Nieves L. González

Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes

Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p < 0.001) and had higher body mass index (p < 0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14–2.32], p = 0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p = 0.02). The rate of macrosomia was higher in the GDM group (p = 0.002) and small for gestational age (SGA) babies were significantly less frequent (p = 0.03). GDM was an independent predictor of macrosomia (p = 0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.

The effect of customized growth charts on the identification of large for gestational age newborns

Objective: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. Methods: We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. Results: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen’s κ <0.4). Conclusions: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.

Video-EEG recordings in full-term neonates of diabetic mothers: observational study

Objetive To determine whether full-term newborn infants of diabetic mothers (IDM) present immature/disorganised EEG patterns in the immediate neonatal period, and whether there was any relationship with maternal glycaemic control. Design and setting Cohort study with an incidental sample performed in a tertiary hospital neonatal unit. Patients 23 IDM and 22 healthy newborns born between 2010 and 2013. Interventions All underwent video-EEG recording lasting >90 min at 48–72 h of life. Main outcome measures We analysed the percentage of indeterminate sleep, transient sharp waves per hour and mature-for-gestational age EEG patterns (discontinuity, maximum duration of interburst interval (IBI), asynchrony, asymmetry, δ brushes, encoches frontales and α/θ rolandic activity). The group of IDM was divided into two subgroups according to maternal HbA1c: (1) HbA1c≥6% and (2) HbA1c<6%. Results Compared with healthy newborns, IDM presented significantly higher percentage of indeterminate sleep (57% vs 25%; p<0.001), discontinuity (2.5% vs 0%; p=0.044) and δ brushes in the bursts (6% vs 3%; p=0.024); higher duration of IBI (0.3 s vs 0 s; p=0.017); fewer encoches frontales (7/h vs 35/h; p<0.001), reduced θ/α rolandic activity (3/h vs 9/h; p<0.001); and more transient sharp waves (25/h vs 5/h; p<0.001). IDM with maternal HbA1c≥6% showed greater percentage of δ brushes in the burst (14% vs 4%; p=0.007). Conclusions Full-term IDM newborns showed video-EEG features of abnormal development of brain function. Maternal HbA1c levels<6% during pregnancy could minimise the risk of cerebral dysmaturity.

Customized weight curves for Spanish fetuses and newborns

Abstract Objectives: To construct a model of customized birthweight curves for use in a Spanish population. Materials and methods: Data of 20 331 newborns were used to construct a customized birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27 507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models. Results: The resulting formula for the calculation of optimal neonatal weight was: Optimum weight (g) = 3289.681 + 135.413*GA40–14.063*GA402–0.838*GA403 + 113.889 (if multiparous) + 165.560 (if origin = Asia) + 161.550 (South America) + 67.927 (rest of Europe) +109.265 (North Africa) + 9.392*Maternal-Height + 4.856*Maternal-Weight–0.098*Maternal-Weight2 + 0.001*Maternal-Weight3 + 67.188*Sex + GA40*(6.890*Sex + 9.032 (If multiparous) +0.006*Maternal-Height3 + 0.260*Maternal-Weight) + GA402 (−0.378*Maternal-Height – 0.008*Maternal-Height2) + GA403 (−0.032*Maternal-Height). Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was “good” (κ = 0.717 and κ = 0.736; p < 0.001). Conclusions: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.

First and second trimester screening for large for gestational age infants.

Abstract Objectives: To find the best early predictor model for fetal growth and large for gestational age (LGA) infants considering clinical, ultrasonographic and biochemical variables. Method: In 2097 singleton pregnancies at first trimester, we evaluated maternal characteristics, PAPP-A and ß-HCG proteins, fetal nuchal translucency thickness and uterine artery pulsatility index (UtA-PI). At second trimester fetal ultrasound biometry and UtA-PI were then measured. The relationships between birth weight and LGA and maternal characteristics, first and second trimester variables, and all variables combined, were studied. The performance of screening was determined by receiver operating characteristic curves analysis. Results: Stepwise regression analysis showed that in the prediction of birthweight percentile there were significant contributions from all maternal factors, PAPP-A and Ut-A PI in the first trimester, and fetal biometric variables in the second trimester. Maternal charateristics combined with PAPP-A, β-hCG, fetal NT and uterine artery PI identified 30.2 % LGA (FPR 10%). The combined model reached a sensitivity of 41.2% (FPR 10%) and 56.2% (FPR 20%). Conclusions: Sensitivity of the screening for LGA improves significantly after addition of second trimester ultrasound measurements to first trimester variables and maternal characteristics.

Effectiveness of a screening protocol for gestational diabetes in pregnant Spanish women

Objective. Screening for gestational diabetes mellitus (GDM) and its treatment can reduce health risks for the mother and child. This study estimated the prevalence of undetected GDM in Tenerife Island, to determine the rate of dropout from the diagnostic protocol and to identify the features of the protocol that reduced its effectiveness. Methods. We calculated GDM prevalence and the breaches of the diagnostic protocol out of 12,084 pregnant women who started the GDM detection program during 2004–2006. The prevalence of protocol breaches was used to estimate overall prevalence of GDM for the study population. Results. The overall prevalence of GDM was 6.4% (95% CI: 5.9–6.9%). Ten percent of them did not comply with the protocol. Noncompliant subjects were, on average, older (31.4 ± 5.7 vs. 30.0 ± 5.7 years, p < 0.001) and those with higher fasting blood glucose, 83 vs. 78 mg/dl (4.6 vs. 4.3 mmol/l) p < 0.001) than compliant subjects. About one third (30%) of the noncompliant women may be additional cases of GDM, which would increase the prevalence by 2.2% (95% CI: 1.9–2.5%) for an estimated total figure of 8.6% (95% CI: 8.1–9.1%). Conclusions. One out of every three cases of GDM may escape detection among women who do not complete the GDM screening protocol.

Twin pregnancy among women with pregestational type 1 or type 2 diabetes mellitus

To assess the impact of twin versus singleton pregnancy on obstetric and perinatal outcomes among women with pregestational diabetes mellitus (DM).