Determining the influence of maternal body composition and glucose control during pregnancy on fetal outcome
| dc.contributor.advisor | Blaauw, Renee | en_ZA |
| dc.contributor.advisor | Van Zyk, D. G. | en_ZA |
| dc.contributor.author | Mookadam, Iman | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition. | en_ZA |
| dc.date.accessioned | 2021-03-02T14:00:03Z | |
| dc.date.accessioned | 2021-04-22T10:12:28Z | |
| dc.date.available | 2022-07-05T03:00:18Z | |
| dc.date.issued | 2021-03 | |
| dc.description | Thesis (MNutr)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: Introduction: Gestational Diabetes Mellitus (GDM); abnormal oral glucose tolerance test (OGTT) and maternal obesity (body mass index (BMI >30kg/m2)) are risk factors for the rise in macrosomic neonates (i.e. birth weight >4kg). The OGTT is usually done around 20–24 weeks gestation, by which time fetal programming has already occurred. The only reliable anthropometric measurement to use during pregnancy is the mid-upper arm circumference (MUAC), since maternal MUAC changes minimally during pregnancy and often is a good indicator of pre-pregnancy nutritional status. MUAC is also done routinely at clinics in South Africa. As both maternal anthropometry and abnormal glucose control contribute to macrosomic neonates, the question can be asked: which can be considered a better predictor of neonatal macrosomia? Aim: The aim of the study was to compare whether maternal anthropometry or maternal glucose control best predicted fetal outcome (i.e. macrosomia) in a group of women with a high risk of GDM. Methodology: The study design was an ambidirectional cohort study – combining both retrospective and prospective components. There was a total of 300 participants, divided into two groups. The GDM group comprised the retrospective component, using an existing database. The non-GDM group constituted the prospective component, where pregnant women were followed up until birth. Several statistical tests were used to prove the hypotheses. Results: The majority of participants in the study were of African race. The mean age of the participants was 34 years; however, maternal age was not found to be significantly associated with fetal birthweight (r=0.014 p=0.5220). As expected, gestational age (34.61 5.68) was found to be significantly associated with fetal birthweight (r=0.453; p<0.001), showing that as gestational age increases, so too does birth weight. Although maternal blood glucose control and GDM are risk factors for delivering a large-for-gestational age (LGA) or macrosomic baby, no significant association between the two variables was found in this study (Chi2 = 2.24; p=0.523). A significant correlation was found between maternal BMI and fetal birth weight in the non-GDM group (p=0.032), clearly indicating that as maternal BMI increases, so too does fetal birth weight. Similarly, a significant correlation was found between maternal MUAC and fetal birth weight (r=0.235; p<0.001). It was found that as maternal MUAC increases, the greater the chance of delivering an LGA or macrosomic baby. After adjusting for confounding factors, for every centimetre increase in maternal MUAC, fetal birth weight increased by 0.029kg, keeping all other variables constant. If maternal MUAC was >31cm, it was 2.89 times more likely that the mother would deliver an LGA or macrosomic baby. Similarly, for every week increase in gestational age, the baby’s birth weight increased by 0.173g. Conclusion: This study showed that maternal obesity (i.e. raised BMI and MUAC) was significantly associated with neonatal LGA and macrosomia. Guidelines on weight gain and a management protocol on overweight and obesity in pregnancy are urgently needed in South Africa. Closer monitoring of these ‘high-risk’ patients with a maternal MUAC >31cm is needed to decrease the risk of delivering LGA and macrosomic babies. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Inleiding: Swangerskap-diabetes (SD); ‘n abnormale orale glukose toleransie toets (OGTT) en maternale vetsug (liggaamsmassa-indeks (LMI> 30kg/m2) is risiko faktore vir die toename in makrosomiese neonate (d.w.s. geboortegewig >4kg). Die OGTT van die moeder word normaalweg op gestasie-ouderdom van 20-24 weke geneem wanneer die periode van fetale programmering reeds plaasgevind het. Die middel bo-arm-omtrek (MBAO) is die enigste betroubare antropometriese meting wat gedurende swangerskap geneem kan word weens die feit dat maternale MBOA minimaal verander tydens swangerskap. MBOA is ook ‘n goeie aanduiding van voor-swangerskap voedingstatus. MBOA word roetine-weg by klinieke in Suid-Afrika geneem. Beide maternale antropometrie en abnormale bloedglukose vlakke is bydraende faktore tot ‘n makrosomiese neonaat. Daarom is die vraag: “watter faktor is die beter voorspeller vir neonatale makrosomie?” Doelwit: Die doel van die studie is om te bepaal of maternale antopometrie versus maternale bloedglukose-beheer ‘n beter voorspelling kan maak rakende die fetale geboorte gewig (d.w.s. makrosomie) in ‘n groep van hoe-risiko vroue. Metodiek: Die studie-ontwerp was ‘n ambi-rigting kohortstudie; wat retrospektiewe en voornemende komponente kombineer. Daar was ‘n totaal van 300 deelnemers wat in twee groepe verdeel is. Die SD-groep het die voornemende komponent verteenwordig waar die swanger vroue tot in met geboorte van die fetus opgevolg is. Verskeie statistiese toetse is gebruik om die hipoteses te bewys. Resultate: Die meerderheid studie-deelnemers was van Afrika-ras. Die gemiddelde ouderdom van die deelnemers was 34 jaar, maar daar is gevind dat maternale ouderdom nie-beduidend geassosieer is met fetale geboortemassa (r = 0,014 p = 0,5220). Soos voorspel, is gevind dat gestasie-ouderdom (34,61 5,68) beduidend geassosieer word met fetale geboortemassa (r = 0,453; p <0,001), wat toon dat namate die gestasie-ouderdom toeneem, die geboortemassa ook toeneem. Alhoewel bloedglukose-beheer by moeders met swangerskap-diabetes 'n risikofaktor is vir die geboorte van 'n groot-vir-gestasie-ouderdom (GGO) of makrosomiese baba, is daar geen beduidende verband tussen die twee veranderlikes gevind nie (Chi2 = 2.24; p = 0.523). 'n Beduidende korrelasie is gevind tussen die liggamsmassa-indeks (LMI) van die moeder en die geboortemassa van die fetus (r = 0,214; p <0,001) Dit dui aan dat namate die LMI van die moeder toeneem, die geboortemassa van die fetus ook toeneem. 'n Beduidende korrelasie is ook gevind tussen maternale MBOA en fetale geboortemassa (r = 0.235; p <0.001). Namate die MBOA van die moeders toeneem, hoe groter is die kans om 'n groot-vir-gestasie-ouderdom (GGO) of 'n makrosomiese baba te hê. Na aanpassing van bynemende faktore is gevind dat die geboortemassa van die fetus met 0,029 kg styg na elke sentimeter toename in maternale MBOA; terwyl alle ander veranderlikes konstant gehou is. As moeders ‘n MBOA>31 cm gehad het, is gevind dat dit 2,89 keer meer waarskynlik is dat die moeder ‘n GGA/ makrosomiese baba sal he. Net so, neem die baba se geboortemassa toe met 0.173g vir elke week tydens die gestasie tydperk. Gevolgtrekking: Hierdie studie het getoon dat maternale vetsug (d.w.s. verhoogde LMI en MBOA) beduidend geassosieer word met neonatale makrosomie en GGO. Riglyne oor gewigstoename en 'n protokol vir oorgewig en vetsug tydens swangerskap word dringend in Suid-Afrika benodig. Noukeurige monitering van hierdie 'hoe risiko'-pasiente (maternale MBOA> 31cm), word dringend benodig om die risiko vir die geboorte van GGO en makrosomiese babas te verminder. | af_ZA |
| dc.description.version | Masters | |
| dc.embargo.terms | 2022-07-01 | |
| dc.format.extent | xiv, 84 pages ; includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/110284 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject.lcsh | Diabetes in pregnancy -- South Africa | en_ZA |
| dc.subject.lcsh | Glucose tolerance tests -- South Africa | en_ZA |
| dc.subject.lcsh | Pregnancy -- Complications -- South Africa | en_ZA |
| dc.subject.name | UCTD | |
| dc.title | Determining the influence of maternal body composition and glucose control during pregnancy on fetal outcome | en_ZA |
| dc.type | Thesis | en_ZA |