA1c during the first trimester.
The study highlights that planned pregnancy and preconception care is necessary for high-risk older and/or obese women. On the other hand, investigators report that despite early assessment, diagnosis, and current best practice treatment of GDM, the poor pregnancy outcomes such as macrosomia, was not significantly improved in early-onset GDM than in late-onset GDM.
As this study was retrospective in nature, investigators did not evaluate interobserver variability on the assessment via ultrasonography. Authors acknowledge future studies focusing on management criteria for GDM to prevent the risk of developing FAO.
Image Credit : Bed photo created by gpointstudio – www.freepik.com