Macrosomy Despite Well-Controlled Diabetic Pregnancy

Russell, George; Farmer, George; Lloyd, DavidJ.; Pearson, David; Ross, I.S.; Stowers, J. M.; Sutherland, H. W.; Visser, G.H.A.; Ballegooie, E. van; Sluiter, W.J.; Verhaaren, HenriA.; Craen, Margarita; Gomme, Patrick De; Rubens, Robert; Parewijck, W; Derom, R.

doi:10.1016/s0140-6736(84)90159-4

Cited by 12 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of macrosomia is similar to that reported in other studies of women with well‐controlled Type 1 diabetes mellitus[11]. Even in subgroups of women with very tight blood glucose control from before pregnancy through to parturition, rates of macrosomia remain high and unchanged in Type 1 diabetes mellitus[12].…”

Section: Discussionsupporting

confidence: 84%

Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice

et al. 1999

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 84%

Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice

et al. 1999

View full text Add to dashboard Cite

show abstract

“…Our own data show that chronic blood glucose levels, as measured by the concentration of maternal HbAh are not critical in determining fetal size, regardless of the diabetic or nondiabetic status of the mother. This agrees with results from other investigators [11,12] and with reports [3,4] where diabetic mothers whose blood glucose levels have been tightly controlled by contin uous subcutaneous infusion of insulin gave birth to macrosomic infants. Alternatively, it might be argued that HbA| is an accurate index capable of reflecting small disturbances in glucose homeostasis.…”

Section: Discussionsupporting

confidence: 93%

“…Mater nal blood glucose levels have been consid ered the key of such disregulation and, there fore, the reason for the high incidence of macrosomia among infants of diabetic moth ers [2], However, controversy has been raised recently by reports claiming macrosomic in fants in diabetic mothers maintained in a strict euglycemic state [3,4], The concentration of glycosylated hemo globin (HbA |) has been considered a good index of long-term glucose control in the mother [5], Therefore, this value might iden tify women with chronic hyperglycemia before delivery. An assessment of the fetal hyperinsulincmic state might, theoretically, be ob tained through the measurement of either in sulin or proinsulin-connecting-peptide (Cpeptide) in cord blood.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Maternal Glycosylated Hemoglobin and Fetal Beta-Cell Activity with Birth Weight

Cano¹,

Barcelo²,

Fuente³

et al. 1986

Gynecol Obstet Invest

View full text Add to dashboard Cite

A population of 40 mother-newborn pairs with a wide range of birth weight has been studied. Seventeen of the mothers were diabetic, while the other 23 were normal pregnant women. The chronic blood glucose levels were assessed in the mothers through the percentage of glycosylated hemoglobin (HbA₁) at delivery. The functional activity of the pancreatic Β-cells in the newborns was estimated through the concentration of insulin and C-peptide in the cord blood. Maternal HbA₁ was not quantitatively related to the birth weight ratio. In contrast, both insulin and C-peptide correlated significantly with it. Is is concluded that in populations with a good metabolic control, blood glucose levels, as measured by HbA₁ are not the major determinant of fetal growth.

show abstract

“…The fact that fetal macrosomia occasionally occurs despite very rigid control of maternal blood glucose is a puzzling observation 29,30 . Furthermore, the recent observation that more than 30 % of macrosomic infants of non‐diabetic mothers exhibit hyperinsulinaemia at birth is also of interest in this context 31 suggesting that as well as diabetes there may be additional explanations of exaggerated fetal insulin secretion and anabolism as has been recently discussed 32 .…”

Section: Discussionmentioning

confidence: 99%

Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus

Persson

Hanson²

1996

BJOG

View full text Add to dashboard Cite

Objective To determine the relation between maternal levels of blood glucose and glycated haemoglobin (HbAlc) and infant size at birth in pregestational diabetes. Design Longitudinal study from 6 to 14 weeks gestation. Women were treated intensively with insulin, aiming at normoglycaemia but avoiding hypoglycaemia. Blood glucose was determined six times daily, HbAlc every four weeks. Individual mean fasting and postprandial glucose levels were calculated for three‐week periods of gestation. Birthweight > 2 SD or within ±2 SD for gestational age and gender was classified as large (LGA) or appropriate (AGA), respectively. Birthweight ratio was calculated as the ratio of birthweight to normal mean birthweight after correction for gestational age and gender. Participants One hundred and thirteen consecutive pregnant women with pregestational diabetes and their newborn infants. Results Perinatal mortality was nil, the rates of spontaneous preterm delivery (8.9 %) and severe maternal hypoglycaemia (4.4 %) were low. Mothers with LGA infants (26 %) had a significantly higher fasting glucose between weeks 27 and 32 than mothers of AGA infants (P < 0.01). Relative birthweight was significantly and independently associated with pre‐pregnancy bodyweight (r = 0.24, P 005) and fasting glucose at weeks 27 to 29 (r = 0.27, P 0.01) but together could only explain 12.3 % of the variation in birthweight (mult. r = 0.35, P 0.01). HbAlc correlated with glucose levels but was unrelated to birthweight ratio. The fasting glucose level between weeks 30 and 32 was significantly interrelated with the fasting glucose level from each of the six preceding three‐week periods. Conclusion Near normoglycaemia cannot be obtained in all patients, presumably due to intrinsic differences in glucoregulatory ability between individuals. The incidence of LGA infants was unexpectedly high. The modest abnormality in glycaemic control in mothers with LGA infants could only partly explain fetal oversize, suggesting that other factors must be implicated to explain fetal growth acceleration.

show abstract

Macrosomy Despite Well-Controlled Diabetic Pregnancy

Cited by 12 publications

References 19 publications

Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice

Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice

Relationship of Maternal Glycosylated Hemoglobin and Fetal Beta-Cell Activity with Birth Weight

Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus

Contact Info

Product

Resources

About