Effects of diabetic pregnancy on the fetus and newborn

Schwartz, Robert; Teramo, Kari

doi:10.1053/sp.2000.6363

Cited by 431 publications

(134 citation statements)

References 97 publications

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“…A similar trend is seen elsewhere in Europe and a doubling of new cases of type 1 diabetes in European children aged under 15 years has been forecast from 2005 to 2020 [2]. Consequently, a growing number of pregnant women have type 1 diabetes and are predisposed to perinatal complications associated with maternal hyperglycaemia, including congenital malformations, macrosomia and fetal asphyxia [3]. Numerous studies indicate that the rates of perinatal complications among type 1 diabetic patients are still substantially higher than those of the general population [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 55%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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Section: Introductionmentioning

confidence: 55%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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“…[1][2][3][4] Both chronic fetal hyperglycemia and hyperinsulinemia increase cellular oxygen consumption. 1,3,4 The resulting hypoxemia stimulates fetal erythropoiesis and accelerates erythrocyte iron delivery. 1,3,4 Iron is shunted into erythrocyte mass and away from developing organs and tissues.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4 The resulting hypoxemia stimulates fetal erythropoiesis and accelerates erythrocyte iron delivery. 1,3,4 Iron is shunted into erythrocyte mass and away from developing organs and tissues. [2][3][4][5] Iron is an essential nutrient for normal perinatal growth and development.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4 Iron is shunted into erythrocyte mass and away from developing organs and tissues. [2][3][4][5] Iron is an essential nutrient for normal perinatal growth and development. Although infants born to women with poorly controlled diabetes may experience impaired childhood intellectual development, 6 only recently has the role of brain iron deficiency been explored.…”

Section: Introductionmentioning

confidence: 99%

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Elevated zinc protoporphyrin/heme ratios in umbilical cord blood after diabetic pregnancy

2006

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Objective: Offspring of diabetes patients may suffer from tissue iron deficiency. Erythrocyte zinc protoporphyrin/heme (ZnPP/H) ratios measure impaired iron status. The aim of the study was to examine whether cord ZnPP/H ratios were associated with pregnancy glycemic control.Methods: ZnPP/H was measured in cord blood from 31 pregnancies with insulin-treated diabetes (diabetes group) and compared to population normal values. Maternal glycemic control was assessed by daily glucose log, glycosylated hemoglobin and birth weight.Results: Median cord ZnPP/H was higher in the diabetes group than the population normal values (106 (65.2 to 146.8) mM/M vs 68.2 (37.6 to 98.8) mM/M, P<0.0001). Ratios were directly correlated to surrogates of control (glycosylated hemoglobin, P ¼ 0.05, and birth weight, P<0.04). Cord ZnPP/H ratios from pregnancies with pre-existing and gestational diabetes were similar.Conclusion: Because cord ZnPP/H was higher in large offspring of diabetic pregnancy, it might identify greater iron utilization for fetal erythropoiesis.

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“…Diabetic pregnancy represents a significant threat to the health of both the fetus and the diabetic mother [1][2][3][4]. Pregnant women with poorly controlled diabetes risk embryopathies, spontaneous abortion and perinatal mortality [5,6] in direct relation to the severity of the diabetes [7].…”

Section: Introductionmentioning

confidence: 99%

Oxidant release is dramatically increased by elevated glucose concentrations in neutrophils from pregnant women

Petty

Kindzelskii

Chaiworapongsa

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective. To evaluate the mechanism of oxidative stress at glucose levels accompanying diabetic pregnancy. Specifically, we hypothesize that elevated glucose overwhelms hexose monophosphate shunt (HMS) down-regulation observed during pregnancy. Methods. Peripheral blood cells from normal healthy pregnant women were exposed to heightened glucose levels to provide an in vitro model of the effects of diabetic pregnancy. Changes in NAD(P)H, reactive oxygen species (ROS) and nitric oxide (NO) production were evaluated in single cells. Results. Altered metabolic dynamics, as judged by NAD(P)H autofluorescence of neutrophils from both pregnant and nonpregnant women, were observed during incubation with 14 mM glucose, a pathophysiologic level. In parallel, increased production of ROS and NO was observed. The ROS and NO levels attained in cells from pregnant women were greater than those observed in cells from non-pregnant women. Inhibitors of the HMS and NAD(P)H oxidase blocked these effects. These metabolic and oxidant changes required approximately one minute, suggesting that transient glucose spikes during pregnancy could trigger this response. Conclusions. Elevated glucose levels enhance HMS activity and oxidant production in cells from pregnant women. This mechanism may be generally applicable in understanding the role of diabetes in materno-fetal health.

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Effects of diabetic pregnancy on the fetus and newborn

Cited by 431 publications

References 97 publications

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Elevated zinc protoporphyrin/heme ratios in umbilical cord blood after diabetic pregnancy

Oxidant release is dramatically increased by elevated glucose concentrations in neutrophils from pregnant women

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