Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

Abstract

Maternal diabetes is known to be related to an increase in birth weight of the offspring. However, the mechanism of the association is not entirely clear. In addition, the contribution of the demographic, obstetric and metabolic factors to birth weight in diabetic mothers is not well defined. All the diabetic women (68 requiring insulin-treatment and 403 on diet alone) and a random sample of 1 in 12 of all non-diabetic women (893 women) who delivered in one regional hospital between March 1987 and June 1988 inclusive, were included in the study. Tests for gestational diabetes are routinely performed in our pregnant women population, thus, the study is a population based one. The mean birth weight of infants of diabetic mothers adjusted for gestational age was higher than in those of non-diabetic mothers. However, no relationship was found between maternal glycosylated hemoglobin measured at delivery and the infants birth weight. Furthermore, at each week of gestation, infants born to diabetic mothers were heavier than the infants of non-diabetic mothers (for weeks 37 to 40, p less than 0.05), while no differences were found in glycosylated hemoglobin levels between the two groups at any time. In a multivariate model we showed that after controlling for gestational age, the only factors which independently and significantly affected birth weight in our population were diabetes, ethnic origin, and the parity of the mother. Our findings support the possibility that substances which induce hyperinsulinemia, other than glucose, may be related to the higher birth weight of infants of diabetic mothers.

Ethnic Differences in Perinatal Outcome of Gestational Diabetes Mellitus

“…By contrast, several studies have found ethnicity to be an independent risk factor for GDM and related outcomes (10,11,29). Results found in this retrospective study also support prior studies indicating ethnicity as an independent risk factor for perinatal outcomes such as macrosomia.…”

Birthweight in women with potential gestational diabetes mellitus ‐ an effect of obesity rather than glucose intolerance?

“…As glucose is the principal substrate for fetal growth, the mechanism of increased birthweight ratio was the maternal hyperglycemia which led to fetal hyperinsulinism, enhanced glycogen synthesis, lipogenesis, and increased protein synthesis in the fetus (8). Even with a non-diabetic OGTT, obesity is accompanied by progressive fasting hyperglycemia during pregnancy (9) and other factors than glucose are related to higher birthweight in GDM (10,11).…”

Placental Accumulation of Triacylglycerols in Gestational Diabetes Mellitus and Its Association with Altered Fetal Growth are Related to the Differential Expressions of Proteins of Lipid Metabolism

“…Maternal hyperglycemia contributes to fetal macrosomia by increasing substrate availability, stimulating excessive growth and adiposity [4]. Macrosomia is also observed even in newborns of diabetic mothers with satisfactory glycemic control [5,6]; this suggests that substrates other than glucose could contribute to the excess fat deposition in fetal adipose tissue. Szabo et al proposed that maternal plasma FFA could undergo transplacental transfer and get deposited as triacylglycerols in fetal adipocytes [7].…”