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obesityApril 13 2016

Pregnant obese women should be screened earlier in their pregnancy for gestational diabetes mellitus (GDM), a study has recommended. It found that the babies of obese women who develop GDM are five times as likely to be excessively large six months in to the pregnancy.

The study of 4,069 pregnant women found that 171 or 4.2% were diagnosed with GDM at or beyond 28 weeks. Based on ultrasound scan measurements of the foetus during the pregnancies, the University of Cambridge researchers “found no association between the child at 20 weeks and the mother subsequently developing gestational diabetes.

“However, they found that the foetuses of women subsequently diagnosed with gestational diabetes grew excessively prior to diagnosis, between 20 and 28 weeks. Hence, the babies were already large at the time of diagnosis, and their findings suggest that the onset of foetal growth disorder in gestational diabetes predates the usual time of screening.”

Even where there was no GDM, babies of obese women were twice as likely to be big at week 28 compared to babes of non-obese women. “The combination of obesity and gestational diabetes was associated with an almost 5-fold risk of excessive foetal growth by the 28 week scan.”

The study notes that pregnant women are usually tested for blood glucose levels at 8-12 weeks into the pregnancy, and that guidelines advise that those considered at risk of GDM should be given a full test at between week 24 and 28. “However, in practice the majority of women are screened at the 28 week mark.”

Warning of the risk of complications in pregnancy associated with GDM, the researchers have advised that early screening would be particularly beneficial for obese women, and that any intervention intended to reduce the risk of a high birthweight in the infant of an obese women should be implemented earlier than 20 weeks.

Professor Neena Modi, President of the Royal College of Paediatrics and Child Health, said the study “adds to the increasing volume of research that shows that a woman’s weight and health during pregnancy have a detrimental impact on her child’s wellbeing. If the burden of obesity related conditions in children is to be reduced it is essential that a life-course approach to prevention is adopted.

“Children who are overweight are much more likely to be overweight or obese in adult life, so an emphasis on supporting women to maintain a healthy weight before conception is crucial to breaking this cycle of health adversity. Research is also important to determine the most effective means to safeguard the health of the growing number of infants whose mothers are overweight or obese, or have diabetes.”

A Cochrane Review published online last week points out that GDM is associated with hypertension during the pregnancy and pre-eclampsia. In addition, women with GDM are more likely to require a caesarean birth, and develop type 2 diabetes, postnatal depression and cardiovascular disease later on in life.

However, there is limited published research looking at what can be recommended for women newly diagnosed with GDM in terms of the most effective blood sugar range to aim for. Only one small study from Canada was found, based on data from 180 women.

“There is insufficient evidence to guide clinical practice for targets for glycaemic control for women with GDM to minimise adverse effects on maternal and foetal health,” said the Cochrane researchers. “Glycaemic target recommendations from international professional organisations for maternal glycaemic control vary widely and are reliant on consensus given the lack of high-quality evidence.”

Links:

University of Cambridge announcement

U Sovio, HR Murphy, GCS Smith. ‘Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women’. Diabetes Care. Published online April 7 2016

RCPSH comment

R Martis et al. ‘What is the most effective blood sugar range to guide treatment for women who develop gestational diabetes mellitus (GMD) in their pregnancy?’. Cochrane Pregnancy and Childbirth group. Published online April 7 2016

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