Fetal overgrowth is associated with maternal body mass index and obesity status even in the absence of gestational diabetes mellitus: data from a multi-centre cohort study

Background and aims In addition to the well-known association between increased glucose concentrations and the development of fetal overgrowth, some recent evidence suggested that also other factors, such as preconceptional, maternal body mass index (BMI) have possible impact on the development of large for gestational age (LGA) offspring even in in non-diabetic women. This study aims to assess the associations between LGA in offspring with maternal biometry, biomarkers, and early pregnancy glucose metabolism.

Materials and methods In the setting of a prospective cohort study, we included 703 pregnant women in six middle European centres. Women`s history as well as a blinded 75 g OGTT, and biochemical markers were assessed at 13.4 GW. A second 75g OGTT was performed between 24-28 GW to identify women with GDM according to the World Health Organisation criteria (n=87) which were excluded from the present analysis. In addition, 1402 examinations of fetal biometry were analysed.

Results The development of LGA neonates occurred in 92 (14.1%) women and was associated with maternal BMI (OR 1.06, 95%CI 1.01-1.10, p=0.015), glycated albumin (p=0.015) and modestly with maternal age (p=0.041), whereas no associations with glucose concentrations were observed. Longitudinal analyses of ultrasound derived fetal abdominal circumference revealed that overweight (BMI 25-29.9 kg/m²) increased by 42 mm every four gestational weeks, p=0.011) and obese mothers (BMI≥30 kg/m²) increased by 43 mm every four gestational weeks, p=0.004) showed a more pronounced increase as compared to normal weight mothers (BMI<25kg/m²) increased by 40 mm every four gestational weeks). Thus, abdominal circumference was already elevated at 34 gestational weeks in overweight (297 vs. 293 mm, p=0.044) and obese mothers (299 vs. 293 mm, p=0.035).

Conclusion Fetal overgrowth is a major issue not only for mothers affected by GDM. Especially maternal BMI should be considered as a risk factor and detailed fetal biometry at late pregnancy should be offered also to normal glucose tolerant overweight and obese mothers.

 

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Artikel online veröffentlicht:
29. August 2023