الفهرس 
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Abstract
SUMMARY
Diabetes mellitus increases the risk of both maternal and perinatal morbidity and mortality. Fetal macrosomia is one of the main perinatal complications in all types of diabetic pregnancy, especially in women with poor glycemic control. Macrosomia is associated with maternal, perinatal as well as long-term harmful consequences for offspring. Tight control of diabetes during pregnancy has been shown to decrease the diabetic complications including macrosomia. However, strict glycemic control sometimes fails to prevent macrosomia.
Birth weight is one of the most significant postnatal predictors of pregnancy outcome and is an important predictive parameter for neonatal morbidity and mortality. It is the main growth parameter that is routinely evaluated in newborns. Hence, accurate estimation of fetal weight may be a valuable tool for determining further obstetric management.
Fetal growth in a diabetic pregnancy is a complex process and maternal metabolic parameters other than glucose levels should be addressed to reduce the risk of macrosomia in this group of patients.
Growth and development of the fetus depends upon nutrients such as glucose, lipids, and amino acids. Although the placental transfer of lipid components is limited, they play a major role in fetal development. Changes in the availability of lipid components as in case of changes in dietary fatty acids, and similarly changes in the gestational adaptations of maternal lipid metabolism especially the rise of TG levels in all stages of pregnancy have been demonstrated to have implications on fetal and postnatal development.
In diabetes, both TG and phospholipids are accumulated in the placental unit. This indicates an enhanced uptake, hydrolysis, and re-esterification activity in the placenta and could be viewed as a physiological brake to diminish the excessive transfer of free FA and TG to the fetus. However, the increased placental storage may not be sufficient to prevent excess transfer because higher BW seen in diabetes is correlated to the extent of maternal hyperlipoproteinemia
This study included prospectively, 41 pregnant women at GA of 26-28 week with controlled diabetes as denoted by serum HbA1C level< 7 mg% before inclusion.
The aim of the present study was to determine the association between maternal serum lipid levels, particularly TG levels and newborn BW. Also, the ability of TG levels was tested to predict macrosomia.
The following lipid parameters were measured: fasting serum TG, TC, LDL and HDL cholesterol between 26 and 28 weeks of gestation as well as fetal weight by US. All subjects were followed until delivery. Information regarding time and mode of delivery and BW were recorded in all women. SPSS version 15.0 for Windows software was used for statistical analysis.
The findings of this prospective study demonstrated that maternal fasting hypertriglyceridemia GA between 26 and 28 week in 41 pregnant women with controlled diabetes, was an independent and a significant risk factor for delivering macrosomic newborns at term. In addition, fasting serum TG showed a good correlation with fetal weight determined by US. Therefore, serum TG level might help in predicting neonatal BW in this cohort of patients.
The findings of this study also showed that there was a positive significant correlation between neonatal BW and each of maternal age, parity, prepregnancy BMI, and previous macrosomia. In addition, there was a negative significant correlation between neonatal BW and serum HDL level. Only TG level was independently correlated to neonatal BW and was different between macrosomic and non-macrosomic groups and was able to predict neonatal BW with a reasonable sensitivity and specificity.
The present study concludes that: fasting serum TG levels at mid-term diabetic pregnancy correlates positively with neonatal BW, and may be considered as an independent predictor of fetal overgrowth at term.