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Il parto nella donna con diabete Federico Mecacci Prenatal Medicine High Risk Pregnancy Unit Careggi Universitary Hospital Newborn’s and Women's Health Department
41

Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Jun 04, 2018

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Page 1: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Il parto nella donna con diabeteFederico Mecacci

Prenatal Medicine High Risk Pregnancy Unit

Careggi Universitary Hospital Newbornrsquos and Womens Health Department

0

1

2

3

4

5

6

7

madri obese

48

Del 20 delle madri obese dal 2008 al 2016Dati regione Toscana

57

Nascere in Toscana 2015

MATERNAL AGE DELAYED CHILDBEARING AND METASBOLIC SYNDROME

2016

Prevalence of metabolic syndrome(NCEP ATP III) in the NHANES III survey Ford ES JAMA 2002 287356

Balkau B Diabet Metabol 2002

36 of Europeans were observed at the ageof 40-55 years with metabolic syndrome

Prevalence of hyperglycaemia in pregnancy by age

Global estimates of the prevalence of hyperglycaemia in pregnancy L Guariguata et al Diabettesresearch and clinical practice 2014

Global prevalence of hyperglycaemia in pregnancy 169

The prevalence of HIP increases sharply with age with a prevalenceof 392 in women40ndash44 and up to 479 in women 45ndash59 years

IN CHE MODO IL DIABETE INFLUENZAIL TIMING LA MODALITAgrave E LrsquoOUTCOME DEL

PARTO

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 2: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

0

1

2

3

4

5

6

7

madri obese

48

Del 20 delle madri obese dal 2008 al 2016Dati regione Toscana

57

Nascere in Toscana 2015

MATERNAL AGE DELAYED CHILDBEARING AND METASBOLIC SYNDROME

2016

Prevalence of metabolic syndrome(NCEP ATP III) in the NHANES III survey Ford ES JAMA 2002 287356

Balkau B Diabet Metabol 2002

36 of Europeans were observed at the ageof 40-55 years with metabolic syndrome

Prevalence of hyperglycaemia in pregnancy by age

Global estimates of the prevalence of hyperglycaemia in pregnancy L Guariguata et al Diabettesresearch and clinical practice 2014

Global prevalence of hyperglycaemia in pregnancy 169

The prevalence of HIP increases sharply with age with a prevalenceof 392 in women40ndash44 and up to 479 in women 45ndash59 years

IN CHE MODO IL DIABETE INFLUENZAIL TIMING LA MODALITAgrave E LrsquoOUTCOME DEL

PARTO

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM 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Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 3: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

MATERNAL AGE DELAYED CHILDBEARING AND METASBOLIC SYNDROME

2016

Prevalence of metabolic syndrome(NCEP ATP III) in the NHANES III survey Ford ES JAMA 2002 287356

Balkau B Diabet Metabol 2002

36 of Europeans were observed at the ageof 40-55 years with metabolic syndrome

Prevalence of hyperglycaemia in pregnancy by age

Global estimates of the prevalence of hyperglycaemia in pregnancy L Guariguata et al Diabettesresearch and clinical practice 2014

Global prevalence of hyperglycaemia in pregnancy 169

The prevalence of HIP increases sharply with age with a prevalenceof 392 in women40ndash44 and up to 479 in women 45ndash59 years

IN CHE MODO IL DIABETE INFLUENZAIL TIMING LA MODALITAgrave E LrsquoOUTCOME DEL

PARTO

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM 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Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 4: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Prevalence of hyperglycaemia in pregnancy by age

Global estimates of the prevalence of hyperglycaemia in pregnancy L Guariguata et al Diabettesresearch and clinical practice 2014

Global prevalence of hyperglycaemia in pregnancy 169

The prevalence of HIP increases sharply with age with a prevalenceof 392 in women40ndash44 and up to 479 in women 45ndash59 years

IN CHE MODO IL DIABETE INFLUENZAIL TIMING LA MODALITAgrave E LrsquoOUTCOME DEL

PARTO

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM 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Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 5: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

IN CHE MODO IL DIABETE INFLUENZAIL TIMING LA MODALITAgrave E LrsquoOUTCOME DEL

PARTO

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM 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Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 6: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

THE EFFECTS OF HYPERGLYCEMIAMETABOLIC SYNDROME

FFA(fat mobilization)

Glucose

leptina

INSULIN RESISTANCE

OBESITY

GESTATIONAL DIABETES

IGF1

Adiponectina

insulin

FETAL NUTRIENT AVAILABILITY

PLACENTAL TRASPORT OF NUTRIENTS

mTOR+

ldquoadaptive regulationrdquo

FETAL OVERNUTRITION-MACROSOMIALGA

Romero Am J Obstet Gynecol 2017

Brett KE Int J Mol Sci 2014

MACROSOMIAL

MACROSOMIALG

DISTOCIA STILLBIRTH

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM 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Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 7: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Macrosomia e rischio di distocia

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 8: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Birth weight distribution in diabetic pregnancies

Persson et al Diab Care 2011341145-1149

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 9: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

ldquoDIABESITYrdquo and MACROSOMIA

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 10: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

MACROSOMIA ASIMMETRICA

OBESITY IS INDEPENDENTLY ASSOCIATED WITH FETAL HYPERINSULINEMIABIRTH WEIGHT AND NEWBORN ADIPOSITY

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 11: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio

Fetal growth profiles in diabetic pregnancies

08

085

09

095

1

105

11

115

12

125

13

100 120 140 160 180 200 220 240 260 280

Gestational age in days

Hea

d to

abd

omin

al c

ircu

mfe

renc

e ra

tio

(HC

AC

rati

o)

IDDM non-macrosomia

IDDM macrosomia

DM2 non-macrosomia

DM2 macrosomia

GDM non-macrosomia

GDM macrosomia

Birthweightgt90th

Type-1-diabetes LGA

Type-1 AGA

N Hammoud et al UOG 2012

Type-2-diabetes LGA

GDM LGA

Grafiek3

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

iddm gdm 977

IDDM

IDDM lt9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631103696580000000211212701600000001113882472000000011156360261173876780000000111913742812088527612263122200000001124375266000000011261174080000000112785764800000001129595986000000011313324220000000113306695613479958813653031799999999138259146000000021399860720000000114171109614343421800000002145155438146874755999999991485921720000000115030768600000002152021298153733008000000041554428159999999915715072200000003158856726000000011605608280000000116226302799999999163963326000000021656617221673582160000000316905280817074549800000003172436286174125172000000021758121559999999917749723800000001179180418180861696000000021825410719999999918421854600000003185894117999999991875677880000000118923955599999999190909422000000011925773860000000219424344800000003195907608000000011975698660000000219923022200000003200888676000000032025452280000000120419987800000001205852626000000012075034720000000220915241600000002210799458000000022124445980000000121408783600000001215729172000000012173686060000000321900613800000002220641768000000012222754962239073220000000222553724600000001227165268000000032287913880000000123041560600000003232037922000000012336583360000000223527684823689345800000001238508166000000022401209720000000224173187624334087824494797800000001246553176000000012481564720000000124975786600000001251357358252954948254550636256144422000000022577363060000000125932628799999998260914368000000022625005459999999926408482200000003265667195999999992672476680000000326882623799999999270402906000000032719776719999999827355053600000002275121497999999972766905580000000127825771600000002279822972000000052813863262829477780000000328450732799999997286064976287620722289174566000000032907265080000000229227654800000005293824685999999992953709220000000129691525629845768800000002299998218000000013015368460000000330307357200000001304608396000000033061413180000000130767233800000002309201456000000063107286720000000231225398631377739800000001315298908000000043168185160000000531833622199999996319852026000000023213659280000000532287792832438802599999997325896222000000023274025160000000532890690800000004330409398000000013319099863334086720000000233490545600000002336400337999999983378933180000000233938439600000004340873572000000023423608459999999834384621800000002IDDM =gt 9771191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631094598540000000211125305500000002113048962000000021148475750000000211664889400000003118452919000000021202596500000000212206908700000002123881230000000021256960790000000312751363400000002129333895000000011311568620000000213298253500000001134810914000000031366419990000000313847579000000002140312287000000031421514900000000214399339900000001145838014000000021476853350000000114953536200000002151388095000000021532435340000000115510167900000002156962530000000021588260870000000316069235000000003162561319000000031644329940000000416630737500000004168184462000000021700642550000000317194675400000003173831959000000011757198700000000117761048700000003179503810000000021813998390000000118329857400000003185200015000000041871041620000000318901101500000001190920574000000021928328390000000419474781000000002196665487000000011985858700000000320050895900000003202434754000000032043632550000000120629446200000001208228375000000032101649940000000421210431900000003214046350000000022159910870000000221793853000000001219888679000000022218415340000000222379709500000001225755362000000022277163350000000222968001400000003231646399000000032336154900000000223558728700000003237561790000000032395389990000000224151891400000002243501535000000022454868620000000324747489500000003249465634000000022514590790000000325345523000000003255454087000000022574556499999999925945991900000001261466893999999972634765749999999726548896200000001267504054999999992695218540000000227154235899999998273565569999999982755914869999999727762011000000001279651438999999982816854742837222150000000128576166228780381499999999289848674000000022918962389999999829394650999999999295999486999999992980551699999999830011355900000001302174653999999983042384549999999930630496199999999308374174999999983104460940000000231252071899999999314598053166780873187608332084627899999998322934434000000013250252949999999732711886199999998329215134999999983313141140000000233341579899999999335520190000000013376272870000000233973709000000002341849599000000013439648139999999934608273500000001348203361999999973503266949999999735245273400000002354581479356712929999999973588470869999999936098394999999999363123518999999993652657939999999736741077536955846200000002371708854999999973738619539999999737601775900000001378176269999999993803374870000000138250141000000002384668039000000023868373740000000138900941499999999391184162000000013933616149999999739554177399999998

Gestational age in days

Fetal abdominal circumference (mm)

GDM

GDM lt97711912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311821037200000001119969022999999991217245379999999812347691712522615999999999126972266999999991287152381304550730000000313219177200000001133925334999999991356557620000000113738305299999999139107207999999991408282271425461114426085699999999145972468000000021476809429999999814938628199999999151088484999999991527875520000000115448348299999998156176278157865937000000031595524616123584700000001162916098000000011645932129999999916626719199999999167938035000000011696057419999999917127031299999999172931748174590047176245209999999991778972370000000217954612799999998181191882999999991828345019999999918447398500000003186110332187743542999999991893736180000000219100055700000001192624361942450270000000219586255800000001197476952999999981990882122006963352023013222039031730000000120550188800000001207097467000000022086899121027921699999999211865388213448422999999992150283222166050852181787119999999921974920300000002221316558000000012228807769999999922444186000000002225999807227554617999999982291062929999999923065483223220023500000002233742502235281633236817628000000012383504869999999923988021000000001241406797000000012429302480000000124445056300000002245967742000000022474817852489926920000000125050046325200509799999998253506597255004959999999982565001869999999825799227825948123300000003260967051999999972624497349999999826392928226540569299999999266878967999999992683491072698161100000000427127997699999997272740707999999982741983029999999527565276227710408527855227200000002279997322999999992814392379999999928287801728431365999999997285746167000000012871755380000000228860177300000004290024872000000022914448350000000129286166199999997294275353295685907999999982970933270000000429849761000000001299898756999999993012967679999999930269164330408338200000003305471985000000023068574520000000230823978299999999309618978000000033109950369999999731236795999999998313737747000000013151043980000000631646791300000001317828292000000033191855349999999632053964200000001321890613000000033232384480000000132458314732592471327263137000000033285984279999999632993058300000001331259602000000033325854850000000633390823233522784300000001336544317999999983378576570000000233916786000000002GDM =gt 977119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120182679000000011216229731230675110000000112451629300000002125969319127426589000000011288881031303538609999999913182386300000002133298109000000011347765991362593330000000313774631100000002139237533000000011407329990000000114223270914373666299999999145244861000000011467573030000000114827398914979491899999999151320092999999991528495109999999815438317315592107899999999157463229000000011590096231605602611621151430000000216367426900000001165237639166805253000000021683771110000000116995321300000003171533559000000031731181489999999917470698300000001176300061177897383000000021794989490000000118110475918271481300000002184329110999999981859476531875704389999999918919746899999998190828743192464260999999991941040230000000119574802919739627900000002199048773000000012007055112023664930000000220403171900000001205701189207374902999999992090528610000000121073506321242150900000001214112199215807133000000022175063110000000121920973300000003220917399000000022226293090000000122434546322606586100000001227790503229519389000000022312525190000000123298989300000002234731511000000012364773730000000323822747900000002239981829000000032417404229999999924350326100000001245270343247041669000000012488172392505970530000000225238111125416941300000002255961959000000012577587489999999725955978299999998261365060999999972631745829999999826498834900000003266806358999999992686286130000000327045511099999999272285853000000032741208389999999927596006900000003277803543000000052796512610000000328150322300000005283359429000000032852198790000000528708457300000003288953510999999992908266930000000329270411899999999294585788999999982964717029999999929836186099999998300256262999999993021549089999999830405779899999999305964933000000033078763109999999930979193300000003311711798999999983136359090000000331556426300000004317496861000000023194337030000000432137478900000002323320119000000033252696929999999632722351100000003329181572999999963311438790000000333311042900000001335081223000000023370562610000000133903554300000002341019069343006839000000013449988533469951110000000134899561299999999351000359353009348999999993550225833570400610000000435906178299999999361087749000000033631179590000000436515241300000002367191110999999983692340530000000237128123899999997

Gestational age in days

Fetal abdominal circumference (mm)

FAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311463706227116228381219117819700168119411019117000011210023380660000112259365701500001124184975964125776294913127367613862128958932811000011305502517600000113214157070900001133732889658135324208607136915527556138506846505140098165454141689484402999991432808033520000214487212230099999146463441250000021480547601989999914964607914800001151237398096999981528287170460000115442003599500001156011354944157602673893159193992842160785311791162376630741639679496889999916555926863799999167150587587000021687419065359999917033322548500001171924544433999981735158633830000117510718233200001176698501281000011782898202317988113917918147245812818306377707718465509602618624641497499999187837733923999991894290528729999919102037182200002192611690770999991942030097200000119579432866900001197385647618000011989769665670000120056828551620215960446520375092341420534224236320693356131199999208524880260999992101161992099999921170751815899999213298837107999992148901560570000121648147500600001218072793955000012196641129040000122125543185322284675080222443806975122602938872276207076492292120265979999923080334554699999232394664495999992339859834449999923557730239399999237168621342999982387599402920000124035125924100001241942578190000012435338971392451252160882467165350372483078539862498991729352514904918839999925308181083299999254673129781999992562644487310000225785576767999999259447086629000012610384055779999826262972452700001264221043475999982658123624252674036813739999726899500032327058631927199997272177638221273768957170000022753602761189999927695159506800002278542914016999992801342329660000128172555191499998283316870864000012849081898129999828649950876228809082771099997289682146662912734656090000329286478455829445610350699997296047422455999992976387414050000229923006035399999300821379303000013024126982519999830400401720100001305595336149999983071866550990000130877797404799998310369292997311960611945999973135519308953151432498440000231673456879299999318325887741999963199172066909999932150852564000002323099844588999993246911635380000132628248248699998327873801436000013294651203849999833105643933433264775828299997334239077232335830396180999973374217151333901303407900002340604353027999993421956719769999634378699092599999IDDM macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631131321413511492848268500001116724824021185211653550000112031750669122113848025000011239101893612570653069512750287203000001129299213365000011310955547000000113289189603513468823737000002136484578704999991382809200400000114007726137500001141873602711436699440450000214546628537999999147262626715000011490589680515085530938515265165072000002154447992054999991562443333900000115804067472515983701606161633357395000021634296987300000116522604006500001167022381416881872273499999170615064070000021724114054050000117420774674176004088075177800429409999991795967707450000118139311208000001183189453415184985794750000031867821360850000218857847742000001190374818755000011921711600919396750142500002195763842760000021975601840950000119935652543201152866765202949208100000022047455494350000220654189077000001208338232105210134573442119309147750000221372725611000001215523597445000012173199387821911628011500002220912621450000022227089627850000122450530412000001226301645455000032280979867900000222989432812500002231690669460000012334870107952352833521300000323707969346500002238876034800000012406723761350000124246871747244265058805000022460614001400000224785774147500001249654082810000012514504241452532467654800000225504310681500002256839448150000012586357894850000326043213082262228472155000022640248134900000426582115482500001267617496160000032694138374952712101788300000227300652016500004274802861500000012765992028350000327839554416999999280191885505000022819882268400000428378456817528558090951000003287377250845000052891735921800000129096993351500004292766274852945626161850000229635895751999999298155298855000012999516401900000330174798152530354432286000002305340664195000043071370055300000130893334686500003310729688200000063125260295350000231432237086999999316118712205000013179150535400000331971139487532150773621000002323304077545000043251004188800000132689676021500003328693101550000053304894428850000233228578422000004334082125555335878466890000033376748082249999933947114956000001341267490895000043430638322334486017356500003346656514900000053484528562350000135024919757000004352045538905000063538418802400000235563822157499999357434562910000013592309042450000336102724558362823586915000023646199282500000436641626958500001368212610920000033700089522550000537180529359000002DM2 non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263117561169644999991191476615939999812073415354299999122320645491999981239071374409999912549362938999998127080121338999991286666132880000113025310523713183959718599999133426089134999981350125810839999813659907303299997138185564981999991397720569309999814135854888142945040828999991445315327779999814611802472699998147704516675999971492910086249999915087750057399998152463992523154050484471999991556369764209999915722346836999998158809960318999971603964522679999916198294421699998163569436166165155928114999991667424200639999916832891201299998169915403961999971715018959109999917308838785999998174674879809176261371758177847863706999991794343556559999818102084760499997182607339553999991841938315029999818578032345218736681540118895330734999999190539799298999981921262912479999719371278319699999195299275145999991968857670949999819847225904420005875099299999201645242941999982032317348909999720481822683999999206404718788999992079912107379999820957770268721116419463599999212750686584999982143371785339999721592367048321751016243199999219096654380999982206831463322226963827899999223856130227999982254426221769999822702911412622861560607499999230202098023999982317885899732333750819219999923496157387099998236548065819999982381345577692397210497179999924130754166699998242894033616244480525564999992460670175139999924765350946299998249240001412250826493360999992524129853099999825399947725925558596920799999257172461156999992587589531059999826034544505499997261931937004000022635184289530000126510492090226669141285126827790479999999269864396748999982714508886979999727303738064699996274623872596000012762103645452777968564942793833484429999928096984039199998282556332340999972841428242899999628572931623900001287315808188000012889023001372904887920859999929207528403499998293661775983999972952482679329999729683475988199996298421251831000013000077437830159423572899999303180727677999983047672196269999730635371157600002307940203525000023095266954740000131111318742331269967937199999314286171320999983158726632699999831745915521899997319045647167999963206321391170000132221863106632380512301499999325391614963999983269781069129999832856459886199997330151090811000023317375827600000133332407470933491056665799999336497058606999993380835505559999833967004250499997341256534453999963428430264029999534442951835234601601030099999DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631149421065111672301552711850392454412028483356112206574257812384665159512562756061212740846962912918937864599999130970287662999991327511966799999913453210569699999136313014713999991380939237309999913987483274799999141655741765000021434366507820000214521755979900001146998468816000011487793778330000115056028685000001152341195867000011541221048840000115590301390100001157683922918000011594648319350000116124574095200001163026649969164807558986166588468003168369377021701502860371719311950541737121040711754930130881772739221051790548311221808357401389999918261664915599999184397558172999991861784671899999918795937620699999189740285223999991915211942409999919330210325799999195083012274999991968639212919999919864483030899999200425739325999982022066483429999820398755735999998205768466376999982075493753939999820933028441099998211111193427999982128921024449999821467301146199998216453920479218234829496220015738513221796647532235775565472253584655642271393745812289202835982307011926152324821016322342630106489999923604391966599999237824828682999992396057376999999924138664671699999243167555733999992449484647509999924672937376799999248510282784999992502911918019999925207210081899998253853009835999982556339188529999825741482787000001259195736887000012609766459040000126275755492100001264538463938000012663193729550000126810028197226988119098927166210000627344300902327522391804277004827057278785736074280566645091282347554108284128463125285909372142287690281158999992894711901759999929125209919299999293033008209999992948139172269999929659482624399999298375735260999993001566442779999930193755329499999303718462311999993054993713289999830728028034599998309061189362999983108420983799999831262300739699998314403916413999983161848254309999831796573444799998319746643464999983215275524819999832330846149899997325089370515999973268702795329999732865118854999997330432097566999973322130065839999733399391560099997335774824617999973375557336349999733933664265200002341117551669000023428984606860000234467936970300002346460278720000023482411877370000235002209675400002351803005771000023535839147880000235536482380500001357145732822000013589266418390000136070755085600001362488459873000013642693688900000136605027790700001367831186924000013696120959410000137139300495800001GDM non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263119123845098120706214957000011222885848160000112387095467500001125453324534000021270356943930000112861806425200001130200434110999991317828039713336517382900001134947543688136529913547000011381122834060000213969465326514127702312400001142859392983000021444417628421460241327010000114760650256000002149188872419000011507712422780000215235361213700003153935981996000011555183518549999915710072171415868309157300001160265461432161847831291000011634302011500000216501257100916659494086800001168177310727000021697596805861713420504450000117292442030400002174506790163000011760891600220000217767152988100003179253899740000011808362695989999918241863945818400100931700001185583379175999991871657490351887481188940000219033048875319191285861200001193495228471000021950775983319665996818900001198242338048000021998247079072014070777660000120298944762520457181748400001206154187343000022077365572022093189270610000121090129691999999212483666779214066036638000012156484064972172307763560000121881314621500002220395516074221977885933000012235602557920000222514262565122672499551000001228307365369229889735228000012314721050870000223305447494623463684480500001236219214663999992378015845232393839543820000124096632424124254869410000001244131063959000022457134338182472958036770000124887817353600002250460543395252042913254000012536252831129999925520765297200001256790022830999992583723926900000325995476254900001261537132407999992631195022670000326470187212600001266284241984999992678666118439999826944898170300002271031351562272613721421000042741960912800000227577846113927736083099799998278943200857000022805255707162821079405749999928369031043400003285272680293000012868550501519999928843742001099997290019789870000012916021597289999929318452958800003294766899447000012963492693062979316391649999829951400902400002301096378883302678748742000043042611186010000230584348846307425858318999993090082281779999731059059803700001312172967895999993137553377550000331533770761400001316920077472999993185024473319999732008481719100001321667187053232495569090000332483192676800002326414296627327996666485999983295790363450000233116140620433274377606299998334326145922000023359085157810000133749088563999999339073255498999973406556253580000134223799521699999343820365076000033454027349350000134698510479399999GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263118366695550000021200538851470000212174107474400002123428264341000021251154539380000212680264353500002128489833132130177022729000021318642123260000313355140192300001135238591521369257811170000113861297071400003140300160311000011419873499081436745395050000114536172910200003147048918699000011487361082961504232978930000115211048749000003153797677087000011554848666841571720562810000115885924587800002160546435475000011622336250721639208146690000116560800426600002167295193863000011689823834599999917066957305700001172356762654000021740439522510000117573114184800002177418331445000011791055210420000218079271063900001182479900236000021841670898330000118585427943000002187541469027000011892286586240000219091584822119260303781800002194290227415195977417012000021976646066091993517962060000220103898580320272617540000002204413364997206100554594000022077877441912094749337880000221116212338521284931298200001214536502579216223692176000012179108817732195980713700000122128526096722297245056400001224659640161226346829758000012280340193552297212089520000123140839854923309558814600001234782777743236469967340000012381571569370000223984434653400001241531536131000022432187257280000124490591532500002246593104922000012482802945190000224996748411600001251654673713000022533418633100000125502905290700002256716242504000042584034321010000226009062169800001261777811294999992634650008920000326515219048900002266839380086000012685265696829999927021375928000003271900948877000022735881384742752753280709999927696251766800003278649707265000022803368968622820240864589999928371127605600003285398465653000022870856552528877284484699999290460034444000032921472240410000229383441363829552160323499999297208792832000032988959824290000130058317202630227036162299999303957551220000033056447408170000130733193041430901912001100004310706309608000033123934992050000131408068880231576787839899998317455067996000033191422575930000132082944719322516636787000043242038263840000232589101598100001327578205578329265395174999983309525847720000233263977436900001334326963965999993360141535630000433770134316000002339388532757000013410757223539999934276291195099998344450101548000023461372911450000134782448074199999349511670339000033511988599360000235288604953335457323912999999356260428726999983579476183240000235963480792136132199751799999

Gestational age in days

Fetal abdominal circumference (mm)

HC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM 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non-macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263141936936246000021434432504890000114494956473214645587897500002147962193218000011494685074611509748217040000215248113594700001153987450191554937644330000215700007867599999158506392919000011600127071620000316151902140499999163025335648000011645316498911660379641339999916754427837700001169050592621705569068629999917206322110600001173569535349000011750758495921765821638350000217808847807800001179594792321181101106564000021826074208070000118411373505185620049293000021871263635360000118863267777900001190138992022000021916453062650000219315162050800001194657934751196164248994000021976705632370000119917687748200683191722999992021895059660000120369582020920520213445220670844869500002208214762938000012097210771812112273914240000221273370566700001214240019912157463341530000221725264839600001218758962639220265276882000022217715911250000122327790536800001224784219611226290533854000022277968480970000122930316234230809476583000022323157908260000123382210506923532841931200002236834733555000012383410477980000123984736204124135367628400002242859990527000012443663047724587261901300002247378933256000012488852474992503915617420000225189787598500001253404190228254910504471000022564168187139999925792313295700001259429447200000032609357614429999926244207568600001263948389929000032654547041719999926696101841500001268467332658000032699736469012714799611440000127298627538700003274492589632759989038730000227750521811600004279011532359280517846602000022820241608449999828353047508828503678933100002286543103574000042880494178170000128955573206000003291062046302999992925683605460000129407467478900003295580989031999992970873032750000129859361751800003300099931760999993016062460040000130311256024700003304618874493061251887330000230763150297600004309137817219310644131462000023121504457050000431365675994831516307419100002316669388433999983181757026773196820169200000232118833116300004322694645406000013242009596490000332570727389199999327213588135000013287199023780000333022621662100005331732530864000013332388451070000333474515934999999336251473593000013377577878360000333926410207934077041632200002342276730564999983437830448083452893590510000234679567329400004348301987537349808301780000023513146160229999935282093026635432724450900002355833558752000043573398729950000135884618723800003DM2 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macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631595104670616083397623100001162157485402000021634809945730000316480450374400002166128012915167451522086000011687750312570000217009854042800001171422049598999991727455587717406906794100001175392577112000031767160862830000117803959545399999179363104625000011806866137960000218201012296700003183333632138000011846571413091859806504800000118730415965100002188627668822189951177993000021912746871641925981963350000119392170550600002195245214677000011965687238480000219789223301919921574219000001200539251361000032018627605320000120318626970299999204509778874000012058332880450000220715679721620848030638700001209803815558211127324729000012124508339000000221377434307121509785224200002216421361413217744870584000012190683797550000222039188892600001221715398097000022230389072682243624164390000122568592561000003227009434781000012283329439520000222965645312300001230979962294000022323034714652336269806360000123495048980723627399897800001237597508149000022389210173224024452649100002241568035662242891544833000012442150540040000224553856317500001246862072346000022481855815172495090906880000125083259985925215610903000001253479618201000022548031273720000125612663654300002257450145714000032587736548849999826009716405626142067322700001262744182398000022640676915690000326539120073999999266714709911268038219082000012693617282530000227068523742400004272008746594999992733322557662746557649370000127597927410800003277302783278999982786262924499999927994980162100001281273310792000022825968199630000328392032913399999285243838305286567347476000012878908566470000228921436581800003290537874988999992918613841629318489333100001294508402502000022958319116730000429715542084399999298478930015299802439186000023011259483570000330244945752800004303772966698999993050964758700000130641998504100002307743494212000033090670033829999931039051255431171402172500001313037530896000023143610400670000331568454923799999317008058409318331567580000013196550767510000232097858592199998322302095092999993236256042643249491134350000232627262260600003327596131776999983289196409479999933024315011900001331566659290000023328901684610000333421367763199999335537186803336860695974000013381842051450000233950771431600003340831223486999993421547326583434782418290000134480175100000002346125260171000043474487693419999934877227851335009578768400002

Gestational age in days

Head circumference (mm)

HCAC 6 groups

Fetal growth profiles in diabetic pregnancies

IDDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631200577381119903700111974966211195956241119441586111928754811191335101118979472099999991188254340999999911867139609999999118517358099999991183633200999999911820928209999999118055244099999991179012060999999911774716809999999117593130099999991174390920999999911728505409999999117131016099999981169769780999999811682294009999998116668902099999981165148640999999811636082609999998116206788099999981160527500999999811589871211157446740999999811559063611154365981115282560111512852211149744841114820446111466640809999999114512370099999991143583320999999911420429409999999114050256099999991138962180999999911374218009999999113588142099999991134341040999999911328006609999999113126028099999991129719900999999911281795209999999112663914099999981125098760999999811235583809999998112201800099999981120477620999999811189372409999998111739686099999981115856480999999811143161011112775721111123534111096949611108154581110661420111050738211103533440999999911019930609999999110045268099999991098912300999999910973719209999999109583154099999991094291160999999910927507809999999109121040099999991089670020999999910881296409999999108658926099999991085048880999999910835085009999998108196812099999981080427740999999810788873609999998107734698099999981075806600999999810742662209999998107272584099999981071185460999999810696450811068104701106656432110650239411063483561106194318110604028011058862420999999910573220409999999105578166099999991054241280999999910527009009999999105116052099999991049620140999999910480797609999999104653938099999991044999000999999910434586209999999104191824099999991040377860999999810388374809999998103729710099999981035756720999999810342163409999998103267596099999981031135580999999810295952009999998102805482110265144409999998102497406110234336811021893301102035292110188125411017272161101573178099999991014191400999999910126510209999999101111064099999991009570260999999910080298809999999100648950099999991004949120999999910034087409999999100186836099999991000327980999999909987876009999998609972472209999998509957068409999998409941664609999998309926260809999999409910857009999999309895453209999999209880049409999999109864645609999999109849241809999999098338380099999989098184342099999988098030304099999988097876266099999987IDDM macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226312314344909999999122909766112267608309999998122442400099999981222087170999999912197503409999999121741351099999971215076680999999812127398509999998121040302099999991208066190999999912057293609999999120339253099999981201055700999999811987188709999999119638204099999991194045210999999711917083809999998118937155099999981187034720999999811846978909999999118236106099999991180024230999999811776874009999998117535057099999981173013740999999911706769109999999116834008099999981166003250999999811636664209999998116132959099999991158992760999999911566559309999997115431910099999981151982270999999811496454409999999114730861099999991144971780999999711426349509999998114029812099999981137961290999999911356244609999999113328763111309508009999998112861397099999981126277140999999911239403109999999112160348099999971119266650999999811169298209999998111459299099999991112256160999999911099193311107582500999999811052456709999998110290884099999991100572010999999910982351809999999109589835099999981093561520999999810912246909999999108888786099999991086551030999999910842142009999998108187737099999981079540540999999910772037109999999107486688099999991072530050999999810701932209999998106785639099999981065519560999999910631827309999999106084590099999981058509070999999810561722409999998105383541099999991051498580999999910491617509999998104682492099999981044488090999999810421512609999999103981443099999991037477600999999710351407709999998103280394099999981030467110999999910281302809999999102579345099999971023456620999999810211197909999998101878296099999991016446130999999910141093011011772470999999810094356409999998100709881099999991004761980999999910024251509999997100008832099999980997751490999999820995414660999999870993077830999999910990741000999999840988404170999999890986067340999999820983730510999999860981393680999999910979056850999999840976720020999999880974383190999999820972046360999999860969709530999999909673727009999998309650358709999998809626990409999998109603622109999998509580253809999999095568855099999983095335172099999987095101489099999981094867806099999985094634123099999989094400440099999983094166757099999987093933074099999980936993910999999850934657080999999890932320250999999820929983420999999870927646590999999809253097609999998409229729309999998909206361009999999309182992709999998609159624409999997909136256109999998409112887809999998809089519509999999209066151209999998609042782909999999090194146099999983089960463099999988089726780099999992089493097099999985DM2 non-macrosomia11912012112212312412512612712812913013113213313413513613713813914014114214314414514614714814915015115215315415515615715815916016116216316416516616716816917017117217317417517617717817918018118218318418518618718818919019119219319419519619719819920020120220320420520620720820921021121221321421521621721821922022122222322422522622722822923023123223323423523623723823924024124224324424524624724824925025125225325425525625725825926026126226311562740819999997115534842499999971154422767999999911534971109999999115257145399999981151645796999999811507201399999998114979448299999981148868825999999711479431689999997114701751199999971146091854999999911451661979999999114424054099999981143314883999999811423892269999998114146356999999981140537912999999711396122559999997113868659899999971137760941999999911368352849999999113590962799999981134983970999999811340583139999998113313265699999981132206999999999711312813429999997113035568599999971129430028999999911285043719999999112757871499999981126653057999999811257274009999998112480174399999981123876086999999711229504299999997112202477299999971121099115999999911201734589999999111924780199999981118322144999999811173964879999998111647083099999981115545173999999811146195169999997111369385999999971112768202999999911118425459999999111091688899999991109991231999999811090655749999998110813991799999981107214260999999811062886039999997110536294699999971104437289999999711035116329999999110258597599999991101660318999999811007346619999998109980900499999981098883347999999810979576909999997109703203399999971096106376999999710951807199999999109425506299999991093329405999999810924037489999998109147809199999981090552434999999810896267779999997108870112099999971087775463999999710868498069999999108592414999999991084998492999999810840728359999998108314717899999981082221521999999810812958649999997108037020799999971079444550999999710785188939999999107759323699999991076667579999999810757419229999998107481626599999981073890608999999810729649519999997107203929499999971071113637999999710701879809999997106926232399999991068336666999999910674110099999998106648535299999981065559695999999810646340389999998106370838199999971062782724999999710618570679999997106093141099999991060005753999999910590800969999998105815443999999981057228782999999810563031259999998105537746899999971054451811999999710535261549999997105260049799999991051674840999999910507491839999998104982352699999981048897869999999810479722129999998104704655599999971046120898999999710451952419999997104426958499999991043343927999999910424182709999998104149261399999981040566956999999810396412999999998103871564299999971037789985999999710368643289999997103593867199999991035013014999999910340873579999998103316170099999981032236043999999810313103869999998103038472999999971029459072999999710285334159999997102760775899999991026682101999999910257564449999999102483078799999981023905130999999810229794739999998DM2 macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631183880550999999911821121210000001118034369111785752611176806830999999911750384009999999117326997100000011171501541116973311111679646809999999116619625099999991164427821000000111626593911160890961115912253111573541009999999115558567100000011153817241115204881111502803811148511950999999911467435209999999114497509100000011143206661114143823111396698009999999113790137099999991136132941000000111343645111132596081113082765099999991129059220999999911272907910000001112552236111237539311121985500999999911202170709999999111844864100000011116680211111491178111131433509999999111137492099999991109606491000000111078380611106069631110430120111025327709999999110076434100000011098995911109722748110954590511093690620999999910919221910000001109015376100000011088385331108661690110848484709999999108308004099999991081311611000000110795431811077774751107600632099999991074237890999999910724694610000001107070103110689326011067164170999999910653957409999999106362731100000011061858881106009045110583220209999999105655359099999991054785161000000110530167311051248301104947987110477114409999999104594301100000011044174581104240615110406377211038869290999999910371008610000001103533243100000011033564001103179557110300271409999999102825871099999991026490281000000110247218511022953421102118499099999991019416560999999910176481310000001101587970110141112711012342840999999910105744109999999100880598100000011007037551100526912110035006909999999100173226099999990999963830999999970998195401000000040996426970999999990994658540999999950992890111000000020991121680999999980989353251000000040987584821098581639099999996098404796100000003098227953099999998098051110099999994097874267100000001097697424099999997097520581099999992097343738099999999097166895099999995096990052100000002096813209099999997096636366099999993096459523109628268009999999509610583710000000209592899409999999809575215109999999409557530810953984650999999960952216221000000030950447790999999990948679360999999940946910931000000010945142500999999970943374071000000040941605640999999990939837210999999950938068781000000020936300350999999980934531921000000040932763491093099506099999996092922663099999991GDM non-macrosomia1191201211221231241251261271281291301311321331341351361371381391401411421431441451461471481491501511521531541551561571581591601611621631641651661671681691701711721731741751761771781791801811821831841851861871881891901911921931941951961971981992002012022032042052062072082092102112122132142152162172182192202212222232242252262272282292302312322332342352362372382392402412422432442452462472482492502512522532542552562572582592602612622631171395040999999811701596669999998116892429299999991167688918999999711664535449999998116521817099999981163982796999999811627474229999999116151204899999971160276674999999811590413009999998115780592699999981156570552999999911553351789999997115409980499999981152864430999999811516290569999998115039368299999991149158308999999711479229349999998114668756099999981145452186999999811442168129999999114298143899999971141746064999999811405106909999998113927531699999981138039942999999911368045689999997113556919499999981134333820999999811330984469999998113186307299999991130627698999999711293923249999998112815695099999981126921576999999811256862029999999112445082899999971123215454999999811219800809999998112074470699999981119509332999999911182739589999997111703858499999981115803210999999811145678369999998111333246299999991112097088999999711108617149999997110962634099999981108390966999999811071555929999999110592021899999971104684844999999711034494709999998110221409699999981100978722999999910997433489999997109850797499999971097272600999999810960372269999998109480185299999991093566478999999710923311049999997109109573099999981089860356999999810886249829999999108738960899999971086154234999999710849188609999998108368348699999981082448112999999910812127389999997107997736499999971078741990999999810775066169999998107627124299999991075035868999999710738004949999997107256512099999981071329746999999810700943729999999106885899899999971067623624999999710663882509999998106515287699999981063917502999999910626821289999997106144675499999971060211380999999810589760069999998105774063299999991056505258999999710552698849999997105403451099999981052799136999999810515637629999999105032838899999971049093014999999710478576409999998104662226699999981045386892999999910441515189999997104291614499999971041680770999999810404453969999998103921002299999991037974648999999710367392749999997103550390099999981034268526999999810330331529999999103179777899999971030562404999999710293270309999998102809165699999981026856282999999910256209089999997102438553499999971023150160999999810219147869999998102067941299999991019444038999999710182086649999997101697329099999981015737916999999810145025429999999101326716899999971012031794999999710107964209999998100956104699999981008325672999999910070902989999997100585492499999971004619550999999810033841769999998100214880299999991000913428999999709996780549999997309984426809999997809972073069999998209959719329999997509947365589999998099350118499999973GDM macrosomia119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263120192611099999991200218000999999911985098911196801781119509367111933855609999999119167745099999991189969341000000111882612311186553121118484501099999991183136900999999911814287909999999117972068111780125711176304461117459635099999991172888240999999911711801310000001116947202111677639111166055800999999911643476909999999116263958099999991160931471115922336111575152511155807140999999911540990309999999115239092100000011150682811114897470111472665909999999114555848099999991143850370999999911421422611140434151113872604111370179309999999113530982099999991133601711000000111318936011130185491112847738099999991126769270999999911250611609999999112335305111216449411119936831111822872099999991116520610999999911148125010000001111310439111113962811109688170999999911079800609999999110627195099999991104563841110285573111011476211099439510999999910977314009999999109602329100000011094315181109260707110908989609999999108919085099999991087482740999999910857746311084066521108235841110806503009999999107894219099999991077234081000000110755259711073817861107210975099999991070401640999999910686935309999999106698542110652773111063569201106186109099999991060152980999999910584448710000001105673676110550286511053320540999999910516124309999999104990432099999991048196211104648810110447799911043071880999999910413637709999999103965566100000011037947551103623944110345313309999999103282322099999991031115110999999910294070011027698891102599078110242826709999999102257456099999991020866451000000110191583411017450231101574212099999991014034010999999910123259009999999101061779110089096811007201571100549346099999991003785350999999910020772410000001100036913109986610209999999809969529109999999409952448009999999099353669099999997099182858099999993099012047109884123609999999609867042509999999209849961409999999909832880309999999509815799209999999109798718109999999809781637009999999409764555909999999097474748099999997097303937099999993097133126109696231509999999609679150409999999209662069309999999909644988209999999509627907109999999109610826009999999809593744909999999409576663809999999095595827099999997

Gestational age in days

Head to abdominal circumference ratio (HCAC ratio)

Model

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 1200577381 1231434491 1156274082 1183880551 1171395041 1201926111 1109612 LINE
120 -69 4761 1199037001 1229097661 1155348425 1182112121 1170159667 1200218001 1110695 Estimates of Fixed Effectsa
121 -68 4624 1197496621 1226760831 1154422768 1180343691 1168924293 1198509891 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 1195956241 1224424001 1153497111 1178575261 1167688919 1196801781 1112783 Lower Bound Upper Bound
123 -66 4356 1194415861 1222087171 1152571454 1176806831 1166453545 1195093671 1113788 Intercept 10927507815 00076442085 2483861646118 1429514624586 156360851038611E-240 10776950494 11078065136
124 -65 4225 1192875481 1219750341 1151645797 1175038401 1165218171 1193385561 1114767 ctime -000154038 00001873813 2361894509163 -8220563736 0 -00019095322 -00011712279
125 -64 4096 1191335101 1217413511 115072014 1173269971 1163982797 1191677451 111572 DM1M -00248943874 00128608391 2384370237175 -19356736562 00540899658 -00502297654 00004409907
18 126 -63 3969 1189794721 1215076681 1149794483 1171501541 1162747423 1189969341 1116647 DM2nM -00012726893 00110006433 2439624938932 -01156922599 09079916115 -00229410469 00203956684
127 -62 3844 1188254341 1212739851 1148868826 1169733111 1161512049 1188261231 1117548 DM2M -00326603281 00143197289 2333680597702 -22807923425 00234630719 -00608727913 -00044478648
128 -61 3721 1186713961 1210403021 1147943169 1167964681 1160276675 1186553121 1118423 DM3nM -00078319191 00102230349 2661779271785 -07661050855 04442926229 -00279602193 00122963812
129 -60 3600 1185173581 1208066191 1147017512 1166196251 1159041301 1184845011 1119272 DM3M -00103923671 00168121354 4167163320542 -06181467632 05368162888 -00434395286 00226547944
130 -59 3481 1183633201 1205729361 1146091855 1164427821 1157805927 1183136901 1120095 ctime DM1M -00007964546 0000313309 2294715100798 -2542073658 00116788476 -00014137849 -00001791244
131 -58 3364 1182092821 1203392531 1145166198 1162659391 1156570553 1181428791 1120892 ctime DM2nM 0000614723 00002699383 2384913816816 2277271851 00236562253 0000082955 0001146491
132 -57 3249 1180552441 1201055701 1144240541 1160890961 1155335179 1179720681 1121663 ctime DM2M -00002280464 000035415 2299388660551 -06439259603 05202652078 -00009258404 00004697476
19 133 -56 3136 1179012061 1198718871 1143314884 1159122531 1154099805 1178012571 1122408 ctime DM3nM 00003050062 00002515002 2587066853334 12127472744 02263327011 -0000190242 00008002544
134 -55 3025 1177471681 1196382041 1142389227 1157354101 1152864431 1176304461 1123127 ctime DM3M -00001677324 00003926162 3843503141477 -04272172818 06694603024 -00009396769 0000604212
135 -54 2916 1175931301 1194045211 114146357 1155585671 1151629057 1174596351 112382 a Dependent Variable HCAC ratio echo 1
136 -53 2809 1174390921 1191708381 1140537913 1153817241 1150393683 1172888241 1124487
137 -52 2704 1172850541 1189371551 1139612256 1152048811 1149158309 1171180131 1125128
138 -51 2601 1171310161 1187034721 1138686599 1150280381 1147922935 1169472021 1125743 Estimates of Fixed Effectsa
139 -50 2500 1169769781 1184697891 1137760942 1148511951 1146687561 1167763911 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 1168229401 1182361061 1136835285 1146743521 1145452187 1166055801 1126895 Lower Bound Upper Bound
141 -48 2304 1166689021 1180024231 1135909628 1144975091 1144216813 1164347691 1127432 Intercept 1100131329 00097239735 5091201207314 1131359859981 0 10810272758 11192353823
142 -47 2209 1165148641 1177687401 1134983971 1143206661 1142981439 1162639581 1127943 ctime -00015055347 00001896264 2453458441236 -79394796061 0 -0001879038 -00011320314
143 -46 2116 1163608261 1175350571 1134058314 1141438231 1141746065 1160931471 1128428 ctimesq -00000041757 00000034043 552737663669 -12265704583 02205063137 -00000108627 00000025114
144 -45 2025 1162067881 1173013741 1133132657 1139669801 1140510691 1159223361 1128887 DM1M -00337425008 00167371296 5123546308965 -20160267375 00443186119 -00666243475 -00008606541
145 -44 1936 1160527501 1170676911 1132207 1137901371 1139275317 1157515251 112932 DM2nM -00143395763 00140808978 4950486711294 -10183708815 03089991569 -0042005267 00133261143
146 -43 1849 1158987121 1168340081 1131281343 1136132941 1138039943 1155807141 1129727 DM2M -00289134247 00183010824 4962153900811 -15798751207 01147726649 -00648705897 00070437403
21 147 -42 1764 1157446741 1166003251 1130355686 1134364511 1136804569 1154099031 1130108 DM3nM -00092688892 00131390588 5276671855448 -0705445447 0480844366 -0035080175 00165423965
148 -41 1681 1155906361 1163666421 1129430029 1132596081 1135569195 1152390921 1130463 DM3M -00041390353 00195639063 5795483919757 -02115648675 08325208967 -00425638329 00342857623
149 -40 1600 1154365981 1161329591 1128504372 1130827651 1134333821 1150682811 1130792 ctime DM1M -00008318378 00003148002 2321213468068 -26424313041 00087914156 -00014520686 -0000211607
150 -39 1521 1152825601 1158992761 1127578715 1129059221 1133098447 1148974701 1131095 ctime DM2nM 0000549327 00002737601 2493756838497 20066000847 00458718509 00000101504 00010885037
151 -38 1444 1151285221 1156655931 1126653058 1127290791 1131863073 1147266591 1131372 ctime DM2M -00002165967 00003577736 2405317547939 -06054015692 05454829861 -00009213661 00004881728
152 -37 1369 1149744841 1154319101 1125727401 1125522361 1130627699 1145558481 1131623 ctime DM3nM 00003046641 00002553443 2697544368655 11931503388 02338588418 -0000198057 00008073851
153 -36 1296 1148204461 1151982271 1124801744 1123753931 1129392325 1143850371 1131848 ctime DM3M 00002377602 00004715353 5115217222776 05042255855 06143199743 -00006886239 00011641443
22 154 -35 1225 1146664081 1149645441 1123876087 1121985501 1128156951 1142142261 1132047 ctimesq DM1M 00000049385 00000057245 5269246547768 08626995541 0388695145 -00000063071 00000161842
155 -34 1156 1145123701 1147308611 112295043 1120217071 1126921577 1140434151 113222 ctimesq DM2nM 00000075322 00000050896 5888156924564 14798997622 01394348201 -00000024639 00000175282
156 -33 1089 1143583321 1144971781 1122024773 1118448641 1125686203 1138726041 1132367 ctimesq DM2M -00000022137 0000006526 55535916331 -03392053768 07345832447 -00000150323 0000010605
157 -32 1024 1142042941 1142634951 1121099116 1116680211 1124450829 1137017931 1132488 ctimesq DM3nM 00000005286 00000048671 5971385213096 01086008014 0913555607 -00000090301 00000100872
158 -31 961 1140502561 1140298121 1120173459 1114911781 1123215455 1135309821 1132583 ctimesq DM3M -00000085347 0000008227 6863599279549 -10373953144 02999169916 -00000246879 00000076185
159 -30 900 1138962181 1137961291 1119247802 1113143351 1121980081 1133601711 1132652 a Dependent Variable HCAC ratio echo 1
160 -29 841 1137421801 1135624461 1118322145 1111374921 1120744707 1131893601 1132695
23 161 -28 784 1135881421 1133287631 1117396488 1109606491 1119509333 1130185491 1132712
162 -27 729 1134341041 1130950801 1116470831 1107838061 1118273959 1128477381 1132703
163 -26 676 1132800661 1128613971 1115545174 1106069631 1117038585 1126769271 1132668
164 -25 625 1131260281 1126277141 1114619517 1104301201 1115803211 1125061161 1132607
165 -24 576 1129719901 1123940311 111369386 1102532771 1114567837 1123353051 113252
166 -23 529 1128179521 1121603481 1112768203 1100764341 1113332463 1121644941 1132407
167 -22 484 1126639141 1119266651 1111842546 1098995911 1112097089 1119936831 1132268
24 168 -21 441 1125098761 1116929821 1110916889 1097227481 1110861715 1118228721 1132103
169 -20 400 1123558381 1114592991 1109991232 1095459051 1109626341 1116520611 1131912
170 -19 361 1122018001 1112256161 1109065575 1093690621 1108390967 1114812501 1131695
171 -18 324 1120477621 1109919331 1108139918 1091922191 1107155593 1113104391 1131452
172 -17 289 1118937241 1107582501 1107214261 1090153761 1105920219 1111396281 1131183
173 -16 256 1117396861 1105245671 1106288604 1088385331 1104684845 1109688171 1130888
174 -15 225 1115856481 1102908841 1105362947 1086616901 1103449471 1107980061 1130567
25 175 -14 196 1114316101 1100572011 110443729 1084848471 1102214097 1106271951 113022
176 -13 169 1112775721 1098235181 1103511633 1083080041 1100978723 1104563841 1129847
177 -12 144 1111235341 1095898351 1102585976 1081311611 1099743349 1102855731 1129448
178 -11 121 1109694961 1093561521 1101660319 1079543181 1098507975 1101147621 1129023
179 -10 100 1108154581 1091224691 1100734662 1077774751 1097272601 1099439511 1128572
180 -9 81 1106614201 1088887861 1099809005 1076006321 1096037227 1097731401 1128095
181 -8 64 1105073821 1086551031 1098883348 1074237891 1094801853 1096023291 1127592
26 182 -7 49 1103533441 1084214201 1097957691 1072469461 1093566479 1094315181 1127063
183 -6 36 1101993061 1081877371 1097032034 1070701031 1092331105 1092607071 1126508
184 -5 25 1100452681 1079540541 1096106377 1068932601 1091095731 1090898961 1125927
185 -4 16 1098912301 1077203711 109518072 1067164171 1089860357 1089190851 112532
186 -3 9 1097371921 1074866881 1094255063 1065395741 1088624983 1087482741 1124687
187 -2 4 1095831541 1072530051 1093329406 1063627311 1087389609 1085774631 1124028
188 -1 1 1094291161 1070193221 1092403749 1061858881 1086154235 1084066521 1123343
27 189 0 0 1092750781 1067856391 1091478092 1060090451 1084918861 1082358411 1122632
190 1 1 1091210401 1065519561 1090552435 1058322021 1083683487 1080650301 1121895
191 2 4 1089670021 1063182731 1089626778 1056553591 1082448113 1078942191 1121132
192 3 9 1088129641 1060845901 1088701121 1054785161 1081212739 1077234081 1120343
193 4 16 1086589261 1058509071 1087775464 1053016731 1079977365 1075525971 1119528
194 5 25 1085048881 1056172241 1086849807 1051248301 1078741991 1073817861 1118687
195 6 36 1083508501 1053835411 108592415 1049479871 1077506617 1072109751 111782
28 196 7 49 1081968121 1051498581 1084998493 1047711441 1076271243 1070401641 1116927
197 8 64 1080427741 1049161751 1084072836 1045943011 1075035869 1068693531 1116008
198 9 81 1078887361 1046824921 1083147179 1044174581 1073800495 1066985421 1115063
199 10 100 1077346981 1044488091 1082221522 1042406151 1072565121 1065277311 1114092
200 11 121 1075806601 1042151261 1081295865 1040637721 1071329747 1063569201 1113095
201 12 144 1074266221 1039814431 1080370208 1038869291 1070094373 1061861091 1112072
202 13 169 1072725841 1037477601 1079444551 1037100861 1068858999 1060152981 1111023
29 203 14 196 1071185461 1035140771 1078518894 1035332431 1067623625 1058444871 1109948
204 15 225 1069645081 1032803941 1077593237 1033564001 1066388251 1056736761 1108847
205 16 256 1068104701 1030467111 107666758 1031795571 1065152877 1055028651 110772
206 17 289 1066564321 1028130281 1075741923 1030027141 1063917503 1053320541 1106567
207 18 324 1065023941 1025793451 1074816266 1028258711 1062682129 1051612431 1105388
208 19 361 1063483561 1023456621 1073890609 1026490281 1061446755 1049904321 1104183
209 20 400 1061943181 1021119791 1072964952 1024721851 1060211381 1048196211 1102952
30 210 21 441 1060402801 1018782961 1072039295 1022953421 1058976007 1046488101 1101695
211 22 484 1058862421 1016446131 1071113638 1021184991 1057740633 1044779991 1100412
212 23 529 1057322041 1014109301 1070187981 1019416561 1056505259 1043071881 1099103
213 24 576 1055781661 1011772471 1069262324 1017648131 1055269885 1041363771 1097768
214 25 625 1054241281 1009435641 1068336667 1015879701 1054034511 1039655661 1096407
215 26 676 1052700901 1007098811 106741101 1014111271 1052799137 1037947551 109502
216 27 729 1051160521 1004761981 1066485353 1012342841 1051563763 1036239441 1093607
31 217 28 784 1049620141 1002425151 1065559696 1010574411 1050328389 1034531331 1092168
218 29 841 1048079761 1000088321 1064634039 1008805981 1049093015 1032823221 1090703
219 30 900 1046539381 0997751491 1063708382 1007037551 1047857641 1031115111 1089212
220 31 961 1044999001 0995414661 1062782725 1005269121 1046622267 1029407001 1087695
221 32 1024 1043458621 0993077831 1061857068 1003500691 1045386893 1027698891 1086152
222 33 1089 1041918241 0990741001 1060931411 1001732261 1044151519 1025990781 1084583
223 34 1156 1040377861 0988404171 1060005754 0999963831 1042916145 1024282671 1082988
32 224 35 1225 1038837481 0986067341 1059080097 0998195401 1041680771 1022574561 1081367
225 36 1296 1037297101 0983730511 105815444 0996426971 1040445397 1020866451 107972
226 37 1369 1035756721 0981393681 1057228783 0994658541 1039210023 1019158341 1078047
227 38 1444 1034216341 0979056851 1056303126 0992890111 1037974649 1017450231 1076348
228 39 1521 1032675961 0976720021 1055377469 0991121681 1036739275 1015742121 1074623
229 40 1600 1031135581 0974383191 1054451812 0989353251 1035503901 1014034011 1072872
230 41 1681 1029595201 0972046361 1053526155 0987584821 1034268527 1012325901 1071095
33 231 42 1764 1028054821 0969709531 1052600498 0985816391 1033033153 1010617791 1069292
232 43 1849 1026514441 0967372701 1051674841 0984047961 1031797779 1008909681 1067463
233 44 1936 1024974061 0965035871 1050749184 0982279531 1030562405 1007201571 1065608
234 45 2025 1023433681 0962699041 1049823527 0980511101 1029327031 1005493461 1063727
235 46 2116 1021893301 0960362211 104889787 0978742671 1028091657 1003785351 106182
236 47 2209 1020352921 0958025381 1047972213 0976974241 1026856283 1002077241 1059887
237 48 2304 1018812541 0955688551 1047046556 0975205811 1025620909 1000369131 1057928
34 238 49 2401 1017272161 0953351721 1046120899 0973437381 1024385535 0998661021 1055943
239 50 2500 1015731781 0951014891 1045195242 0971668951 1023150161 0996952911 1053932
240 51 2601 1014191401 0948678061 1044269585 0969900521 1021914787 0995244801 1051895
241 52 2704 1012651021 0946341231 1043343928 0968132091 1020679413 0993536691 1049832
242 53 2809 1011110641 0944004401 1042418271 0966363661 1019444039 0991828581 1047743
243 54 2916 1009570261 0941667571 1041492614 0964595231 1018208665 0990120471 1045628
244 55 3025 1008029881 0939330741 1040566957 0962826801 1016973291 0988412361 1043487
35 245 56 3136 1006489501 0936993911 10396413 0961058371 1015737917 0986704251 104132
246 57 3249 1004949121 0934657081 1038715643 0959289941 1014502543 0984996141 1039127
247 58 3364 1003408741 0932320251 1037789986 0957521511 1013267169 0983288031 1036908
248 59 3481 1001868361 0929983421 1036864329 0955753081 1012031795 0981579921 1034663
249 60 3600 1000327981 0927646591 1035938672 0953984651 1010796421 0979871811 1032392
250 61 3721 0998787601 0925309761 1035013015 0952216221 1009561047 0978163701 1030095
251 62 3844 0997247221 0922972931 1034087358 0950447791 1008325673 0976455591 1027772
36 252 63 3969 0995706841 0920636101 1033161701 0948679361 1007090299 0974747481 1025423
253 64 4096 0994166461 0918299271 1032236044 0946910931 1005854925 0973039371 1023048
254 65 4225 0992626081 0915962441 1031310387 0945142501 1004619551 0971331261 1020647
255 66 4356 0991085701 0913625611 103038473 0943374071 1003384177 0969623151 101822
256 67 4489 0989545321 0911288781 1029459073 0941605641 1002148803 0967915041 1015767
257 68 4624 0988004941 0908951951 1028533416 0939837211 1000913429 0966206931 1013288
258 69 4761 0986464561 0906615121 1027607759 0938068781 0999678055 0964498821 1010783
37 259 70 4900 0984924181 0904278291 1026682102 0936300351 0998442681 0962790711 1008252
260 71 5041 0983383801 0901941461 1025756445 0934531921 0997207307 0961082601 1005695
261 72 5184 0981843421 0899604631 1024830788 0932763491 0995971933 0959374491 1003112
262 73 5329 0980303041 0897267801 1023905131 0930995061 0994736559 0957666381 1000503
263 74 5476 0978762661 0894930971 1022979474 0929226631 0993501185 0955958271 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 14544665153 145370711215 141936936246 148214015655 151802867413 15951046706 1109612 LINE
120 -69 4761 146818513261 146806320467 143443250489 14965054802 153138453854 160833976231 1110695 Estimates of Fixed Effectsa
121 -68 4624 148190374992 148241929719 144949564732 151087080385 154474040295 162157485402 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 149562236723 149677538971 146455878975 15252361275 155809626736 163480994573 1112783 Lower Bound Upper Bound
123 -66 4356 150934098454 151113148223 147962193218 153960145115 157145213177 164804503744 1113788 Intercept 2414769727386 20910126541 2614067643015 1154832670487 245604019415608E-226 2373596005981 2455943448792
124 -65 4225 152305960185 152548757475 149468507461 15539667748 158480799618 166128012915 1114767 ctime 13718617315 00571400378 239396876075 240087648764 112260983751603E-65 12593002691 14844231939
125 -64 4096 153677821916 153984366727 150974821704 156833209845 159816386059 167451522086 111572 DM1M 43863861553 35074992723 247879000216 12505736466 02122692588 -25219155524 112946878629
18 126 -63 3969 155049683647 155419975979 152481135947 15826974221 1611519725 168775031257 1116647 DM2nM 5901960556 29970254861 2551351047471 19692727284 00500037953 -0000098509 118040196211
127 -62 3844 156421545378 156855585231 15398745019 159706274575 162487558941 170098540428 1117548 DM2M 72946085053 3886017583 2465909153986 18771424342 00616792034 -03594115822 149486285928
128 -61 3721 157793407109 158291194483 155493764433 16114280694 163823145382 171422049599 1118423 DM3nM 38169455833 2797671658 2794039624019 13643293602 01735618163 -16902451354 9324136302
129 -60 3600 15916526884 159726803735 157000078676 162579339305 165158731823 17274555877 1119272 DM3M 106791363334 46009359799 4361065178194 23210790978 00207427924 16363715676 197219010992
130 -59 3481 160537130571 161162412987 158506392919 16401587167 166494318264 174069067941 1120095 ctime DM1M 0063747521 00954499537 23168698318 06678632999 05048855867 -01243133127 02518083548
131 -58 3364 161908992302 162598022239 160012707162 165452404035 167829904705 175392577112 1120892 ctime DM2nM 01344525116 00820224568 2396055602523 16392158554 01024806101 -00271246799 02960297032
132 -57 3249 163280854033 164033631491 161519021405 1668889364 169165491146 176716086283 1121663 ctime DM2M 00646706337 01071763367 2349426497429 06034040315 05468220328 -01464788125 02758200798
19 133 -56 3136 164652715764 165469240743 163025335648 168325468765 170501077587 178039595454 1122408 ctime DM3nM -00362752914 00761558388 2589784113082 -04763297459 06342410886 -01862388048 01136882221
134 -55 3025 166024577495 166904849995 164531649891 16976200113 171836664028 179363104625 1123127 ctime DM3M -00483525556 01165322709 3612630049027 -04149284594 06784405727 -02775193575 01808142462
135 -54 2916 167396439226 168340459247 166037964134 171198533495 173172250469 180686613796 112382 a Dependent Variable hoofdomtrek echo 1 (mm)
136 -53 2809 168768300957 169776068499 167544278377 17263506586 17450783691 182010122967 1124487
137 -52 2704 170140162688 171211677751 16905059262 174071598225 175843423351 183333632138 1125128 Estimates of Fixed Effectsa
138 -51 2601 171512024419 172647287003 170556906863 17550813059 177179009792 184657141309 1125743 Estimates of Fixed Effectsa
139 -50 2500 17288388615 174082896255 172063221106 176944662955 178514596233 18598065048 1126332 Parameter Estimate Std Error df t Sig 95 Confidence Interval
20 140 -49 2401 174255747881 175518505507 173569535349 17838119532 179850182674 187304159651 1126895 Lower Bound Upper Bound
141 -48 2304 175627609612 176954114759 175075849592 179817727685 181185769115 188627668822 1127432 Intercept 2493205006423 26818036416 5445674623465 929674703907 0 244052553921 2545884473637
142 -47 2209 176999471343 178389724011 176582163835 18125426005 182521355556 189951177993 1127943 ctime 14061521215 00566931885 2517092044335 248028406738 152316286832415E-69 12944986657 15178055773
143 -46 2116 178371333074 179825333263 178088478078 182690792415 183856941997 191274687164 1128428 ctimesq -00043893444 00009648269 5486636325832 -45493595563 0000006629 -00062845511 -00024941378
144 -45 2025 179743194805 181260942515 179594792321 18412732478 185192528438 192598196335 1128887 DM1M 43894056115 4616065213 5456102232991 09508976605 0342077354 -46780300913 134568413143
145 -44 1936 181115056536 182696551767 181101106564 185563857145 186528114879 193921705506 112932 DM2nM 15590683451 38785326012 5275565255826 04019737631 06878661352 -60601959221 91783326124
146 -43 1849 182486918267 184132161019 182607420807 18700038951 18786370132 195245214677 1129727 DM2M 8676546146 50408117368 5336958254148 17212597096 00857832245 -12257196918 185788119839
21 147 -42 1764 183858779998 185567770271 18411373505 188436921875 189199287761 196568723848 1130108 DM3nM 2989076674 36263773904 5595101673168 08242596818 04101432535 -4133900658 10112054006
148 -41 1681 185230641729 187003379523 185620049293 18987345424 190534874202 197892233019 1130463 DM3M 105484092442 54153335157 6097005984079 19478780418 00518881117 -00865609965 211833794849
149 -40 1600 18660250346 188438988775 187126363536 191309986605 191870460643 19921574219 1130792 ctime DM1M 00294596956 00942274862 2385137605335 03126443967 0754824023 -01561646683 02150840595
150 -39 1521 187974365191 189874598027 188632677779 19274651897 193206047084 200539251361 1131095 ctime DM2nM 011746192 00814521259 2525904242866 1442097659 01505135651 -0042949909 02778737491
151 -38 1444 189346226922 191310207279 190138992022 194183051335 194541633525 201862760532 1131372 ctime DM2M 00627324914 01060902424 2467164426328 05913125468 05548523969 -01462255978 02716905806
152 -37 1369 190718088653 192745816531 191645306265 1956195837 195877219966 203186269703 1131623 ctime DM3nM -00385302299 00755558747 270985031372 -05099567717 06104968317 -01872813721 01102209122
153 -36 1296 192089950384 194181425783 193151620508 197056116065 197212806407 204509778874 1131848 ctime DM3M 0104905579 01297608419 4609998204995 08084532857 04192466886 -01500904642 03599016222
22 154 -35 1225 193461812115 195617035035 194657934751 19849264843 198548392848 205833288045 1132047 ctimesq DM1M 00003662169 00016182018 5261476667666 02263109881 08210474432 -00028127131 00035451468
155 -34 1156 194833673846 197052644287 196164248994 199929180795 199883979289 207156797216 113222 ctimesq DM2nM 00023659357 00014377496 586198451208 16455826512 01003857522 -00004578318 00051897033
156 -33 1089 196205535577 198488253539 197670563237 20136571316 20121956573 208480306387 1132367 ctimesq DM2M -0000812769 00018523286 5638208329212 -04387823077 06609873692 -00044510765 00028255384
157 -32 1024 197577397308 199923862791 19917687748 202802245525 202555152171 209803815558 1132488 ctimesq DM3nM 00002363901 00013671209 5962454146829 01729109033 08627801407 -00024485679 00029213481
158 -31 961 198949259039 201359472043 200683191723 20423877789 203890738612 211127324729 1132583 ctimesq DM3M -00017469554 00022279554 6974552491839 -07841069586 04332435648 -00061212587 0002627348
159 -30 900 20032112077 202795081295 202189505966 205675310255 205226325053 2124508339 1132652 a Dependent Variable hoofdomtrek echo 1 (mm)
160 -29 841 201692982501 204230690547 203695820209 20711184262 206561911494 213774343071 1132695
23 161 -28 784 203064844232 205666299799 205202134452 208548374985 207897497935 215097852242 1132712
162 -27 729 204436705963 207101909051 206708448695 20998490735 209233084376 216421361413 1132703
163 -26 676 205808567694 208537518303 208214762938 211421439715 210568670817 217744870584 1132668
164 -25 625 207180429425 209973127555 209721077181 21285797208 211904257258 219068379755 1132607
165 -24 576 208552291156 211408736807 211227391424 214294504445 213239843699 220391888926 113252
166 -23 529 209924152887 212844346059 212733705667 21573103681 21457543014 221715398097 1132407
167 -22 484 211296014618 214279955311 21424001991 217167569175 215911016581 223038907268 1132268
24 168 -21 441 212667876349 215715564563 215746334153 21860410154 217246603022 224362416439 1132103
169 -20 400 21403973808 217151173815 217252648396 220040633905 218582189463 22568592561 1131912
170 -19 361 215411599811 218586783067 218758962639 22147716627 219917775904 227009434781 1131695
171 -18 324 216783461542 220022392319 220265276882 222913698635 221253362345 228332943952 1131452
172 -17 289 218155323273 221458001571 221771591125 224350231 222588948786 229656453123 1131183
173 -16 256 219527185004 222893610823 223277905368 225786763365 223924535227 230979962294 1130888
174 -15 225 220899046735 224329220075 224784219611 22722329573 225260121668 232303471465 1130567
25 175 -14 196 222270908466 225764829327 226290533854 228659828095 226595708109 233626980636 113022
176 -13 169 223642770197 227200438579 227796848097 23009636046 22793129455 234950489807 1129847
177 -12 144 225014631928 228636047831 22930316234 231532892825 229266880991 236273998978 1129448
178 -11 121 226386493659 230071657083 230809476583 23296942519 230602467432 237597508149 1129023
179 -10 100 22775835539 231507266335 232315790826 234405957555 231938053873 23892101732 1128572
180 -9 81 229130217121 232942875587 233822105069 23584248992 233273640314 240244526491 1128095
181 -8 64 230502078852 234378484839 235328419312 237279022285 234609226755 241568035662 1127592
26 182 -7 49 231873940583 235814094091 236834733555 23871555465 235944813196 242891544833 1127063
183 -6 36 233245802314 237249703343 238341047798 240152087015 237280399637 244215054004 1126508
184 -5 25 234617664045 238685312595 239847362041 24158861938 238615986078 245538563175 1125927
185 -4 16 235989525776 240120921847 241353676284 243025151745 239951572519 246862072346 112532
186 -3 9 237361387507 241556531099 242859990527 24446168411 24128715896 248185581517 1124687
187 -2 4 238733249238 242992140351 24436630477 245898216475 242622745401 249509090688 1124028
188 -1 1 240105110969 244427749603 245872619013 24733474884 243958331842 250832599859 1123343
27 189 0 0 2414769727 245863358855 247378933256 248771281205 245293918283 25215610903 1122632
190 1 1 242848834431 247298968107 248885247499 25020781357 246629504724 253479618201 1121895
191 2 4 244220696162 248734577359 250391561742 251644345935 247965091165 254803127372 1121132
192 3 9 245592557893 250170186611 251897875985 2530808783 249300677606 256126636543 1120343
193 4 16 246964419624 251605795863 253404190228 254517410665 250636264047 257450145714 1119528
194 5 25 248336281355 253041405115 254910504471 25595394303 251971850488 258773654885 1118687
195 6 36 249708143086 254477014367 256416818714 257390475395 253307436929 260097164056 111782
28 196 7 49 251080004817 255912623619 257923132957 25882700776 25464302337 261420673227 1116927
197 8 64 252451866548 257348232871 2594294472 260263540125 255978609811 262744182398 1116008
198 9 81 253823728279 258783842123 260935761443 26170007249 257314196252 264067691569 1115063
199 10 100 25519559001 260219451375 262442075686 263136604855 258649782693 26539120074 1114092
200 11 121 256567451741 261655060627 263948389929 26457313722 259985369134 266714709911 1113095
201 12 144 257939313472 263090669879 265454704172 266009669585 261320955575 268038219082 1112072
202 13 169 259311175203 264526279131 266961018415 26744620195 262656542016 269361728253 1111023
29 203 14 196 260683036934 265961888383 268467332658 268882734315 263992128457 270685237424 1109948
204 15 225 262054898665 267397497635 269973646901 27031926668 265327714898 272008746595 1108847
205 16 256 263426760396 268833106887 271479961144 271755799045 266663301339 273332255766 110772
206 17 289 264798622127 270268716139 272986275387 27319233141 26799888778 274655764937 1106567
207 18 324 266170483858 271704325391 27449258963 274628863775 269334474221 275979274108 1105388
208 19 361 267542345589 273139934643 275998903873 27606539614 270670060662 277302783279 1104183
209 20 400 26891420732 274575543895 277505218116 277501928505 272005647103 27862629245 1102952
30 210 21 441 270286069051 276011153147 279011532359 27893846087 273341233544 279949801621 1101695
211 22 484 271657930782 277446762399 280517846602 280374993235 274676819985 281273310792 1100412
212 23 529 273029792513 278882371651 282024160845 2818115256 276012406426 282596819963 1099103
213 24 576 274401654244 280317980903 283530475088 283248057965 277347992867 283920329134 1097768
214 25 625 275773515975 281753590155 285036789331 28468459033 278683579308 285243838305 1096407
215 26 676 277145377706 283189199407 286543103574 286121122695 280019165749 286567347476 109502
216 27 729 278517239437 284624808659 288049417817 28755765506 28135475219 287890856647 1093607
31 217 28 784 279889101168 286060417911 28955573206 288994187425 282690338631 289214365818 1092168
218 29 841 281260962899 287496027163 291062046303 29043071979 284025925072 290537874989 1090703
219 30 900 28263282463 288931636415 292568360546 291867252155 285361511513 29186138416 1089212
220 31 961 284004686361 290367245667 294074674789 29330378452 286697097954 293184893331 1087695
221 32 1024 285376548092 291802854919 295580989032 294740316885 288032684395 294508402502 1086152
222 33 1089 286748409823 293238464171 297087303275 29617684925 289368270836 295831911673 1084583
223 34 1156 288120271554 294674073423 298593617518 297613381615 290703857277 297155420844 1082988
32 224 35 1225 289492133285 296109682675 300099931761 29904991398 292039443718 298478930015 1081367
225 36 1296 290863995016 297545291927 301606246004 300486446345 293375030159 299802439186 107972
226 37 1369 292235856747 298980901179 303112560247 30192297871 2947106166 301125948357 1078047
227 38 1444 293607718478 300416510431 30461887449 303359511075 296046203041 302449457528 1076348
228 39 1521 294979580209 301852119683 306125188733 30479604344 297381789482 303772966699 1074623
229 40 1600 29635144194 303287728935 307631502976 306232575805 298717375923 30509647587 1072872
230 41 1681 297723303671 304723338187 309137817219 30766910817 300052962364 306419985041 1071095
33 231 42 1764 299095165402 306158947439 310644131462 309105640535 301388548805 307743494212 1069292
232 43 1849 300467027133 307594556691 312150445705 3105421729 302724135246 309067003383 1067463
233 44 1936 301838888864 309030165943 313656759948 311978705265 304059721687 310390512554 1065608
234 45 2025 303210750595 310465775195 315163074191 31341523763 305395308128 311714021725 1063727
235 46 2116 304582612326 311901384447 316669388434 314851769995 306730894569 313037530896 106182
236 47 2209 305954474057 313336993699 318175702677 31628830236 30806648101 314361040067 1059887
237 48 2304 307326335788 314772602951 31968201692 317724834725 309402067451 315684549238 1057928
34 238 49 2401 308698197519 316208212203 321188331163 31916136709 310737653892 317008058409 1055943
239 50 2500 31007005925 317643821455 322694645406 320597899455 312073240333 31833156758 1053932
240 51 2601 311441920981 319079430707 324200959649 32203443182 313408826774 319655076751 1051895
241 52 2704 312813782712 320515039959 325707273892 323470964185 314744413215 320978585922 1049832
242 53 2809 314185644443 321950649211 327213588135 32490749655 316079999656 322302095093 1047743
243 54 2916 315557506174 323386258463 328719902378 326344028915 317415586097 323625604264 1045628
244 55 3025 316929367905 324821867715 330226216621 32778056128 318751172538 324949113435 1043487
35 245 56 3136 318301229636 326257476967 331732530864 329217093645 320086758979 326272622606 104132
246 57 3249 319673091367 327693086219 333238845107 33065362601 32142234542 327596131777 1039127
247 58 3364 321044953098 329128695471 33474515935 332090158375 322757931861 328919640948 1036908
248 59 3481 322416814829 330564304723 336251473593 33352669074 324093518302 330243150119 1034663
249 60 3600 32378867656 331999913975 337757787836 334963223105 325429104743 33156665929 1032392
250 61 3721 325160538291 333435523227 339264102079 33639975547 326764691184 332890168461 1030095
251 62 3844 326532400022 334871132479 340770416322 337836287835 328100277625 334213677632 1027772
36 252 63 3969 327904261753 336306741731 342276730565 3392728202 329435864066 335537186803 1025423
253 64 4096 329276123484 337742350983 343783044808 340709352565 330771450507 336860695974 1023048
254 65 4225 330647985215 339177960235 345289359051 34214588493 332107036948 338184205145 1020647
255 66 4356 332019846946 340613569487 346795673294 343582417295 333442623389 339507714316 101822
256 67 4489 333391708677 342049178739 348301987537 34501894966 33477820983 340831223487 1015767
257 68 4624 334763570408 343484787991 34980830178 346455482025 336113796271 342154732658 1013288
258 69 4761 336135432139 344920397243 351314616023 34789201439 337449382712 343478241829 1010783
37 259 70 4900 33750729387 346356006495 352820930266 349328546755 338784969153 344801751 1008252
260 71 5041 338879155601 347791615747 354327244509 35076507912 340120555594 346125260171 1005695
261 72 5184 340251017332 349227224999 355833558752 352201611485 341456142035 347448769342 1003112
262 73 5329 341622879063 350662834251 357339872995 35363814385 342791728476 348772278513 1000503
263 74 5476 342994740794 352098443503 358846187238 355074676215 344127314917 350095787684 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 non macro DM1 macro DM2 non macro DM2 macro GDM non macro GDM macro controle
17 119 -70 4900 11463706227 11313214135 117561169645 11494210651 119123845098 11836669555 1109612 LINE
120 -69 4761 116228381219 114928482685 119147661594 116723015527 120706214957 120053885147 1110695 Estimates of Fixed Effectsa
121 -68 4624 117819700168 11672482402 120734153543 118503924544 122288584816 121741074744 1111752 Parameter Estimate Std Error df t Sig 95 Confidence Interval
122 -67 4489 119411019117 118521165355 122320645492 120284833561 123870954675 123428264341 1112783 Lower Bound Upper Bound
123 -66 4356 121002338066 12031750669 123907137441 122065742578 125453324534 125115453938 1113788 Intercept 2260293877445 15832942499 2075124501314 1427589266846 388446233098433E-209 2229079836699 2291507918191
124 -65 4225 122593657015 122113848025 12549362939 123846651595 127035694393 126802643535 1114767 ctime 15913189487 00257269757 1842828363543 618541008714 333232731447193E-125 1540561671 16420762263
125 -64 4096 124184975964 12391018936 127080121339 125627560612 128618064252 128489833132 111572 DM1M 128466647132 26637571167 2050371372228 48227612918 00000027571 75947975092 180985319172
18 126 -63 3969 125776294913 125706530695 128666613288 127408469629 130200434111 130177022729 1116647 DM2nM 25862183751 22924441061 2120345443705 11281489343 02605319151 -19326822206 71051189709
127 -62 3844 127367613862 12750287203 130253105237 129189378646 13178280397 131864212326 1117548 DM2M 13576357083 30226756059 2068960521546 44915031756 00000117494 76171635627 195355506033
128 -61 3721 128958932811 129299213365 131839597186 130970287663 133365173829 133551401923 1118423 DM3nM 38603475284 20991973988 2240865618358 18389635632 00672437607 -02763451957 79970402525
129 -60 3600 13055025176 1310955547 133426089135 13275119668 134947543688 13523859152 1119272 DM3M 104405796385 31656025476 3066137679353 32981334458 00010878058 42115250622 166696342147
130 -59 3481 132141570709 132891896035 135012581084 134532105697 136529913547 136925781117 1120095 ctime DM1M 0283151845 00432712225 1817500471523 65436525391 00000000006 0197773299 03685303911
131 -58 3364 133732889658 13468823737 136599073033 136313014714 138112283406 138612970714 1120892 ctime DM2nM -00048270024 00376596757 1948296000005 -01281742952 0898143248 -0079099973 00694459682
132 -57 3249 135324208607 136484578705 138185564982 138093923731 139694653265 140300160311 1121663 ctime DM2M 01895900684 00490866258 1769361289612 38623569074 00001573593 00927194724 02864606643
19 133 -56 3136 136915527556 13828092004 139772056931 139874832748 141277023124 141987349908 1122408 ctime DM3nM -00894909013 00351840743 2100120618088 -2543505923 00116941229 -01588501162 -00201316865
134 -55 3025 138506846505 140077261375 14135854888 141655741765 142859392983 143674539505 1123127 ctime DM3M 00958706475 00550271082 3275705288599 17422439719 00824043069 -00123804614 02041217564
135 -54 2916 140098165454 14187360271 142945040829 143436650782 144441762842 145361729102 112382 a Dependent Variable buikomtrek echo 1 (mm)
136 -53 2809 141689484403 143669944045 144531532778 145217559799 146024132701 147048918699 1124487
137 -52 2704 143280803352 14546628538 146118024727 146998468816 14760650256 148736108296 1125128 Estimates of Fixed Effectsa
138 -51 2601 144872122301 147262626715 147704516676 148779377833 149188872419 150423297893 1125743 Parameter Estimate Std Error df t Sig 95 Confidence Interval
139 -50 2500 14646344125 14905896805 149291008625 15056028685 150771242278 15211048749 1126332 CURVE Lower Bound Upper Bound
20 140 -49 2401 148054760199 150855309385 150877500574 152341195867 152353612137 153797677087 1126895 Intercept 2279083606289 17563094035 2995277576238 1297654958632 282728501152131E-265 2244520919941 2313646292636
141 -48 2304 149646079148 15265165072 152463992523 154122104884 153935981996 155484866684 1127432 ctime 15999477276 00263569131 1888603928837 607031529296 763256315745845E-126 15479559629 16519394924
142 -47 2209 151237398097 154447992055 154050484472 155903013901 155518351855 157172056281 1127943 ctimesq -00010312178 00004063238 4962942680429 -25379214479 00114560307 -00018295447 -0000232891
143 -46 2116 152828717046 15624433339 155636976421 157683922918 157100721714 158859245878 1128428 DM1M 103127687062 2964514122 2995736875962 34787382626 00005785175 44788588131 161466785993
144 -45 2025 154420035995 158040674725 15722346837 159464831935 158683091573 160546435475 1128887 DM2nM 34564457141 25599984087 309718791599 13501749463 01779456963 -15807426566 84936340847
145 -44 1936 156011354944 15983701606 158809960319 161245740952 160265461432 162233625072 112932 DM2M 122005558 33556108055 3012230798113 36358673598 00003257347 55971477889 18803963811
146 -43 1849 157602673893 161633357395 160396452268 163026649969 161847831291 163920814669 1129727 DM3nM 42962102717 23463154496 326488482678 18310454685 00680049689 -03195941768 89120147201
21 147 -42 1764 159193992842 16342969873 161982944217 164807558986 16343020115 165608004266 1130108 DM3M 89716998107 33847002499 3726004476445 26506630272 00083759649 23161905447 156272090768
148 -41 1681 160785311791 165226040065 163569436166 166588468003 165012571009 167295193863 1130463 ctime DM1M 02733356413 00441319342 1835739225022 61936021292 00000000038 01862646214 03604066613
149 -40 1600 16237663074 1670223814 165155928115 16836937702 166594940868 16898238346 1130792 ctime DM2nM -0001801609 00385275434 1993813052744 -00467615844 09627500508 -00777753614 00741721434
150 -39 1521 163967949689 168818722735 166742420064 170150286037 168177310727 170669573057 1131095 ctime DM2M 01835123355 00504002642 185279951151 36410986806 00003521385 00840801581 02829445129
151 -38 1444 165559268638 17061506407 168328912013 171931195054 169759680586 172356762654 1131372 ctime DM3nM -00828939084 00361345176 2154072117374 -22940366688 00227523171 -01541164168 -00116713999
152 -37 1369 167150587587 172411405405 169915403962 173712104071 171342050445 174043952251 1131623 ctime DM3M 01043800754 00683335854 428970440431 15275076642 01273718042 -00299302363 0238690387
153 -36 1296 168741906536 17420774674 171501895911 175493013088 172924420304 175731141848 1131848 ctimesq DM1M 00013868456 0000683559 4864834424972 20288601139 00430166221 00000437531 0002729938
22 154 -35 1225 170333225485 176004088075 17308838786 177273922105 174506790163 177418331445 1132047 ctimesq DM2nM -00005653252 00006296046 5273178841193 -0897905202 03696458706 -00018021664 00006715159
155 -34 1156 171924544434 17780042941 174674879809 179054831122 176089160022 179105521042 113222 ctimesq DM2M 00007500873 00007657059 4782889111002 09796023617 03277776707 -0000754476 00022546507
156 -33 1089 173515863383 179596770745 176261371758 180835740139 177671529881 180792710639 1132367 ctimesq DM3nM -00004192175 00006038751 5431674664601 -06942122545 04878459099 -00016054342 00007669992
157 -32 1024 175107182332 18139311208 177847863707 182616649156 17925389974 182479900236 1132488 ctimesq DM3M 00005962862 00010887151 7036791456733 05476971909 05840735181 -00015412327 0002733805
158 -31 961 176698501281 183189453415 179434355656 184397558173 180836269599 184167089833 1132583 a Dependent Variable buikomtrek echo 1 (mm)
159 -30 900 17828982023 18498579475 181020847605 18617846719 182418639458 18585427943 1132652
160 -29 841 179881139179 186782136085 182607339554 187959376207 184001009317 187541469027 1132695
23 161 -28 784 181472458128 18857847742 184193831503 189740285224 185583379176 189228658624 1132712
162 -27 729 183063777077 190374818755 185780323452 191521194241 187165749035 190915848221 1132703
163 -26 676 184655096026 19217116009 187366815401 193302103258 188748118894 192603037818 1132668
164 -25 625 186246414975 193967501425 18895330735 195083012275 190330488753 194290227415 1132607
165 -24 576 187837733924 19576384276 190539799299 196863921292 191912858612 195977417012 113252
166 -23 529 189429052873 197560184095 192126291248 198644830309 193495228471 197664606609 1132407
167 -22 484 191020371822 19935652543 193712783197 200425739326 19507759833 199351796206 1132268
24 168 -21 441 192611690771 201152866765 195299275146 202206648343 196659968189 201038985803 1132103
169 -20 400 19420300972 2029492081 196885767095 20398755736 198242338048 2027261754 1131912
170 -19 361 195794328669 204745549435 198472259044 205768466377 199824707907 204413364997 1131695
171 -18 324 197385647618 20654189077 200058750993 207549375394 201407077766 206100554594 1131452
172 -17 289 198976966567 208338232105 201645242942 209330284411 202989447625 207787744191 1131183
173 -16 256 200568285516 21013457344 203231734891 211111193428 204571817484 209474933788 1130888
174 -15 225 202159604465 211930914775 20481822684 212892102445 206154187343 211162123385 1130567
25 175 -14 196 203750923414 21372725611 206404718789 214673011462 207736557202 212849312982 113022
176 -13 169 205342242363 215523597445 207991210738 216453920479 209318927061 214536502579 1129847
177 -12 144 206933561312 21731993878 209577702687 218234829496 21090129692 216223692176 1129448
178 -11 121 208524880261 219116280115 211164194636 220015738513 212483666779 217910881773 1129023
179 -10 100 21011619921 22091262145 212750686585 22179664753 214066036638 21959807137 1128572
180 -9 81 211707518159 222708962785 214337178534 223577556547 215648406497 221285260967 1128095
181 -8 64 213298837108 22450530412 215923670483 225358465564 217230776356 222972450564 1127592
26 182 -7 49 214890156057 226301645455 217510162432 227139374581 218813146215 224659640161 1127063
183 -6 36 216481475006 22809798679 219096654381 228920283598 220395516074 226346829758 1126508
184 -5 25 218072793955 229894328125 22068314633 230701192615 221977885933 228034019355 1125927
185 -4 16 219664112904 23169066946 222269638279 232482101632 223560255792 229721208952 112532
186 -3 9 221255431853 233487010795 223856130228 234263010649 225142625651 231408398549 1124687
187 -2 4 222846750802 23528335213 225442622177 236043919666 22672499551 233095588146 1124028
188 -1 1 224438069751 237079693465 227029114126 237824828683 228307365369 234782777743 1123343
27 189 0 0 2260293887 2388760348 228615606075 2396057377 229889735228 23646996734 1122632
190 1 1 227620707649 240672376135 230202098024 241386646717 231472105087 238157156937 1121895
191 2 4 229212026598 24246871747 231788589973 243167555734 233054474946 239844346534 1121132
192 3 9 230803345547 244265058805 233375081922 244948464751 234636844805 241531536131 1120343
193 4 16 232394664496 24606140014 234961573871 246729373768 236219214664 243218725728 1119528
194 5 25 233985983445 247857741475 23654806582 248510282785 237801584523 244905915325 1118687
195 6 36 235577302394 24965408281 238134557769 250291191802 239383954382 246593104922 111782
28 196 7 49 237168621343 251450424145 239721049718 252072100819 240966324241 248280294519 1116927
197 8 64 238759940292 25324676548 241307541667 253853009836 2425486941 249967484116 1116008
198 9 81 240351259241 255043106815 242894033616 255633918853 244131063959 251654673713 1115063
199 10 100 24194257819 25683944815 244480525565 25741482787 245713433818 25334186331 1114092
200 11 121 243533897139 258635789485 246067017514 259195736887 247295803677 255029052907 1113095
201 12 144 245125216088 26043213082 247653509463 260976645904 248878173536 256716242504 1112072
202 13 169 246716535037 262228472155 249240001412 262757554921 250460543395 258403432101 1111023
29 203 14 196 248307853986 26402481349 250826493361 264538463938 252042913254 260090621698 1109948
204 15 225 249899172935 265821154825 25241298531 266319372955 253625283113 261777811295 1108847
205 16 256 251490491884 26761749616 253999477259 268100281972 255207652972 263465000892 110772
206 17 289 253081810833 269413837495 255585969208 269881190989 256790022831 265152190489 1106567
207 18 324 254673129782 27121017883 257172461157 271662100006 25837239269 266839380086 1105388
208 19 361 256264448731 273006520165 258758953106 273443009023 259954762549 268526569683 1104183
209 20 400 25785576768 2748028615 260345445055 27522391804 261537132408 27021375928 1102952
30 210 21 441 259447086629 276599202835 261931937004 277004827057 263119502267 271900948877 1101695
211 22 484 261038405578 27839554417 263518428953 278785736074 264701872126 273588138474 1100412
212 23 529 262629724527 280191885505 265104920902 280566645091 266284241985 275275328071 1099103
213 24 576 264221043476 28198822684 266691412851 282347554108 267866611844 276962517668 1097768
214 25 625 265812362425 283784568175 2682779048 284128463125 269448981703 278649707265 1096407
215 26 676 267403681374 28558090951 269864396749 285909372142 271031351562 280336896862 109502
216 27 729 268995000323 287377250845 271450888698 287690281159 272613721421 282024086459 1093607
31 217 28 784 270586319272 28917359218 273037380647 289471190176 27419609128 283711276056 1092168
218 29 841 272177638221 290969933515 274623872596 291252099193 275778461139 285398465653 1090703
219 30 900 27376895717 29276627485 276210364545 29303300821 277360830998 28708565525 1089212
220 31 961 275360276119 294562616185 277796856494 294813917227 278943200857 288772844847 1087695
221 32 1024 276951595068 29635895752 279383348443 296594826244 280525570716 290460034444 1086152
222 33 1089 278542914017 298155298855 280969840392 298375735261 282107940575 292147224041 1084583
223 34 1156 280134232966 29995164019 282556332341 300156644278 283690310434 293834413638 1082988
32 224 35 1225 281725551915 301747981525 28414282429 301937553295 285272680293 295521603235 1081367
225 36 1296 283316870864 30354432286 285729316239 303718462312 286855050152 297208792832 107972
226 37 1369 284908189813 305340664195 287315808188 305499371329 288437420011 298895982429 1078047
227 38 1444 286499508762 30713700553 288902300137 307280280346 29001978987 300583172026 1076348
228 39 1521 288090827711 308933346865 290488792086 309061189363 291602159729 302270361623 1074623
229 40 1600 28968214666 3107296882 292075284035 31084209838 293184529588 30395755122 1072872
230 41 1681 291273465609 312526029535 293661775984 312623007397 294766899447 305644740817 1071095
33 231 42 1764 292864784558 31432237087 295248267933 314403916414 296349269306 307331930414 1069292
232 43 1849 294456103507 316118712205 296834759882 316184825431 297931639165 309019120011 1067463
233 44 1936 296047422456 31791505354 298421251831 317965734448 299514009024 310706309608 1065608
234 45 2025 297638741405 319711394875 30000774378 319746643465 301096378883 312393499205 1063727
235 46 2116 299230060354 32150773621 301594235729 321527552482 302678748742 314080688802 106182
236 47 2209 300821379303 323304077545 303180727678 323308461499 304261118601 315767878399 1059887
237 48 2304 302412698252 32510041888 304767219627 325089370516 30584348846 317455067996 1057928
34 238 49 2401 304004017201 326896760215 306353711576 326870279533 307425858319 319142257593 1055943
239 50 2500 30559533615 32869310155 307940203525 32865118855 309008228178 32082944719 1053932
240 51 2601 307186655099 330489442885 309526695474 330432097567 310590598037 322516636787 1051895
241 52 2704 308777974048 33228578422 311113187423 332213006584 312172967896 324203826384 1049832
242 53 2809 310369292997 334082125555 312699679372 333993915601 313755337755 325891015981 1047743
243 54 2916 311960611946 33587846689 314286171321 335774824618 315337707614 327578205578 1045628
244 55 3025 313551930895 337674808225 31587266327 337555733635 316920077473 329265395175 1043487
35 245 56 3136 315143249844 33947114956 317459155219 339336642652 318502447332 330952584772 104132
246 57 3249 316734568793 341267490895 319045647168 341117551669 320084817191 332639774369 1039127
247 58 3364 318325887742 34306383223 320632139117 342898460686 32166718705 334326963966 1036908
248 59 3481 319917206691 344860173565 322218631066 344679369703 323249556909 336014153563 1034663
249 60 3600 32150852564 3466565149 323805123015 34646027872 324831926768 33770134316 1032392
250 61 3721 323099844589 348452856235 325391614964 348241187737 326414296627 339388532757 1030095
251 62 3844 324691163538 35024919757 326978106913 350022096754 327996666486 341075722354 1027772
36 252 63 3969 326282482487 352045538905 328564598862 351803005771 329579036345 342762911951 1025423
253 64 4096 327873801436 35384188024 330151090811 353583914788 331161406204 344450101548 1023048
254 65 4225 329465120385 355638221575 33173758276 355364823805 332743776063 346137291145 1020647
255 66 4356 331056439334 35743456291 333324074709 357145732822 334326145922 347824480742 101822
256 67 4489 332647758283 359230904245 334910566658 358926641839 335908515781 349511670339 1015767
257 68 4624 334239077232 36102724558 336497058607 360707550856 33749088564 351198859936 1013288
258 69 4761 335830396181 362823586915 338083550556 362488459873 339073255499 352886049533 1010783
37 259 70 4900 33742171513 36461992825 339670042505 36426936889 340655625358 35457323913 1008252
260 71 5041 339013034079 366416269585 341256534454 366050277907 342237995217 356260428727 1005695
261 72 5184 340604353028 36821261092 342843026403 367831186924 343820365076 357947618324 1003112
262 73 5329 342195671977 370008952255 344429518352 369612095941 345402734935 359634807921 1000503
263 74 5476 343786990926 37180529359 346016010301 371393004958 346985104794 361321997518 0997868
PDM1
PDM 2
GDM
Intercepting Curves Random Effects are intercept and ctime (=slope)
AD week AD dagen ctime ctimesq DM1 lt977 DM1 gt977 DM2 GDMlt977 GDN gt977 controle
17 119 -70 4900 110369658 109459854 118210372 120182679 1109612 CURVE
120 -69 4761 112127016 111253055 119969023 121622973 1110695
121 -68 4624 113882472 113048962 121724538 123067511 1111752 DM1
122 -67 4489 115636026 114847575 123476917 124516293 1112783
123 -66 4356 117387678 116648894 12522616 125969319 1113788 Estimates of Fixed Effectsa
124 -65 4225 119137428 118452919 126972267 127426589 1114767 Parameter Estimate Std Error df t Sig 95 Confidence Interval
125 -64 4096 120885276 12025965 128715238 128888103 111572 Lower Bound Upper Bound
18 126 -63 3969 122631222 122069087 130455073 130353861 1116647 Intercept 228791388 1520384 108618 150483 000 225777917 231804859
127 -62 3844 124375266 12388123 132191772 131823863 1117548 ctime 1625169 022128 71096 73444 000 1581048 1669290
128 -61 3721 126117408 125696079 133925335 133298109 1118423 ctimesq -000951 000354 194196 -2688 008 -001648 -000253
129 -60 3600 127857648 127513634 135655762 134776599 1119272 macro977 12727526 3337854 108996 3813 000 6112005 19343047
130 -59 3481 129595986 129333895 137383053 136259333 1120095 ctime macro977 356099 048599 71065 7327 000 259198 453001
131 -58 3364 131332422 131156862 139107208 137746311 1120892 ctimesq macro977 002304 000793 188703 2906 004 000740 003867
132 -57 3249 133066956 132982535 140828227 139237533 1121663
19 133 -56 3136 134799588 134810914 14254611 140732999 1122408 109459854
134 -55 3025 136530318 136641999 144260857 142232709 1123127 GDM
135 -54 2916 138259146 13847579 145972468 143736663 112382
136 -53 2809 139986072 140312287 147680943 145244861 1124487 Estimates of Fixed Effectsa
137 -52 2704 141711096 14215149 149386282 146757303 1125128 Parameter Estimate Std Error df t Sig 95 Confidence Interval
138 -51 2601 143434218 143993399 151088485 148273989 1125743 Lower Bound Upper Bound
139 -50 2500 145155438 145838014 152787552 149794919 1126332 Intercept 233742502 1590949 123524 146920 000 230593448 236891556
20 140 -49 2401 146874756 147685335 154483483 151320093 1126895 ctime 1540699 026577 94983 57971 000 1487937 1593462
141 -48 2304 148592172 149535362 156176278 152849511 1127432 ctimesq -001568 000409 171203 -3835 000 -002376 -000761
142 -47 2209 150307686 151388095 157865937 154383173 1127943 macro977 -2489983 5139890 126886 -484 629 -12660984 7681019
143 -46 2116 152021298 153243534 15955246 155921079 1128428 ctime macro977 194553 123152 180726 1580 116 -048449 437554
144 -45 2025 153733008 155101679 161235847 157463229 1128887 ctimesq macro977 003690 001862 234405 1982 049 000022 007359
145 -44 1936 155442816 15696253 162916098 159009623 112932
146 -43 1849 157150722 158826087 164593213 160560261 1129727
21 147 -42 1764 158856726 16069235 166267192 162115143 1130108
148 -41 1681 160560828 162561319 167938035 163674269 1130463
149 -40 1600 162263028 164432994 169605742 165237639 1130792
150 -39 1521 163963326 166307375 171270313 166805253 1131095
151 -38 1444 165661722 168184462 172931748 168377111 1131372
152 -37 1369 167358216 170064255 174590047 169953213 1131623
153 -36 1296 169052808 171946754 17624521 171533559 1131848
22 154 -35 1225 170745498 173831959 177897237 173118149 1132047
155 -34 1156 172436286 17571987 179546128 174706983 113222
156 -33 1089 174125172 177610487 181191883 176300061 1132367
157 -32 1024 175812156 17950381 182834502 177897383 1132488
158 -31 961 177497238 181399839 184473985 179498949 1132583
159 -30 900 179180418 183298574 186110332 181104759 1132652
160 -29 841 180861696 185200015 187743543 182714813 1132695
23 161 -28 784 182541072 187104162 189373618 184329111 1132712
162 -27 729 184218546 189011015 191000557 185947653 1132703
163 -26 676 185894118 190920574 19262436 187570439 1132668
164 -25 625 187567788 192832839 194245027 189197469 1132607
165 -24 576 189239556 19474781 195862558 190828743 113252
166 -23 529 190909422 196665487 197476953 192464261 1132407
167 -22 484 192577386 19858587 199088212 194104023 1132268
24 168 -21 441 194243448 200508959 200696335 195748029 1132103
169 -20 400 195907608 202434754 202301322 197396279 1131912
170 -19 361 197569866 204363255 203903173 199048773 1131695
171 -18 324 199230222 206294462 205501888 200705511 1131452
172 -17 289 200888676 208228375 207097467 202366493 1131183
173 -16 256 202545228 210164994 20868991 204031719 1130888
174 -15 225 204199878 212104319 210279217 205701189 1130567
25 175 -14 196 205852626 21404635 211865388 207374903 113022
176 -13 169 207503472 215991087 213448423 209052861 1129847
177 -12 144 209152416 21793853 215028322 210735063 1129448
178 -11 121 210799458 219888679 216605085 212421509 1129023
179 -10 100 212444598 221841534 218178712 214112199 1128572
180 -9 81 214087836 223797095 219749203 215807133 1128095
181 -8 64 215729172 225755362 221316558 217506311 1127592
26 182 -7 49 217368606 227716335 222880777 219209733 1127063
183 -6 36 219006138 229680014 22444186 220917399 1126508
184 -5 25 220641768 231646399 225999807 222629309 1125927
185 -4 16 222275496 23361549 227554618 224345463 112532
186 -3 9 223907322 235587287 229106293 226065861 1124687
187 -2 4 225537246 23756179 230654832 227790503 1124028
188 -1 1 227165268 239538999 232200235 229519389 1123343
27 189 0 0 228791388 241518914 233742502 231252519 1122632
190 1 1 230415606 243501535 235281633 232989893 1121895
191 2 4 232037922 245486862 236817628 234731511 1121132
192 3 9 233658336 247474895 238350487 236477373 1120343
193 4 16 235276848 249465634 23988021 238227479 1119528
194 5 25 236893458 251459079 241406797 239981829 1118687
195 6 36 238508166 25345523 242930248 241740423 111782
28 196 7 49 240120972 255454087 244450563 243503261 1116927
197 8 64 241731876 25745565 245967742 245270343 1116008
198 9 81 243340878 259459919 247481785 247041669 1115063
199 10 100 244947978 261466894 248992692 248817239 1114092
200 11 121 246553176 263476575 250500463 250597053 1113095
201 12 144 248156472 265488962 252005098 252381111 1112072
202 13 169 249757866 267504055 253506597 254169413 1111023
29 203 14 196 251357358 269521854 25500496 255961959 1109948
204 15 225 252954948 271542359 256500187 257758749 1108847
205 16 256 254550636 27356557 257992278 259559783 110772
206 17 289 256144422 275591487 259481233 261365061 1106567
207 18 324 257736306 27762011 260967052 263174583 1105388
208 19 361 259326288 279651439 262449735 264988349 1104183
209 20 400 260914368 281685474 263929282 266806359 1102952
30 210 21 441 262500546 283722215 265405693 268628613 1101695
211 22 484 264084822 285761662 266878968 270455111 1100412
212 23 529 265667196 287803815 268349107 272285853 1099103
213 24 576 267247668 289848674 26981611 274120839 1097768
214 25 625 268826238 291896239 271279977 275960069 1096407
215 26 676 270402906 29394651 272740708 277803543 109502
216 27 729 271977672 295999487 274198303 279651261 1093607
31 217 28 784 273550536 29805517 275652762 281503223 1092168
218 29 841 275121498 300113559 277104085 283359429 1090703
219 30 900 276690558 302174654 278552272 285219879 1089212
220 31 961 278257716 304238455 279997323 287084573 1087695
221 32 1024 279822972 306304962 281439238 288953511 1086152
222 33 1089 281386326 308374175 282878017 290826693 1084583
223 34 1156 282947778 310446094 28431366 292704119 1082988
32 224 35 1225 284507328 312520719 285746167 294585789 1081367
225 36 1296 286064976 31459805 287175538 296471703 107972
226 37 1369 287620722 316678087 288601773 298361861 1078047
227 38 1444 289174566 31876083 290024872 300256263 1076348
228 39 1521 290726508 320846279 291444835 302154909 1074623
229 40 1600 292276548 322934434 292861662 304057799 1072872
230 41 1681 293824686 325025295 294275353 305964933 1071095
33 231 42 1764 295370922 327118862 295685908 307876311 1069292
232 43 1849 296915256 329215135 297093327 309791933 1067463
233 44 1936 298457688 331314114 29849761 311711799 1065608
234 45 2025 299998218 333415799 299898757 313635909 1063727
235 46 2116 301536846 33552019 301296768 315564263 106182
236 47 2209 303073572 337627287 302691643 317496861 1059887
237 48 2304 304608396 33973709 304083382 319433703 1057928
34 238 49 2401 306141318 341849599 305471985 321374789 1055943
239 50 2500 307672338 343964814 306857452 323320119 1053932
240 51 2601 309201456 346082735 308239783 325269693 1051895
241 52 2704 310728672 348203362 309618978 327223511 1049832
242 53 2809 312253986 350326695 310995037 329181573 1047743
243 54 2916 313777398 352452734 31236796 331143879 1045628
244 55 3025 315298908 354581479 313737747 333110429 1043487
35 245 56 3136 316818516 35671293 315104398 335081223 104132
246 57 3249 318336222 358847087 316467913 337056261 1039127
247 58 3364 319852026 36098395 317828292 339035543 1036908
248 59 3481 321365928 363123519 319185535 341019069 1034663
249 60 3600 322877928 365265794 320539642 343006839 1032392
250 61 3721 324388026 367410775 321890613 344998853 1030095
251 62 3844 325896222 369558462 323238448 346995111 1027772
36 252 63 3969 327402516 371708855 324583147 348995613 1025423
253 64 4096 328906908 373861954 32592471 351000359 1023048
254 65 4225 330409398 376017759 327263137 353009349 1020647
255 66 4356 331909986 37817627 328598428 355022583 101822
256 67 4489 333408672 380337487 329930583 357040061 1015767
257 68 4624 334905456 38250141 331259602 359061783 1013288
258 69 4761 336400338 384668039 332585485 361087749 1010783
37 259 70 4900 337893318 386837374 333908232 363117959 1008252
260 71 5041 339384396 389009415 335227843 365152413 1005695
261 72 5184 340873572 391184162 336544318 367191111 1003112
262 73 5329 342360846 393361615 337857657 369234053 1000503
263 74 5476 343846218 395541774 33916786 371281239 0997868
PDM1
PDM 2
GDM
Page 12: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Conseguenze neonataliParalisi transitoria plesso brachiale (30-168)Frattura della clavicola (17-95)Frattura dellrsquo omero (01-42)Paralisi permanente del plesso brachiale(05-16)encefalopatia ipossico-ischemica (03)morte (0-035)

Hoffman MK Obstet Gynecol 2011117(6)1272Gherman RB Am J Obstet Gynecol 2006195(3)657

LA MACROSOMIA Egrave UN IMPORTANTE FATTORE DI RISCHIO PER DISTOCIA DI SPALLA

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 13: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Iperglicemia e rischio di morte fetale a termine di gravidanza

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 14: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Estimated rate of stillbirth in diabetic women 1920-2000

Diabetic-Associated Stillbirth Incidence Pathophysiology and PreventionDonald J Dudley Clin Perinatol 34 (2007)

4 of all stillbirths remain attributable to diabetes

Stillbirth rates are higher than in non diabetic pregnancies by 15 to 6-folds

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 15: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

bull spontaneous and therapeutic abortionbull stillbirthbull neonatal deathbull major congenital abnormalities

Adverse outcome

HbA1C gt7

1 increase in A1Ccorresponded to 55 increased

risk of adverse outcome

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 16: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

The risk of stillbirth appears to increase in diabetic pregnancies starting at 34 weeks

gestation particularly in the presence of fetal macrosomia

fetal and neonatal outcomes are directly correlated with the degree of maternal glycemic control

Langer O 1995

100 mgdLfor stillbirth

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 17: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Diabetic patients n = 271691

Am J Obstet Gynecol 2002

The overall fetal death rates in diabetic women were increased when birth weight was 4000 g (adjusted rela- tive risk of 20 95 [CI] 18ndash22)

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 18: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

4873 diabetic women

pre-existing diabetes (n = 65) GDM lt12 weeks (n = 68)GDM 12ndash23 weeks of gestation (n = 1247)GDM ge24 weeks of gestation (n = 3493)

outcomes in GDM lt12 weeks are the worst of the GDM cohort and approximate those of women with pre-existing diabete

bull higher prepregnancy BMI bull greater insulin requirementsbull higher rates of hypertensive disorders of pregnancybull more insulin-resistant phenotype compared with later

GDMbull dysglycemia was more difficult to manage

2016

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 19: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Differences in placental pathologyaccording to diabetes types

Type 1 Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic Characteristics of UteroplacentalMalperfusion Jennifer Huynh et al Placenta 2016

GDM is associated with a greater rate of villous immaturity

0102030405060708090

100GDMDMIDMII

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 20: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

o decreased tertiary villus formationo reduced vasculosyncytial membrane formationo increased large bullous villi

A retrospective study on 175 placentas with DVM vs 175 controls

Pregestational diabetes (8 vs 28 P lt 005 relative risk 28 Gestational diabetes (86 vs 34 P lt 005 relative risk 25 Prenatal or intrapartum intrauterine death (86 vs 0 P lt 005)

Delayed villous maturation (DVM)is associated with an increased risk of stillbirth in the late third trimester

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 21: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Pathophysiology of fetal compromise in diabetic pregnancy

The growth factor-like effect of insulin producesplacental overgrowth as well as organomegalyand thus results in changes in vascular tone andhaemodynamic

Thickening of the basement membrane of the chorionic villi in diabetic pregnancies

Bjork 1984Nylund 1982Siddiqui 2003

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 22: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

A Lindam et al High maternal body mass index in early pregnancy and risks of stillbirth and infant mortality A population-based Sibling study in Sweden American Journal of Epidemiology 2016

STILLBIRTH RISK

BMI 25-299 OR 151 (95 CI 121-189)BMI 30-349 OR 177 (95 CI 124-25)BMI gt 35 OR 316 (95 CI 210-476)

OBESITArsquo E MORTE FETALE

6-7 per unit BMI for BMI gt 23

Tennant PWG Am J Obstet Gynecol 2007

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 23: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

HYPERINSULINISMHYPERANDROGENISM

IMPAIRED PLACENTATION

THE EFFECTS OF OBESITYMETABOLIC SYNDROME

Cakmak and Taylor Hum Reprod Update 2011

Makieva S Hum Reprod Update 2014

Piltonen TT Hum Reprod 2015 Crujeiras and Casanueva Hum Reprod Update 2015Denison FC Reproduction2010

Hotamisligil GS Nature 2006

LeptinCRH

Urocortin 3IL-6

INFLAMMATIONImpaired decidualizationImpaired trophoblast invasion

INSULIN RESISTANCEDYSLIPIDEMIALOW GRADE CHRONIC INFLAMMATION

Adiponectina Insulin LeptinTNFα IL-6

PLACENTAL ALTERATIONIN GENE EXPRESSION

PRETERM BIRTH PHIPREECLAMPSIASTILLBIRTH

CollagenaseCervical ripening

FFA

OXIDATIVE STRESS

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 24: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

PREVENZIONE STILLBIRTH

PREVENZIONE COMPLICANZE INTRAPARTUM DEL FETO MACROSOMA

MORBIDITAgrave NEONATALE

AUMENTO INCIDENZA TCCOMPLICANZE TRAVAGLIO INDOTTO

TIMING E MODALITArsquo DEL PARTO

Induzione o attesa

INDUZIONE DEL TRAVAGLIO

Quando fare un TC elettivo

gt 4000 grgt 4500 gr gt 5000 gr

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 25: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

ESISTONO RCT SUL TIMING E MODALITAgrave DEL PARTO NELLE GRAVIDANZE COMPLICATE DA DIABETE

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 26: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

425 donne con DMG escluse se PFS gt 4000Induzione tra 38+0 e 39+0 vs attesa fino a 41

No differenza in TC e outcome perinatale

200 donne diabete insulino trattato (13 diabete preesistente)Induzione a 38 vs attesa fino a 42

No differenza in TC gt di LGA e peso medio nel gruppo di attesa

RCT INDUZIONE VS ATTESA in GDM

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 27: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

RACCOMANDAZIONI DELLE LINEE GUIDA INTERNAZIONALI

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 28: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

2014

1 Diet controlled GDMrsquos may deliver post-dates if the fetal parameters are normal

2 Patients well controlled on insulin should probably be delivered by the due date

3 Poorly controlled GDMrsquos using insulin require individual judgment

Estimated weight at birth ge4500 g there is a significant increase in the risk ofshoulder dystocia so a primary section must be consideredWhen estimated weight at birth is 4000ndash4999g an informed consent aboutincreased shoulder dystocia risk

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 29: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

1 the timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation unless otherwise indicatedExpectant management up to 40 67 weeks of gestation in the setting of indicated antepartum testing is generally appropriate

2 For women with GDM that is well controlled by medications (A2GDM) delivery is recommended from 39 07 weeks to 39 67 weeks of gestation

3 Earlier delivery for women with poorly controlled GDM delivery between 37 07 weeks and 38 67 weeks of gestation may be justified but delivery in the late preterm period from 34 07 weeks to 36 67 weeks of gestation should be reserved for those women who fail in-hospital attempts to improve glycemic control or who have abnormal antepartum fetal testing

cesarean delivery when the estimated fetal weight is ge 4500 g

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 30: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

MATERNAL DIABETES + ESTIMATED FETAL WEIGHT

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 31: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

MODALITAgrave E TIMING DEL PARTO nel GDM

GMD in terapia insulinicaBen controllato

+Condizioni fetali rassicuranti

MANAGEMENT DI ATTESANON OLTRE LA 40 SETTIMANAIN ASSENZA DI COMORBIDITAgrave

GDM in terapia nutrizionalecon profili glicemici ottimali

+Feto AGA

MANAGEMENT DI ATTESA FINO ALLA 41 SETTIMANA

Condotta di attesa uarr probabilitagrave di travaglio spontaneo minor rischio di parto cesareo per fallita induzione

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 32: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

EFW lt 4000g LGAControllo metabolico non

ottimale

4000g lt EFW gt 4500g EFW ge 4500g

Programmare TC elettivo

Parto vaginale indotto a 38-39 sett

Parto vaginale o TC Considerare-caratteristiche materne (statura BMI pregravidico pelvi bishop)-anamnesi ostetrica (pregressi parti macrosomici o con distocia)

MODALITAgrave E TIMING DEL PARTO nel GDM

IN BASE AL PESO FETALE STIMATO

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 33: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

- Patients with well-controlled diabetes may be allowed to progress to their expected date of delivery as long as antenatal testing remains reassuring - Expectant management beyond the estimated due date generally is not recommended

- Early delivery may be indicated in some patients with vasculopathy nephropathy poor glucose control or a prior stillbirth

- Cesarean delivery may be considered if the estimated fetal weight is greater than 4500 g

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
  • Diapositiva numero 29
  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 34: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

ANTENATAL CORTICOSTEROIDS FOR IMPROVING PRETERM BIRTH OUTCOMES WITH MATERNAL DIABETES MELLITUS

Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of WomenatRisk of Imminent PretermBirth A Systematic Review and Meta-Analysis RachelMAmiya et al Plos One 2016

The presence of maternal diabetes in pregnancy is not a reason to withholdantenatal corticosteroids where there is an imminent RISK OF PRETERM BIRTH

A HYPERGLYCAEMIC EFFECT of corticosteroids in pregnant women closemonitoring and treatment for glycaemic control essential at all stage

If corticosteroids are administered to accelerate lung maturation an increased insulin requirement over the next 5 days should be anticipated (ACOG)

Betamethasone should be prescribed for inducing fetal lung maturity (beforeWeek34) only if strictly indicated because this will also cause the blood glucose levels to rise (GERMAN DIABETES ASSOCIATION)

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
  • Diapositiva numero 28
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  • Diapositiva numero 30
  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 35: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

GDM and the Use of Betamethasone

bull administration of betamethasone in the late preterm period should be limited to women with GDM only

bull ketoacidosis in the pregnant diabetic individual is a potential cause of fetal demise

bull it is recommended to closely monitor maternal glycaemia after betamethasone administration in women with poorly controlled diabetes particularly during the first 12 hours

Society of Obstetricians and Gynaecologists of Canada

The administration of betamethasone to pregnant women with GDM should be restricted to the routine obstetric indications related to the risk of preterm and

late preterm delivery between 24 to 36 weeksrsquo gestation

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
  • Diapositiva numero 26
  • Diapositiva numero 27
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  • Diapositiva numero 31
  • Diapositiva numero 32
  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 36: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

ASSISTENZA IN TRAVAGLIO

- MONITORAGGIO FETALE CONTINUO

- Monitoraggio glicemie plasmatiche materne nelle pz in terapia insulinica ogni ora

MANTENERE GLICEMIA gt70 E lt 126

(Endocrine Society Clinical Practice Guidelines 2013ACOG 2005)

GDM

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
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  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 37: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

- Intravenous infusion of regular insulin titrated and glucose

- Maintain hourly readings of BLOOD GLUCOSE LEVELS LESS THAN 110 MGDL

(ACOG 2005)

ASSISTENZA IN TRAVAGLIO DIABETE PREGESTAZIONALE

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
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  • Diapositiva numero 33
  • Diapositiva numero 34
  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 38: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Venere di Willendorf

Thank you for your attention

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

  • Diapositiva numero 1
  • Diapositiva numero 2
  • Diapositiva numero 3
  • Diapositiva numero 4
  • Diapositiva numero 5
  • Diapositiva numero 6
  • Diapositiva numero 7
  • Birth weight distribution in diabetic pregnancies
  • Diapositiva numero 9
  • Diapositiva numero 10
  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
  • Diapositiva numero 12
  • Diapositiva numero 13
  • Diapositiva numero 14
  • Diapositiva numero 15
  • Diapositiva numero 16
  • Diapositiva numero 17
  • Diapositiva numero 18
  • Diapositiva numero 19
  • Differences in placental pathology according to diabetes types
  • Diapositiva numero 21
  • Pathophysiology of fetal compromise in diabetic pregnancy
  • Diapositiva numero 23
  • Diapositiva numero 24
  • Diapositiva numero 25
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  • Diapositiva numero 35
  • Diapositiva numero 36
  • GDM and the Use of Betamethasone
  • Diapositiva numero 38
  • Diapositiva numero 39
  • Diapositiva numero 40
  • Pathophysiology of fetal compromise in diabetic pregnancy
Page 39: Presentazione di PowerPoint - siditalia.it · • major congenital abnormalities Adverse outcome. ... Type 2 and Gestational Diabetes Mellitus Differentially Impact Placental Pathologic

Pathophysiology of fetal compromise in diabetic pregnancy

Islet cell hyperplasia common in stillborn IDMs

There is a significant association between fetalplasma insulin concentration and the degree of fetal acidemia

Hyperglycemia (chronic) when accompanied byminimal hypoxemia may result in lactic acidosis

Salvesen 1993Hay 1989Chukwuma 2001

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  • Birth weight distribution in diabetic pregnancies
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  • Fetal growth profiles in diabetic pregnanciesHead to abdomen circumf Ratio
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  • Differences in placental pathology according to diabetes types
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  • Pathophysiology of fetal compromise in diabetic pregnancy
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  • GDM and the Use of Betamethasone
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  • Pathophysiology of fetal compromise in diabetic pregnancy