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Infants who are large for gestational age (LGA) are more likely than other infants to be obese in childhood, adolescence and early adulthood, and are inherently at a higher risk of cardiovascular and metabolic complications in adulthood. We aimed to investigate the association between pregnancies with one abnormal value (OAV) in the oral glucose tolerance test (OGTT) to neonatal skinfold thickness and umbilical cord C-peptide.
This was a prospective controlled trial performed from January 2016 - May 2018. Included were women with OAV in the OGTT performed between 24-28 weeks of gestation, who delivered at the Edith Wolfson Medical Center. The control group included normoglycemic women, who delivered during the same time period. The following 'diabetic' variables were measured: maternal HbA1C and blood glucose level (on admission), umbilical cord (UC) C-peptide concentration, and neonatal skinfold thickness at 3 sites. Maternal and obstetric characteristics, and the 'diabetic variables, were compared between the OAV group and the control group. LGA was defined as birthweight (BW) >90th % and macrosomia was defined as BW>4000 gram.
As compared to the control group (n=56), the OAV group (n=84) was older, 33.4±5 years vs. 32.5±7 years p=0.002, had lower GA at delivery (p=0.01), increased rate of macrosomia (<0.001) and LGA (p=0.003). Regarding the diabetic variables, as compared to the controls, the OAV group had increased concentration of UC C-peptide (1.7±1.6 vs. 1.3±1.1 units, p=0.007) and increased maternal HbA1C (5.3±0.4 vs. 5.1±0.3 units, p=0.01). Neonatal skinfold thickness measurements did not differ between the groups. By logistic regression analysis after controlling for confounders (birthweight, GA at delivery, and maternal body mass index), LGA was independently associated with the presence of OAV group: aOR 4.7, 95%CI 1.48-14.8, p=0.008.
One pathological value on OGTT is associated with increased level of UC C-peptide and increased maternal HbA1C. LGA is independently associated with OAV. These findings indicate the continuum of risk for fetal adiposity that is associated with increasing maternal glucose intolerance in pregnancy.