title: Translation of fetal abdominal circumference-guided therapy of gestational diabetes complicated by maternal obesity to a clinical outpatient setting.
abstract: OBJECTIVE
  To evaluate the effectiveness of fetal abdominal circumference-guided therapy for gestational diabetes (GDM) in an outpatient population characterized by highly-prevalent maternal obesity.
  
  
  METHODS
  Data for this translational retrospective cohort study come from medical records. Fetal abdominal circumference was assessed by ultrasound in late second trimester, and sex- and gestational age-specific percentiles assigned. Taking fetal abdominal circumference percentile as a marker for adequacy of fetal growth, maternal glucose targets were set accordingly: loose, moderate or tight. Associations between mother's targets and neonatal outcomes (small for gestational age (SGA), large for gestational age (LGA), macrosomia, neonatal intensive care unit (NICU) admission, and neonatal hypoglycemia) were assessed using unconditional logistic regression, controlling for pre-gravid body mass index (BMI) and gestational weight gain.
  
  
  RESULTS
  In 419 consecutive pregnancies complicated by GDM, neonatal outcomes compared favorably with previous randomized trials of intensive GDM management. Importantly, adverse outcomes were observed less often than might be expected in an obese GDM population. BMI did not have an independent effect on neonatal outcomes.
  
  
  CONCLUSIONS
  Ultrasound-guided therapy of GDM, in general clinic use, can limit excess macrosomia and LGA, even in a population with significant maternal obesity.
authors.affiliation: a Joslin Diabetes Center Affiliate , Lawrence & Memorial Hospital , New London, CT , USA and.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Quevedo
authors.affiliation: b Epidemiology Program, College of Public Health and Human Sciences , Oregon State University , Corvallis , OR , USA.
authors.forename: Marit L
authors.initials: ML
authors.lastname: Bovbjerg
authors.affiliation: a Joslin Diabetes Center Affiliate , Lawrence & Memorial Hospital , New London, CT , USA and.
authors.forename: Randi L
authors.initials: RL
authors.lastname: Kington
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007328:Insulin / Q000008:administration & dosage*; D057194:Intention to Treat Analysis; D016015:Logistic Models; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055105:Waist Circumference / Q000502:physiology*; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Gestational diabetes; fetal abdominal circumference; fetal macrosomia; prenatal ultrasonography