Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes

Abstract

Large birthweight, or macrosomia, is one of the commonest complications for pregnancies affected by diabetes. As macrosomia is associated with an increased risk of a number of adverse outcomes for both the mother and offspring, accurate antenatal prediction of fetal macrosomia could be beneficial in guiding appropriate models of care and interventions that may avoid or reduce these associated risks. However, current prediction strategies which include physical examination and ultrasound assessment, are imprecise. Biomarkers are proving useful in various specialties and may offer a new avenue for improved prediction of macrosomia. Prime biomarker candidates in pregnancies with diabetes include maternal glycaemic markers (glucose, 1,5-anhydroglucitol, glycosylated hemoglobin) and hormones proposed implicated in placental nutrient transfer (adiponectin and insulin-like growth factor-1). There is some support for an association of these biomarkers with birthweight and/or macrosomia, although current evidence in this emerging field is still limited. Thus, although biomarkers hold promise, further investigation is needed to elucidate the potential clinical utility of biomarkers for macrosomia prediction for pregnancies affected by diabetes.

Keywords: biomarkers; birthweight; diabetes; macrosomia; pregnancy.

Figure 1

Rationale for macrosomia prediction. Macrosomia is associated with a number of adverse outcomes for both the mother and fetus (–231). Prediction of macrosomia may reduce or avoid these via guiding appropriate obstetric management.

Figure 2

Biomarkers associated with birthweight and/or macrosomia. Biomarkers that have previously demonstrated a significant association with birthweight and/or macrosomia. Abbreviations provided in Table 1.

Figure 3

Proposed link between macrosomia risk factors and the selected biomarkers. Maternal diabetes and obesity have proposed links to fetal macrosomia via direct and indirect effects on fetal growth (249, 258). Biomarkers (red) possibly related to these pathways may therefore capture information that has predictive capacity for macrosomia.