Fetal polycythemia and thrombocytopenia in pregnancies complicated by maternal diabetes mellitus

Doppler study of the umbilical and fetal middle cerebral arteries in women with gestational diabetes mellitus

“…Hyperglycemia is thought to cause an increase in the thromboxane/prostacyclin ratio in the umbilical vessels and the placenta18–20. Another contributing factor is fetal hematocrit, as cordocentesis has demonstrated a positive relationship between maternal hyperglycemia and fetal polycythemia21. Theoretically, the increase in blood viscosity due to polycythemia might be reflected by a corresponding decrease in blood flow velocity through the fetal circulation, which is opposite to that in the fetal anemia model.…”

Erythrocytosis in offspring of mothers with Type 1 diabetes—are factors other than insulin critical determinants?

“…Two hundred and fifty women with Type 1 diabetes consented to participate in the study (a 94% participation rate of those enrolled in and planning to deliver in the centres) and cord blood samples were obtained from 200 (80%). The 200 samples were further restricted to those in whom (i) there was no evidence of haemolysis of cord blood (17 excluded); (ii) cord blood had been collected within 20 min (12 exclusions: [median interquartile range (IQR)] collection time for remaining samples, 2 min [1][2][3][4][5][6][7]); (iii) cord blood had been centrifuged and plasma frozen within 60 min (17 exclusions: time from collection to freezing for remaining samples, 17 min [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]); (iv) antenatal glucocorticoids had not been administered in the 24 h before birth (15 excluded); (v) children delivered before 33 weeks gestation (five excluded); and, finally, (vi) there was sufficient volume remaining for assessment of a full blood count using K 2 EDTA tubes (59 excluded). Eighty-nine OT1DM met these restriction criteria.…”

“…The reasons for this altered phenotype are unclear; however, in adult life diabetes is also associated with altered platelet function [21] with improvements in glycaemic control reducing platelet activation status [22]. In the fetus, platelet counts positively associate with maternal HbA 1c and negatively with fetal haematocrit [7]. Collectively this suggests that glycaemia and thereby fetal insulin may play a critical role in platelet function.…”

Fetal Hydrocephalus Caused by Cryptic Intraventricular Hemorrhage

“…VACTERL has been reported in conjunction with Fanconi anemia (4); in rare cases, thrombocytopenia due to Fanconi anemia can present in the neonatal period (34). Another possible explanation for bleeding is the poorly controlled maternal diabetes, which can cause impaired fetal blood clotting (35). Other maternal factors, such as vasoactive and anticoagulant drugs, thrombocytopenia and other coagulopathies, pre-eclampsia, infections and even minor abdominal trauma are recognized risk factors for fetal intracranial hemorrhage (20,21,37,38).…”