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8. Prepregnancy BMI influences maternal and fetal outcomes in women with isolated gestational hyperglycaemia: a multicentre study

Author

Lapolla, Annunziata, Bonomo, M, Dalfra', Mg, Parretti, E, Mannino, D, Mello, G, DI CIANNI, G, Fedele, Domenico, and Gisogd

Subjects
Gestational hypertension, Blood Glucose, Adult, medicine.medical_specialty, Time Factors, Endocrinology, Diabetes and Metabolism, Population, Preeclampsia, Fetal Macrosomia, Body Mass Index, Endocrinology, Models, Risk Factors, Pregnancy, Internal Medicine, medicine, Settore MED/44 - Medicina del Lavoro, Humans, Obesity, education, Retrospective Studies, Glucose tolerance test, education.field_of_study, Eclampsia, Models, Statistical, medicine.diagnostic_test, business.industry, Obstetrics, Pregnancy Outcome, Retrospective cohort study, General Medicine, Statistical, Glucose Tolerance Test, medicine.disease, Prognosis, Surgery, Pregnancy Complications, Female, Italy, Hyperglycemia, Gestational diabetes, business
Abstract

This multicentre study analyzed the maternal and fetal outcomes of women who had one elevated 3-h oral glucose tolerance test (isolated gestational hyperglycaemia [IGH]).From 1999 to 2003, data were collected for 606 IGH women from 31 Italian obstetric or diabetic centres, including time and mode of delivery, gestational hypertension, preeclampsia, eclampsia, congenital malformations, and neonatal mortality and morbidity, to compare them with the general pregnant Italian population. A prognostic model for the outcome of pregnancy was constructed, and the concurrence of certain specified conditions was considered a positive outcome, whereas pregnancies that failed to meet one or more of the stated conditions were classified as "complicated".Macrosomia was significantly more frequent in women with IGH than in the normal pregnant population (10.7 vs 7.4%, respectively; P=0.003). Stillbirth and neonatal mortality rates did not differ from those in normal pregnancies, while a slight rise in the frequency of major malformations was not statistically significant (1.48 vs 0.89%, respectively; P0.11). Multivariate logistic analyses confirmed that the prepregnancy body mass index (BMI) was an independent predictor of a complicated pregnancy. As for fetal growth, multivariate logistic analyses according to BMI showed that being overweight or obese were strong predictors of macrosomia.These findings in a large cohort of Italian women with IGH confirm the detrimental effect of even minimally altered glucose tolerance on fetal outcome. Also, prepregnancy obesity plays an important role in raising the risk of adverse perinatal outcomes in such patients.

Published
2010

10. Prepregnancy BMI influences maternal and fetal outcomes in women with isolated gestational hyperglycaemia: a multicentre study

Author

Lapolla, A, Bonomo, M, Dalfrà, Mg, Parretti, E, Mannino, D, Mello, G, Di Cianni, G, GISOGD: Zotti, S, Minelli, A, Cimino, A, Contini, Pp, Cospite, Am, Confortin, L, Fresa, R, Agrusta, M, Corsi, L, Versari, G, Vitacolonna, E, Capani, F, Magrini, A, Bartoli, E, Tondi, F, Riviello, C, Marcone, T, Merni, M, Tortul, C, Dolci, Ma, Mori, M, Bacetti, F, DI BENEDETTO, Antonino, Gelisio, P, Mion, E, Brambilla, C, Corica, D, Ponziani, Mc, Mauri, Mg, Bruttomesso, D, Lavagnini, T, Masin, M, Fedele, D, Galuzzo, A, Imbergamo, Mp, Torlone, E, Cordoni, Mc, Volpe, L, Cuccuru, I, Ghio, A, Lencioni, C, Napoli, A, Colatrella, A, Fallucca, A, Lisato, G, Bordon, P, Mollo, F, Livolsi, P, Cavani, R, Alberico, S, Cattin, L, Gamba, S, Menato, G, Signorile, A, Tonutti, L, Gallina, L, Franzetti, I, Cromi, A, Zenere, M, and Piva, I.

Published
2010

11. A multicenter Italian study on pregnancy outcome in women with diabetes

Author

Lapolla, A, Dalfrà, Mg, DI CIANNI, G, Bonomo, M, Parretti, E, Mello, G, Scientific, COMMITTEE OF THE GISOGD GROUP, Stefanelli, G, Giorgino, F, Faden, D, Zotti, S, Minelli, A, Cimino, A, Contini, Pp, Cospite, Am, Confortin, L, Fresa, R, Agrusta, M, Corsi, L, Versari, G, Vitacolonna, E, Capani, F, Magrini, A, Bartoli, E, Tondi, F, Riviello, C, Marcone, T, Merni, M, Tortul, C, Dolci, Ma, Mori, M, Bacetti, F, DI BENEDETTO, Antonino, Gelisio, P, Mion, E, Brambilla, C, Corica, D, Ponziani, Mc, Mauri, Mg, Bruttomesso, D, Lavagnini, T, Masin, M, Fedele, D, Botta, Rm, Galuzzo, A, Torlone, E, Cordoni, Mc, Volpe, L, Cuccuru, I, Ghio, A, Lencioni, C, Mannino, D, Napoli, A, Colatrella, A, Fallucca, F, Lisato, G, Bordon, P, Mollo, F, Cavani, R, Miselli, V, Miola, M, Calcaterra, F, Alberico, S, Cattin, L, Gamba, S, Menato, G, Signorile, A, Tonutti, L, Gallina, L, Franzetti, I, Cromi, A, Zenere, M, Piva, A, and Marzari, C.

Published
2008

16. Trombofilie e preeclampsia

Author

Benedetto, Chiara, Marozio, Luca, Gatti, V, Enrietti, M, Pelissetto, S, Parretti, E, Frusca, T, Mello, G, and Facchinetti, F.

Published
2006

31. Endothelial nitric oxide synthase gene influences the risk of pre-eclampsia, the recurrence of negative pregnancy events, and the maternal-fetal flow

Author

Fatini, C, Sticchi, E, Gensini, F, Genuardi, Maurizio, Tondi, F, Gensini, G, Riviello, C, Parretti, E, Mello, G, Abbate, R, Genuardi, M (ORCID:0000-0002-7410-8351), Fatini, C, Sticchi, E, Gensini, F, Genuardi, Maurizio, Tondi, F, Gensini, G, Riviello, C, Parretti, E, Mello, G, Abbate, R, and Genuardi, M (ORCID:0000-0002-7410-8351)

Abstract

Objectives: Pre-eclampsia is associated with vascular endothelial dysfunction, adverse pregnancy outcome and cardiovascular disease in later life. An inadequate nitric oxide availability related to polymorphisms in the endothelial nitric oxide synthase gene (eNOS) might predispose to the disease. Methods: We investigated the role of eNOS T-786C, G894T and 4a4b polymorphisms in predisposing to both pre-eclampsia and the recurrence of negative pregnancy events, per se and in the presence of angiotensin-converting enzyme ( ACE) DD genotype, and investigated their influence on maternal-fetal flow in 106 non-thrombophilic women with a history of pre-eclampsia, compared with 106 women with a history of normal pregnancy. Results: No association between eNOS polymorphisms and predisposition to pre-eclampsia was found; nevertheless, the contemporary presence of eNOS 894TT and -786CC genotypes represented a susceptibility factor to the disease. In 48 out of 106 women, documented complications (pre-eclampsia and fetal growth restriction) were present in the current pregnancy. The eNOS 894TT genotype influenced the risk of recurrence of negative events (odds ratio = 5.45), particularly in contemporary women homozygous for both eNOS 894TT and ACE DD genotypes (odds ratio = 11.4). Throughout the pregnancy, a progressive alteration of maternal-fetal flow indices was found in women carrying the eNOS 894TT genotype, and this effect was strengthened in women with the contemporary presence of the ACE DD genotype. Conclusions: An original finding is the increased risk of pre-eclampsia and recurrence of pregnancy negative events, probably by modulating the maternal-fetal flow, in women homozygous for the eNOS 894T allele previously analyzed for the ACE I/D polymorphism.

Published
2006

32. Maternal-fetal flow, negative events, and preeclampsia - Role of ACE I/D polymorphism

Author

Mello, G, Parretti, E, Gensini, F, Sticchi, E, Mecacci, F, Scarselli, G, Genuardi, M, Abbate, R, Fatini, C, Genuardi, M (ORCID:0000-0002-7410-8351), Mello, G, Parretti, E, Gensini, F, Sticchi, E, Mecacci, F, Scarselli, G, Genuardi, M, Abbate, R, Fatini, C, and Genuardi, M (ORCID:0000-0002-7410-8351)

Abstract

The risk for an adverse pregnancy outcome is markedly higher in women with history of preeclampsia. This may stem from impaired placentation in early gestation and from high impedance to flow in uteroplacental circulation. The renin-angiotensin system is one of the mediators of the remodeling of spiral arteries throughout pregnancy. The D allele of the Insertion/ Deletion (I/D) polymorphism in the ACE gene has been associated with higher ACE activity, accounting for 47% of the total phenotypic variance of serum enzyme levels. To investigate whether the ACE I/D polymorphism affects maternal uteroplacental and fetal umbilical circulation and the pregnancy outcome in women with a history of preeclampsia, 106 women underwent Doppler examination of uterine arteries resistance index and umbilical artery pulsatility index at the 16th, 20th, and 24th weeks of gestation and were genotyped for the I/D polymorphism. This study found a difference in genotype distribution (P=0.0002) and allele frequency (P=0.0001) between women with and those without preeclampsia recurrence and fetal growth restriction as well as an association (P=0.0007) between DD genotype and risk of recurrent preeclampsia or fetal growth restriction. At the 16th, 20th, and 24th weeks, uterine artery resistance indexes were significantly lower in II, higher in DD, and intermediate in ID genotype carriers, whereas the umbilical artery pulsatility index values were significantly higher in the DD group in comparison to ID and II genotypes. The current study shows that the ACE I/D polymorphism affects uteroplacental and umbilical flows and the recurrence of an adverse pregnancy outcome in women with history of preeclampsia.

Published
2003

43. Angiotensin-converting enzyme DD genotype, angiotensin type 1 receptor CC genotype, and hyperhomocysteinemia increase first-trimester fetal-loss susceptibility

Author

Fatini, C., primary, Gensini, F., additional, Battaglini, B., additional, Prisco, D., additional, Cellai, A. P., additional, Fedi, S., additional, Marcucci, R., additional, Brunelli, T., additional, Mello, G., additional, Parretti, E., additional, Pepe, G., additional, and Abbate, R., additional

Published
2000
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48. The 75-gram glucose load in pregnancy: relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism.

Author

Mello G, Parretti E, Cioni R, Lucchetti R, Carignani L, Martini E, Mecacci F, Lagazio C, Pratesi M, Mello, Giorgio, Parretti, Elena, Cioni, Riccardo, Lucchetti, Roberto, Carignani, Lucia, Martini, Elisabetta, Mecacci, Federico, Lagazio, Corrado, and Pratesi, Monica

Abstract

Objective: To investigate, in pregnant women without gestational diabetes mellitus (GDM), the relation among obstetric/demographic characteristics; fasting, 1-h, and 2-h plasma glucose values resulting from a 75-g glucose load; and the risk of abnormal neonatal anthropometric features and then to verify the presence of a threshold glucose value for a 75-g glucose load above which there is an increased risk for abnormal neonatal anthropometric characteristics.Research Design and Methods: The study group consisted of 829 Caucasian pregnant women with singleton pregnancy who had no history of pregestational diabetes or GDM, who were tested for GDM with a 75-g, 2-h glucose load, used as a glucose challenge test, in two periods of pregnancy (early, 16-20 weeks; late, 26-30 weeks), and who did not meet the criteria for a GDM diagnosis. In the newborns, the following abnormal anthropometric characteristics were considered as outcome measures: cranial/thoracic circumference (CC/TC) ratio /=90th percentile for GA, and macrosomia (birth weight >/=90th percentile for GA), on the basis of growth standard development for our population. For the first part of the objective, logistic regression models were used to identify 75-g glucose load values as well as obstetric and demographic variables as markers for abnormal neonatal anthropometric characteristics. For the second part, the receiver operating characteristic (ROC) curve was performed for the 75-g glucose load values to determine the plasma glucose threshold value that yielded the highest combined sensitivity and specificity for the prediction of abnormal neonatal anthropometric characteristics.Results: In both early and late periods, maternal age >35 years was a predictor of neonatal CC/TC ratio 35 years being an independent predictor for macrosomia. The 2-h, 75-g glucose load values were significantly associated in both periods with neonatal CC/TC ratio /=90th percentile, whereas maternal age >35 years was an independent predictor of both neonatal CC/TC ratio Conclusions: This study documented a significant association, seen even in the early period of pregnancy, between 1-h, 75-g glucose load values and abnormal neonatal anthropometric features, and provided evidence of a threshold relation between 75-g glucose load results and clinical outcome. Our results would therefore suggest the possibility of using a 75-g, 1-h oral glucose load as a single test for the diagnosis of GDM, adopting a threshold value of 150 mg/dl at 16-20 weeks and 160 mg/dl at 26-30 weeks. [ABSTRACT FROM AUTHOR]

Published
2003
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