Intravenous glucose tolerance test and its relation to a scoring System for the degree of diabetic fetopathy in newborn infants

Abstract

Diabetes mellitus in the pregnant woman is known to affect her offspring profoundly, and this is true for both gestational diabetes and for longstanding juvenile diabetes. The outcome of the pregnancy depends not only on the duration and the severity of the diabetic s täte before pregnancy [16], but also on the occurrence of complications and the degree of blood sugar control during the pregnancy [13]. The infant of the diabetic mother (IDM) often presents a well-known clinical picture at birth and in the early neonatal period with e. g. high birth weight for gestational stage, a cushingoid face and stature, hypoglycemia, hyperbilirubinemia and polycythemia [3], Infants of healthy mothers (IHM) demonstrate a low carbohydrate tolerance during the first days of life [l, 5, 9], which is even more pronounced in preterm, small-for-gestational-age-infants [3,6]. IDM on the other hand have a more rapid removal of glucose from the circulation than IHM after i. v. injection of glucose suggesting a state of "hyperinsulinism" in the infant of the diabetic mother [l, 5, 9]. In order to evaluate the degree of this "hyperinsulinism" a glucose tolerance test was performed in a group of IDM during the first 24 hours after birth. The values obtained showed wide variations, but were not significantly higher than the values of IHM. This finding might be related to the care of the mothers' diabetes during pregnancy and its effect on the fetal glucose metabolism. A clinical assessment of the, combined picture of the mother's diabetic state and the appearance and behavior of the newborn infant might give the prognostic guidance that the individual glucose tolerance test could not supply. Curriculum vitaeBertil THALME was born 1931. 1951-1959 To test this hypothesis a scoring System based on clinical and laboratory criteria was constructed retrospectively and the individual scores correlated to the infants's k-value. l Material and methodsTwenty-six infants of diabetic mothers (IDM) were subjected to an intravenous glucose tolerance test (IVGTT) at A-24 hours age (mean age 13.4 hours). There were no signs of hyaline membrane disease in 24 of the 26 babies. The mothers, aged 18-36 years, were all insulin treated during pregnancy. Four mothers were classified äs WHITE'S group A, four as^group B, seven äs group C, nine äs group D and two äs group F. Nine mothers were delivered before the end of the 37th pregnancy week and seventeen at 38 to 40 weeks gestation. Eleven women were delivered vaginally and fifthteen by elective caesarean section. The mean birth weight for the IDM was 3.530 ± 530 g. All IDM were delivered at the Department of Obstetrics and Gynecology and after the immediate postnatal care they were brought to the Department of Pediatrics for close observation. About one hour after birth intravenous therapy with glucose-fructose and electrolytes was started and at six hours early feeding was begun [15], J. Perinat. Mcd. 2 (1974) 17

Infants of mothers with a high and of mothers with a low insulin response to glucose infusion. Glucose tolerance, insulin response and clinical appearance during the early neonatal period

“…However, the mean value and the distribu-mothers this poor response persists at least for tion of the k-values in the ILR group (Fig. 4) the first few days of life while IDM show a was almost identical to that previously reported by marked and prompt insulin release after the same THALME and EDSTRÖM [28] for a group of IDM glucose Stimulus [3,21]. This has been related to whose mothers were very rigidly controlled and the exposure of the fetus in a diabetic pregnancy had almost normal blood glucoße levels in the to a sustained hyperglycemia [23], but recently last trimester.…”

“…The scoring System developed earlier [28] was adapted for application to these infatits·.. The criteria chosen are listed in Tab.…”

“…One or usually several blood glucose values were recorded for each infant and the lowest value recorded was used. Two criteria have been added to the ones originally used [28], namely a recorded high k-value at IVGTT (^1.4 per cent) and a high immediate insulin response at the IVGTT (exceeding 100 per cent of fasting value at 5 min). …”

“…cpndition is well known both to afFect the in-A number of clinical indications and routine fant's glucose tolerance [3,11,19] and to cause kboratory findings, known to appear in IDM Symptoms of diabetic fetopathia [23]. It is not during the first few days, were evaluated by a known, though, whether the infant of a truly scoring System which has previously been applied prediabetic woman might be aflected in the same to such infants [28] who scored a significantly way during pregnancy.…”