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

• Published in: BMC pregnancy and childbirth Vol. 22; no. 1; p. 460
• Main Authors: Antoniou, Maria-Christina, Gilbert, Leah, Gross, Justine, Rossel, Jean-Benoît, Fumeaux, Céline Julie Fischer, Vial, Yvan, Puder, Jardena Jacqueline
• Format: Journal Article
• Language: English
• Published: England BioMed Central 01.06.2022; BMC
• Subjects: Abdomen; Body mass index; Body measurements; Ethnicity; Fetal anthropometry; Fetal sex; Fetal ultrasound; Fetuses; Gestational age; Gestational diabetes; Glucose; Insulin; Metabolism; Population; Pregnancy; Risk stratification; Variables; Fetal anthropometry; Gestational diabetes; Fetal sex; Fetal ultrasound; Risk stratification
• DOI: 10.1186/s12884-022-04767-z
• ISSN: 1471-2393

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 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 GDM visit. This prospective study included 189 women with GDM. Maternal predictors were age, ethnicity, prepregnancy BMI, GWG and excessive weight gain until the 1 GDM visit, fasting, 1-hour and 2-hour blood glucose oral glucose tolerance test values, HbA1c at the 1 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. In multivariate analyses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC. GWG until the 1 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/m and a GWG until the 1 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. A personalized fetal ultrasound surveillance guided by fetal sex, prepregnancy BMI and GWG may be beneficial in reducing adverse fetal and neonatal outcomes.