Journal
DIABETOLOGIA
Volume 62, Issue 10, Pages 1880-1890Publisher
SPRINGER
DOI: 10.1007/s00125-019-4957-3
Keywords
Adverse birth outcomes; Fetal growth; Gestational diabetes mellitus; Maternal glucose; Maternal hyperglycaemia; Prospective cohort
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Funding
- Erasmus MC, University Medical Center, Rotterdam
- Erasmus University Rotterdam
- Netherlands Organisation for Health Research and Development (ZonMw)
- Netherlands Organisation for Scientific Research (NWO)
- Ministry of Health, Welfare and Sport
- Ministry of Youth and Families
- Dutch Heart Foundation [2017 T013]
- Dutch Diabetes Foundation [2017.81.002, 543003109]
- Netherlands Organisation for Health Research and Development [VIDI 016.136.361]
- European Research Council [ERC-2014-CoG-648916]
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Aims/hypothesis The study aimed to assess the associations of maternal early-pregnancy blood glucose levels with fetal growth throughout pregnancy and the risks of adverse birth outcomes. Methods In a population-based prospective cohort study among 6116 pregnant women, maternal non-fasting glucose levels were measured in blood plasma at a median 13.2 weeks of gestation (95% range 9.6-17.6). We measured fetal growth by ultrasound in each pregnancy period. We obtained information about birth outcomes from medical records and maternal sociodemographic and lifestyle factors from questionnaires. Results Higher maternal early-pregnancy non-fasting glucose levels were associated with altered fetal growth patterns, characterised by decreased fetal growth rates in mid-pregnancy and increased fetal growth rates from late pregnancy onwards, resulting in an increased length and weight at birth (p <= 0.05 for all). A weaker association of maternal early-pregnancy non-fasting glucose levels with fetal head circumference growth rates was present. Higher maternal early-pregnancy non-fasting glucose levels were also associated with an increased risk of delivering a large-for-gestational-age infant, but decreased risk of delivering a small-for-gestational-age infant (OR 1.28 [95% CI 1.16, 1.41], OR 0.88 [95% CI 0.79, 0.98] per mmol/l increase in maternal early-pregnancy non-fasting glucose levels, respectively). These associations were not explained by maternal sociodemographic factors, lifestyle factors or BMI. Maternal early-pregnancy non-fasting glucose levels were not associated with preterm birth or delivery complications. Conclusions/interpretation Higher maternal early-pregnancy non-fasting glucose levels are associated with decreased fetal growth rates in mid-pregnancy and increased fetal growth rates from late pregnancy onwards, and an increased risk of delivering a large-for-gestational-age infant. Future preventive strategies need to focus on screening for an impaired maternal glucose metabolism from preconception and early pregnancy onwards to improve birth outcomes.
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