Maternal Glycemia and Risk of Large-for-Gestational-Age Babies in a Population-Based Screening
- Zsuzsa Kerényi, MD, PHD1,2,
- Gyula Tamás, MD, PHD1,3,
- Mika Kivimäki, PHD4,5,
- Andrea Péterfalvi, RN1,2,
- Eszter Madarász, MD1,2,6,
- Zsolt Bosnyák, MD, PHD1,7 and
- Adam G. Tabák, MD, PHD1,3,4
- 1National Centre for Diabetes Care, Budapest, Hungary;
- 2Csepel Health Service, Department of Diabetology, Budapest, Hungary;
- 3Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary;
- 4Department of Epidemiology and Public Health, University College London, London, U.K.;
- 5Finnish Institute of Occupational Health, Helsinki, Finland;
- 6Semmelweis University School of PhD Studies, Budapest, Hungary;
- 7Ferencváros Health Service, Budapest, Hungary.
- Corresponding author: Adam G. Tabák, a.tabak{at}ucl.ac.uk.
Abstract
OBJECTIVE Gestational diabetes is a risk factor for large-for-gestational-age (LGA) newborns, but many LGA babies are born to mothers with normal glucose tolerance. We aimed to clarify the association of maternal glycemia across the whole distribution with birth weight and risk of LGA births in mothers with normal glucose tolerance.
RESEARCH DESIGN AND METHODS We undertook a population-based gestational diabetes screening in an urban area of Hungary in 2002–2005. All singleton pregnancies of mothers ≥18 years of age, without known diabetes or gestational diabetes (World Health Organization criteria) and data on a 75-g oral glucose tolerance test at 22–30 weeks of gestation, were included (n = 3,787, 78.9% of the target population). LGA was determined as birth weight greater than the 90th percentile using national sex- and gestational age–specific charts.
RESULTS Mean ± SD maternal age was 30 ± 4 years, BMI was 22.6 ± 4.0 kg/m2, fasting blood glucose was 4.5 ± 0.5 mmol/l, and postload glucose was 5.5 ± 1.0 mmol/l. The mean birth weight was 3,450 ± 476 g at 39.2 ± 1.2 weeks of gestation. There was a U-shaped association of maternal fasting glucose with birth weight (Pcurve = 0.004) and risk of having an LGA baby (lowest values between 4 and 4.5 mmol/l, Pcurve = 0.0004) with little change after adjustments for clinical characteristics. The association of postload glucose with birth weight (P = 0.03) and the risk of an LGA baby (P = 0.09) was weaker and linear.
CONCLUSIONS Both low and high fasting glucose values at 22–30 weeks of gestation are associated with increased risk of an LGA newborn. We suggest that the excess risk related to low glucose reflects the increased use of nutrients by LGA fetuses that also affects the mothers' fasting glucose.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received June 15, 2009.
- Accepted August 25, 2009.
- © 2009 by the American Diabetes Association.
