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Observational Study
. 2021 Aug 19:12:666194.
doi: 10.3389/fendo.2021.666194. eCollection 2021.

Observations of the Effects of Maternal Fasting Plasma Glucose Changes in Early Pregnancy on Fetal Growth Profiles and Birth Outcomes

Fei Guo  1 , Yindi Liu  1 , Zheng Ding  1 , Yong Zhang  1   2   3 , Chen Zhang  1   2   3 , Jianxia Fan  1   2   3
Affiliations
Observational Study

Observations of the Effects of Maternal Fasting Plasma Glucose Changes in Early Pregnancy on Fetal Growth Profiles and Birth Outcomes

Fei Guo et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Although the role of maternal hyperglycemia on birth outcomes is clear, literature regarding fetal growth is scarce. We examined the possible associations between maternal fasting plasma glucose (FPG) and fetal growth.

Materials and methods: A total of 35,981 singleton-pregnant women with FPG in the first trimester were included. Fetal growth parameters were measured during pregnancy by ultrasound at mid and late pregnancy. Information on birth characteristics was retrieved from medical records. We used multivariable linear and logistic regression to determine the associations between FPG and z-scores of fetal parameters and risks of birth outcomes and to assess effect modification by maternal characteristics.

Results: A per-unit increase in FPG levels was negatively associated with fetal parameters in mid pregnancy but positively correlated with those in late pregnancy and with birth characteristics. The effect estimates in late pregnancy were attenuated by maternal pre-pregnancy body mass index (BMI). A significant relationship between FPG and abdominal circumference (AC), an indicator of fetal adiposity, was sustained in subgroups of women with advanced age, positive family history of diabetes, and multiparity in fully adjusted models. After stratification by BMI, high FPG was associated with accelerated AC only in normal controls (0.044 SD; 95% CI: 0.010, 0.079) and overweight/obese women (0.069 SD; 95% CI: -0.002, 0.140) but not in underweight women. High FPG was an independent risk factor for large-for-gestational age in the whole group and stratified subgroups.

Conclusions: Increased FPG in early pregnancy is closely related to fetal growth. Maternal characteristics may modify the associations between FPG and fetal adiposity in late pregnancy.

Keywords: body mass index; fasting plasma glucose; fetal grow; modification effects; pregnancy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study population.
Figure 2
Figure 2
The effect of timing in gestation for FPG values during early pregnancy. FPG, fasting plasma glucose.
Figure 3
Figure 3
Mean differences in estimated fetal weight (EFW) across pregnancy stratified by early gestational diabetes mellitus (GDM) and pre-pregnancy body mass index (BMI). Women with non-early GDM are the reference group in panels (A, B), represented by the black zero-line. Normal weight women are the reference group in panels (C, D).
Figure 4
Figure 4
Results for effect modification by maternal and fetal characteristics in mid pregnancy (A) and late pregnancy (B). Covariates of adjustment in models: maternal age, parity, pre-pregnancy BMI, gestational age of sample collection, family history of diabetes, and fetal gender. AC, abdominal circumference; HC, head circumference; EFW, estimated fetal weight; FL, femur length; FH, family history of diabetes; BMI, body mass index. *Represent significant association after full adjustment in subgroups for AC.
Figure 5
Figure 5
Associations between maternal FPG with birth weight (A), birth length (B) and the estimated probability for LGA stratified by pre-pregnancy BMI (C).
See this image and copyright information in PMC

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