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11/04/2016
The research, which has been led by the University of Cambridge, found that babies of obese women who develop gestational diabetes are five times as likely to be excessively large by six months of pregnancy. It was also discovered that excessive fetal growth begins weeks before at-risk women are screened for gestational diabetes, therefore suggesting that current screening programmes may take place too late during pregnancy to prevent lasting health impacts on the baby.
For the study, a team at the Department of Obstetrics & Gynaecology at the University of Cambridge analysed data from the Pregnancy Outcome Prediction study, which followed more than 4,069 first-time mothers using ultrasound scans to assess the growth of their babies in the womb.
They measured the abdominal and head circumference of the foetuses and compared the growth in women who developed gestational diabetes with those who did not. The results have been published in the journal Diabetes Care.
Of the women studied, 171 (4.2%) were diagnosed with gestational diabetes at or beyond 28 weeks. The researchers found no association between the size of the child at 20 weeks and the mother subsequently developing gestational diabetes, but they found that the foetuses of women subsequently diagnosed with gestational diabetes grew excessively prior to diagnosis, between 20 and 28 weeks.
As a result, the babies were already large at the time of diagnosis. The findings suggest that the onset of fetal growth disorder in gestational diabetes predates the usual time of screening.
The researchers also studied women who were obese, and even in the absence of diabetes, the babies of obese women were also twice as likely to be big at 28 weeks. The combination of obesity and gestational diabetes was associated with an almost five-fold risk of excessive fetal growth by the 28 week scan.
Gestational diabetes is a condition that can affect women during pregnancy, with those who are obese at greater risk. It affects the mother's health, but also that of her unborn child and can cause the child to grow larger.
Not only does this put the mother at risk during childbirth, it increased the chances of her children developing obesity and diabetes in later life. The condition can usually be controlled through a combination of diet and exercise, and medication if these measures fail.
Currently, women are screened for the condition through a blood glucose test at around 8-12 weeks into pregnancy. Guidelines in the UK and the USA recommend that mothers found to be at greatest risk should then be offered a full test at between 24 and 28 weeks into pregnancy; however, in practice the majority of women are screened at the 28 week mark.
Dr Ulla Sovio, from the Department of Obstetrics and Gynaecology at the University of Cambridge, and the first author of the study, said: "Our study suggests that the babies of women subsequently diagnosed with gestational diabetes are already abnormally large by the time their mothers are tested for the disease.
"Given the risk of complications for both mother and child from gestational diabetes, our findings suggest that screening women earlier on in pregnancy may help improve the short and long term outcomes for these women.
"Early screening may be particularly beneficial for obese women, as fetal growth is already abnormal by 20 weeks among these women. Any intervention aimed at reducing the risk of abnormal birthweight in the infants of obese women may need to be implemented even earlier."
Professor Gordon Smith, also from the University of Cambridge, and senior author, added: "We know that the offspring of women with gestational diabetes are at increased risk of childhood obesity, but so far no clinical trials have successfully demonstrated that screening and intervention in pregnancy reduces this risk.
"Our study suggests a possible explanation: screening and intervention is taking place when the effects of gestational diabetes are already manifested in the foetus. The evidence from our study indicates that there is an urgent need for trials to assess the effect of earlier screening, both on the outcome of the pregnancy and the long term health for the offspring."
The work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre and SANDS (the stillbirth and neonatal death charity).
The full study can be accessed here or here.
(JP/LM)
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Pregnancy Diabetes Test 'Takes Place Too Late'
A new study has suggested that current screening programmes which test for diabetes in expectant mothers, are taking place too late.The research, which has been led by the University of Cambridge, found that babies of obese women who develop gestational diabetes are five times as likely to be excessively large by six months of pregnancy. It was also discovered that excessive fetal growth begins weeks before at-risk women are screened for gestational diabetes, therefore suggesting that current screening programmes may take place too late during pregnancy to prevent lasting health impacts on the baby.
For the study, a team at the Department of Obstetrics & Gynaecology at the University of Cambridge analysed data from the Pregnancy Outcome Prediction study, which followed more than 4,069 first-time mothers using ultrasound scans to assess the growth of their babies in the womb.
They measured the abdominal and head circumference of the foetuses and compared the growth in women who developed gestational diabetes with those who did not. The results have been published in the journal Diabetes Care.
Of the women studied, 171 (4.2%) were diagnosed with gestational diabetes at or beyond 28 weeks. The researchers found no association between the size of the child at 20 weeks and the mother subsequently developing gestational diabetes, but they found that the foetuses of women subsequently diagnosed with gestational diabetes grew excessively prior to diagnosis, between 20 and 28 weeks.
As a result, the babies were already large at the time of diagnosis. The findings suggest that the onset of fetal growth disorder in gestational diabetes predates the usual time of screening.
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The researchers also studied women who were obese, and even in the absence of diabetes, the babies of obese women were also twice as likely to be big at 28 weeks. The combination of obesity and gestational diabetes was associated with an almost five-fold risk of excessive fetal growth by the 28 week scan.
Gestational diabetes is a condition that can affect women during pregnancy, with those who are obese at greater risk. It affects the mother's health, but also that of her unborn child and can cause the child to grow larger.
Not only does this put the mother at risk during childbirth, it increased the chances of her children developing obesity and diabetes in later life. The condition can usually be controlled through a combination of diet and exercise, and medication if these measures fail.
Currently, women are screened for the condition through a blood glucose test at around 8-12 weeks into pregnancy. Guidelines in the UK and the USA recommend that mothers found to be at greatest risk should then be offered a full test at between 24 and 28 weeks into pregnancy; however, in practice the majority of women are screened at the 28 week mark.
Dr Ulla Sovio, from the Department of Obstetrics and Gynaecology at the University of Cambridge, and the first author of the study, said: "Our study suggests that the babies of women subsequently diagnosed with gestational diabetes are already abnormally large by the time their mothers are tested for the disease.
"Given the risk of complications for both mother and child from gestational diabetes, our findings suggest that screening women earlier on in pregnancy may help improve the short and long term outcomes for these women.
"Early screening may be particularly beneficial for obese women, as fetal growth is already abnormal by 20 weeks among these women. Any intervention aimed at reducing the risk of abnormal birthweight in the infants of obese women may need to be implemented even earlier."
Professor Gordon Smith, also from the University of Cambridge, and senior author, added: "We know that the offspring of women with gestational diabetes are at increased risk of childhood obesity, but so far no clinical trials have successfully demonstrated that screening and intervention in pregnancy reduces this risk.
"Our study suggests a possible explanation: screening and intervention is taking place when the effects of gestational diabetes are already manifested in the foetus. The evidence from our study indicates that there is an urgent need for trials to assess the effect of earlier screening, both on the outcome of the pregnancy and the long term health for the offspring."
The work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre and SANDS (the stillbirth and neonatal death charity).
The full study can be accessed here or here.
(JP/LM)
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