Latasha Nelson

Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk

Size at birth, postnatal weight gain, and adult risk for type 2 diabetes may reflect environmental exposures during developmental plasticity and may be mediated by epigenetics. Both low birth weight (BW), as a marker of fetal growth restraint, and high birth weight (BW), especially after gestational diabetes mellitus (GDM), have been linked to increased risk of adult type 2 diabetes. We assessed DNA methylation patterns using a bead chip in cord blood samples from infants of mothers with GDM (group 1) and infants with prenatal growth restraint indicated by rapid postnatal catch‐up growth (group 2), compared with infants with normal postnatal growth (group 3). Seventy‐five CpG loci were differentially methylated in groups 1 and 2 compared with the controls (group 3), representing 72 genes, many relevant to growth and diabetes. In replication studies using similar methodology, many of these differentially methylated regions were associated with levels of maternal glucose exposure below that defined by GDM [the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study] or were identified as changes observed after randomized periconceptional nutritional supplementation in a Gambian cohort characterized by maternal deprivation. These studies provide support for the concept that similar epigenetic modifications may underpin different prenatal exposures and potentially increase long‐term risk for diseases such as type 2 diabetes.—Quilter, C. R., Cooper, W. N., Cliffe, K. M., Skinner, B. M., Prentice, P. M., Nelson, L., Bauer, J., Ong, K. K., Constância, M., Lowe, W. L., Affara, N. A., Dunger, D. B., Impact on offspring methylation patterns of maternal gestational diabetes mellitus and intrauterine growth restraint suggest common genes and pathways linked to subsequent type 2 diabetes risk. FASEB J. 28, 4868–4879 (2014). www.fasebj.org

Pregnancy outcomes following placement of elective, urgent and emergent cerclage

Objective. To describe pregnancy outcomes following elective (history-indicated), urgent (ultrasound-indicated) or emergent (physical-exam indicated) cerclage placement. Materials and Methods. Study design was retrospective chart review. Women with singleton gestation and cervical cerclage were categorised into: elective, urgent and emergent group. Results. One hundred and thirty-three women were included; 89 in elective, 26 in urgent and 18 in emergent group. Difference was detected when elective and urgent groups were compared with emergent group for: gestation at delivery (35.9 ± 5.1 vs. 34.2 ± 5.9 vs. 29.3 ± 7.2 weeks, respectively, P < 0.05), delivery beyond 36 weeks, (73.9%, 57.7%vs. 23.5%, respectively, P < 0.05), neonatal death (6.8%, 9.5%vs. 43.8%, respectively, P < 0.05) and Apgar score <7 at 5 min (9.1%, 11.5%vs. 47.1%, respectively, P < 0.05). Difference was also detected between elective vs. urgent and emergent groups for: preterm premature rupture of membranes (PPROM) (19.3%vs. 38.5%vs. 64.7%, respectively, P < 0.05) and chorioamnionitis (1.4%vs. 18.2%vs. 42.9%, respectively, P < 0.05). Conclusions. Emergent cerclage group had the poorest obstetric outcomes. The urgent cerclage group reached similar gestational age at delivery as the elective group but is more likely to have PPROM and chorioamnionitis.

Prediction of Large for Gestational Age Birth Weights in Diabetic Mothers Based on Early Third-Trimester Sonography

The purpose of this study was to evaluate the ability of early third‐trimester sonography to predict large for gestational age (LGA) birth weights in women with diabetes mellitus.

Update on gestational diabetes

Boyd E Metzger1†, LaTasha Nelson2, Charlotte Niznik3 & Sharon L Dooley4 †Author for correspondence 1Professor of Medicine, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Attending Physician, Northwestern Memorial Hospital, Chicago, IL, 60611, USA. Tel.: +1 312 503 7979; Fax: +1 312 503 0037; E-mail: bem@northwestern.edu 2Fellow in Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA 3Advanced Practice Nurse – Clinical Research, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA 4Professor of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Attending Physician, Prentice Women’s Hospital, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

Outcomes of expectant management after betamethasone for hypertensive disorders of pregnancy

Objective: Review the latency period after betamethasone (BMZ) for pregnancies complicated by hypertensive disorders of pregnancy (HDP). Study design: A retrospective chart review of patients that received BMZ for the reduction of preterm morbidity for HDP. Patients were grouped by gestational age of administration of BMZ and type of hypertensive disorder of pregnancy for analysis. The primary outcome was the interval between the gestational age of the patient at BMZ administration and delivery. Results: One-hundred and forty-seven subjects received BMZ for HDP during the study period delivering 168 infants. The median interval between administration of BMZ and delivery was 5 days [interquartile range (IQR) 2–20 days]. The median neonatal intensive care unit length of stay (NICU LOS) was 20 days (IQR 6–33 days). Fifty-seven percent of subjects delivered within 7 days of diagnosis and 32% had a latency period >14 days. Seventy-five percent of subjects were ultimately delivered for worsening hypertension. Conclusions: The median latency period between diagnosis and delivery in the setting of HDP is <7 days. Further studies are warranted to address the use of antihypertensive pharmacotherapy to prolong the latency period for fetal benefit.