Metformin in gestational diabetes: The Offspring Follow-Up (MiG TOFU): body composition at 2 years of age

OBJECTIVE: In women with gestational diabetes mellitus, who were randomized to metformin or insulin treatment, pregnancy outcomes were similar (Metformin in Gestational diabetes [MiG] trial). Metformin crosses the placenta, so it is important to assess potential effects on growth of the children. RESEARCH DESIGN AND METHODS: In Auckland, New Zealand, and Adelaide, Australia, women who had participated in the MiG trial were reviewed when their children were 2 years old. Body composition was measured in 154 and 164 children whose mothers had been randomized to metformin and insulin, respectively. Children were assessed with anthropometry, bioimpedance, and dual energy X-ray absorptiometry (DEXA), using standard methods. RESULTS: The children were similar for baseline maternal characteristics and pregnancy outcomes. In the metformin group, compared with the insulin group, children had larger mid-upper arm circumferences (17.2 6 1.5 vs. 16.7 6 1.5 cm; P = 0.002) and subscapular (6.3 6 1.9 vs. 6.0 6 1.7 mm; P = 0.02) and biceps skinfolds (6.03 6 1.9 vs. 5.6 6 1.7 mm; P = 0.04). Total fat mass and percentage body fat assessed by bioimpedance (n = 221) and DEXA (n = 114) were not different. CONCLUSIONS: Children exposed to metformin had larger measures of subcutaneous fat, but overall body fat was the same as in children whose mothers were treated with insulin alone. Further follow-up is required to examine whether these findings persist into later life and whether children exposed to metformin will develop less visceral fat and be more insulin sensitive. If so, this would have significant implications for the current pandemic of diabetes.Janet A. Rowan, Elaine C. Rush, Victor Obolonkin, Malcolm Battin, Trecia Wouldes and William M. Hagu

Challenges of developing and conducting an international study of resilience in migrant adolescents

The sequelae of migration and the effects of local migration policies on children’s physical and mental health are critical to examine, particularly given the historically high numbers of migrants and displaced people. The vulnerability of the study sample and the need to work across cultures and contexts makes research on this group challenging. We outline lessons learned through conducting a pilot study of resilience resources and mental health among migrant youth in six countries. We describe the benefits and challenges, and then provide recommendations and practical advice for social work researchers attempting cross-cultural team research on migrants

Neurodevelopmental outcome at 2 years in offspring of women randomised to metformin or insulin treatment for gestational diabetes

OBJECTIVE Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is increasingly being treated with metformin that crosses the placenta rather than insulin, which does not. This study seeks to examine the neurodevelopment of offspring of women treated with metformin or insulin for GDM. DESIGN We performed a prospective follow-up study of children whose mothers had been randomly assigned at 20–33 weeks gestation to treatment with metformin or insulin for GDM. Of the 211 children followed up at 2 years, 128 were from Auckland, New Zealand (64 metformin vs 64 insulin), and 83 from Adelaide, Australia (39 metformin vs 49 insulin). Neurodevelopment was examined with the Bayley Scales of Infant Development V.2 mental development index (MDI) and psychomotor development index (PDI). Clinical and demographic background characteristics were obtained at enrolment, birth and follow-up. RESULTS No significant differences were found between treatment groups in clinical or demographic characteristics. The MDI and PDI composite scores were tested with general linear models. No significant differences were found between metformin and insulin, respectively, in New Zealand (MDI, M=83.6 vs 86.9 and PDI, M=83.4 vs M=85.2) or Australia (MDI, M=102.5 vs M=98.4 and PDI, M=105.6 vs M=99.9) and no interactions observed. The differences in neurodevelopmental outcomes between the Auckland and Adelaide cohorts were explained by parental ethnicity, infant birth weight >4000 g, neonatal hypoglycaemia, maternal glycaemia and smoking in the household. CONCLUSIONS This study provides additional data supporting the safety of metformin in the treatment of GDM. TRIAL REGISTRATION NUMBER ACTRN 12605000311651.Trecia A Wouldes, Malcolm Battin, Suzette Coat, Elaine C Rush, William M Hague, Janet A Rowa

Challenges of developing and conducting an international study of resilience in migrant adolescents

202305 bcwwAccepted ManuscriptOthersUniversity of Bristol World Universities Network (WUN) fundingPublishe

Smaller deep grey matter volumes at nine years in children born at risk of neonatal hypoglycaemia: an MRI study

Background: Neonatal hypoglycaemia is a common metabolic disorder that may cause brain damage, most visible in the occipital region on MRI. However, it is not known whether neonatal hypoglycaemia is associated with long term changes in brain growth. Therefore, we compared brain volumes and cortical thickness at nine years of age between those who had and had not experienced neonatal hypoglycaemia. Methods: Children born at risk of neonatal hypoglycaemia at ≥ 36 weeks’ gestation who took part in a prospective cohort study underwent brain MRI at nine years of age. Brain morphometric measures were computed using an automated pipeline using FreeSurfer. Results: Children who had (N=75) and had not (N=26) experienced neonatal hypoglycaemia had similar combined parietal and occipital lobes volumes at nine years of age. However, those who had experienced neonatal hypoglycaemia had smaller caudate (-0.05%, 95%CI, -0.07 to -0.02; p=0.001) and thalamus (-0.03%, 95%CI, -0.06 to 0.00; p=0.05) as percentage of total brain volume, and thinner occipital lobe cortex (-0.05mm, 95%CI -0.10 to 0.00, p=0.05) than those who had not. Boys who had experienced neonatal hypoglycaemia had smaller caudate volume, while girls had smaller combined parietal and occipital lobe volumes (p=0.02 for interaction). Conclusion: Neonatal hypoglycaemia is associated with reduced size of specific brain regions in mid-childhood in a sex-specific manner

Association between size at birth and brain volumes at nine years in children born late preterm and at term

Background: Altered brain development is common after preterm birth, and reduced brain volume in childhood has been associated with functional impairments. However, limited information is available about perinatal factors that may be related to brain volumes in mid-childhood. We examined the association between size at birth and brain volumes at nine years of age. Methods: Children born at 36 to 42 weeks’ gestation at risk of neonatal hypoglycaemia underwent brain magnetic resonance imaging (MRI) at nine years of age. Volumes of total brain, total cortical grey matter and cerebral white matter, subcortical grey matter, and regional structures (frontal, parietal, occipital, and temporal lobes, cerebellum, cerebrospinal fluid) were analysed using the FreeSurfer tool. Relationships between brain volumes and gestational age at birth, birth weight, and head circumference were analysed using linear regression. Results: In the 101 children (49 boys), shorter gestation at birth (R2=0.10, p= <0.001), lower birth weight (R2=0.13, p= <0.001), and smaller head circumference (R2=0.17, p= <0.001) were associated with smaller total brain volume at nine years of age. The associations with birth weight and head circumference remained significant after accounting for gestational age at birth. There was also a positive association between these perinatal factors and most other brain volumes we studied, but not with cerebellum, occipital lobe, and cerebrospinal fluid volumes. Conclusion: Size at birth is associated with brain volumes at nine years of age, suggesting that both growth before and timing of birth might be important for later brain size

Acculturation, resilience, and the mental health of migrant youth : a cross-country comparative study

202305 bcwwAccepted ManuscriptRGCOthersWorldwide Universities Network (WUN) Research Development Fund; University of Bristol; National Health & Medical Research Council (NHMRC) Career Development Fellowship; National Research Foundation Incentive Funding; University of York; University of Auckland postgraduate fundingPublishe