Sex-dependent influence of maternal predictors on fetal anthropometry in pregnancies with gestational diabetes mellitus

Maria-Christina Antoniou; Leah Gilbert; Justine Gross; Jean-Benoît Rossel; Céline Julie Fischer Fumeaux; Yvan Vial; Jardena Jacqueline Puder

doi:10.1186/s12884-022-04767-z

Sex-dependent influence of maternal predictors on fetal anthropometry in pregnancies with gestational diabetes mellitus

BMC Pregnancy Childbirth. 2022 Jun 1;22(1):460. doi: 10.1186/s12884-022-04767-z.

Authors

Maria-Christina Antoniou¹, Leah Gilbert², Justine Gross^{2

3}, Jean-Benoît Rossel⁴, Céline Julie Fischer Fumeaux⁵, Yvan Vial², Jardena Jacqueline Puder²

Affiliations

¹ Pediatric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland. maria-christina.antoniou@chuv.ch.
² Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.
³ Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, 1011, Lausanne, Switzerland.
⁴ Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁵ Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.

Abstract

Background: Third trimester fetal anthropometric parameters are known to predict neonatal complications. A better understanding of predictors of adverse fetal parameters might help to personalize the use and frequency of fetal ultrasound. The objectives of this study were: (a) to evaluate the utility of maternal sociodemographic, anthropometric and metabolic predictors to predict 3^rd trimester fetal anthropometric parameters in women with gestational diabetes mellitus (GDM), (b) to assess whether the impact of these maternal predictors is fetal sex-dependent, and (c) to provide a risk stratification for markers of fetal overgrowth (fetal weight centile (FWC) and fetal abdominal circumference centile (FACC) depending on prepregnancy BMI and gestational weight gain (GWG) until the 1^st GDM visit.

Methods: This prospective study included 189 women with GDM. Maternal predictors were age, ethnicity, prepregnancy BMI, GWG and excessive weight gain until the 1^st GDM visit, fasting, 1-hour and 2-hour blood glucose oral glucose tolerance test values, HbA1c at the 1^st visit and medical treatment requirement. Fetal outcomes included FWC, FWC >90% and <10%, FACC, FACC >90% and <10%, at 29 0/7 to 35 6/7 weeks of gestational age. We performed univariate and multivariate regression analyses and probability analyses.

Results: In multivariate analyses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC. GWG until the 1^st GDM visit was associated with FWC, FACC and FACC > 90% (all p ≤ 0.045). Other maternal parameters were not significantly associated with fetal anthropometry in multivariate analyses (all p ≥ 0.054). In female fetuses, only GWG was associated with FACC (p= 0.044). However, in male fetuses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC and GWG with FWC in multivariate analyses (all p ≤ 0.030). In women with a prepregnancy BMI of ≥ 25 kg/m² and a GWG until the 1^st GDM visit ≥ 10.3 kg (mean GWG), the risk for FWC > 90% and FACC > 90% was 5.3 and 4 times higher than in their counterparts.

Conclusions: A personalized fetal ultrasound surveillance guided by fetal sex, prepregnancy BMI and GWG may be beneficial in reducing adverse fetal and neonatal outcomes.

Keywords: Fetal anthropometry; Fetal sex; Fetal ultrasound; Gestational diabetes; Risk stratification.

MeSH terms

Anthropometry
Body Mass Index
Diabetes, Gestational* / epidemiology
Female
Fetal Macrosomia
Humans
Infant, Newborn
Male
Pregnancy
Prospective Studies

Grants and funding

SNF 32003B_176119/SNSF_/Swiss National Science Foundation/Switzerland