Relationship of Fetal Macrosomia to Maternal Postprandial Glucose Control During Pregnancy

Combs, C. Andrew; Gunderson, Erica P.; Kitzmiller, John L.; Gavin, Laurence A.; Main, Elliott K.

doi:10.2337/diacare.15.10.1251

Cited by 286 publications

(154 citation statements)

References 20 publications

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“…According to Pedersen's [2] widely accepted hypothesis, fetal hyperinsulinaemia in response to maternal hyperglycaemia is the major cause of fetal macrosomia. During diabetic pregnancy, fetal macrosomia is related to maternal postprandial glucose control between the 29th and 32nd week of gestation [3]. Furthermore, it has recently been shown that a subset of macrosomic infants born to non-diabetic mothers have higher insulin levels in cord blood [4].…”

Section: Discussionmentioning

confidence: 99%

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

et al. 1993

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Summary.Maternal diabetes mellitus is complicated by fetal macrosomia and predisposes the offspring to diabetes, but recent evidence indicates that a low, not high, birthweight is associated with a higher incidence of Type 2 (non-insulin dependent) diabetes in adult life. To clarify the relationships between maternal glucose and insulin levels and birthweight, we measured oral glucose tolerance and neonatal weight in a large group (n = 529) of women during the 26th week of pregnancy. Women with gestational diabetes (n = 17) had more familial diabetes, higher pre-pregnancy body weight, and tended to have large-for-gestational-age babies. In contrast, women with essential hypertension (n = 10) gave birth to significantly (p < 0.01) smaller babies. In the normal group (without gestational diabetes or hypertension, n --503), maternal body weight before pregnancy and at term, maternal height, week of delivery, gender of the newborn, and parity were all significant, independent predictors of birthweight, together explaining 23 % of the variability of neonatal weight. In addition, both fasting (p < 0.006) and 2-h post-glucose (p = 0.03) maternal plasma glucose concentrations were positively associated with birthweight independent of the other physiological determinants, accounting, however, for only 10% of the explained variability. In a subgroup of 134 normal mothers with prepregnancy body mass index of less than 25 kg. m 2, in whom plasma insulin measurements were available, the insulin area-under-curve was inversely related to birthweight (p < 0.02) after simultaneously adjusting for physiological factors and glucose area. When glucose and insulin measurements were combined in the I/G ratio (ratio of insulin to glucose area), this was still inversely related to birthweight. Furthermore, maternal insulinaemia was directly related to blood pressure levels (p <0.001) independently of body weight. We conclude that in normal pregnancy, whereas physiological factors account for most of the explainable variability of infant weight, the influence of the maternal metabolic milieu is dual, positive for glucose levels but negative for insulin concentrations. Maternal hyperinsulinaemia during pregnancy may be one trait linking low birthweight with predisposition to diabetes in adult life.

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Section: Discussionmentioning

confidence: 99%

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

et al. 1993

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“…Fetal hyperinsulinaemia has been documented in diabetic pregnancy by a number of analytical techniques, including measurement of insulin and C-peptide in umbilical plasma and amniotic fluid and by cordocentesis [30±32]. Fetal hyperinsulinaemia has also been associated with neonatal macrosomia in both diabetic and non-diabetic pregnancy [32,33], while maternal glucose concentrations have been shown to be poorly correlated with fetal hyperinsulinaemia and the development of macrosomia [7,8,34]. All of the GDM patients in this study were diet-treated, thereby removing exogenous maternal insulin as a possible factor in the observed difference between GDM and control placentae.…”

Section: Discussionmentioning

confidence: 99%

“…For macrosomic neonates, birth weight has not been consistently shown to positively correlate with the degree of control of maternal blood glucose [7,8], suggesting that factors other than or in addition to maternal blood glucose are associated with adverse clinical outcomes during diabetes in pregnancy.Offspring from pregnant women with diabetes are more likely to develop diabetes mellitus and obesity later in life. This observation and evidence that development of diabetes is more closely related to maternal than paternal health, suggests that the intrauterine environment is possibly of importance [9, 10].…”

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Effects of gestational diabetes on human placental glucose uptake, transfer, and utilisation

et al. 2000

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Both pregestational [1] and gestational diabetes mellitus [2,3] can lead to neonatal macrosomia which is associated with fetal death, prematurity, birth trauma, and neonatal respiratory distress syndrome, hypoglycaemia, polycythaemia, hyperbilirubinaemia, hypocalcaemia, hypomagnesaemia and cardiomyopathy [4±6]. For macrosomic neonates, birth weight has not been consistently shown to positively correlate with the degree of control of maternal blood glucose [7,8], suggesting that factors other than or in addition to maternal blood glucose are associated with adverse clinical outcomes during diabetes in pregnancy.Offspring from pregnant women with diabetes are more likely to develop diabetes mellitus and obesity later in life. This observation and evidence that development of diabetes is more closely related to maternal than paternal health, suggests that the intrauterine environment is possibly of importance [9, 10]. Abstract Aims/hypothesis. Gestational diabetes is associated with complications for the offspring before, during and after delivery. Poor maternal glucose control, however, is a weak predictor of these complications. Given its position at the interface of the maternal and fetal circulations, the placenta possibly plays a crucial part in protecting the fetus from adverse effects from the maternal diabetic milieu. We hypothesised that gestational diabetes may result in changes in placental function, particularly with respect to the uptake, transfer, and/or utilisation of glucose. We aimed to examine glucose transport and utilisation in intact human placental lobules from women with gestational diabetes and those from normal pregnancies. Method. Dual perfusion of an isolated placental lobule was done on placentae from diet treated gestational diabetic (n = 7) and normal pregnant patients (n = 9) using maternal glucose concentrations of 4, 8,

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“…However, even in patients with near-normal HbA 1 c levels, macrosomia rates remain high [2,4,5]. Several studies on the relationship between HbA 1 c levels and birthweight have been published [15][16][17][18][19]. It has proved difficult to establish a clear relationship between HbA 1 c levels and infant birthweight.…”

Section: Introductionmentioning

confidence: 99%

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

2005

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Aims/hypothesis: The aim of this study was to establish the value of maternal HbA 1 c levels and older sibling birthweight as predictors of birthweight and macrosomia in the offspring of women with type 1 diabetes. Subjects and methods: A total of 214 pregnancies of 107 women with type 1 diabetes were studied. Regression analysis was performed to test the predictive value of the birthweight of the first-born infant, HbA 1 c levels, maternal BMI, maternal age and time between subsequent births on the birthweight of the second-born infant. Birthweights were corrected for sex and gestational age. The percentages of first-and second-born infants with macrosomia (weight >90th centile) were calculated and compared. Results: Only the birthweight of earlier born infants was significantly related to that of second-born infants (p<0.001) and 40-50% of the variation in the birthweight of second-born infants could be explained by the birthweight of the firstborn infants. About 85% of the mothers who gave birth to a macrosomic infant had a macrosomic infant in a subsequent pregnancy. Conclusions/interpretation: Although it is clear that glycaemic control contributes to birthweight in women with type 1 diabetes, the birthweight of an earlier born infant appears to be a much better predictor of the birthweight of a subsequent infant than HbA 1 c levels during pregnancy. It may, therefore, be used to identify patients at risk of giving birth to a macrosomic infant. Daily home monitoring of glucose levels, rather than HbA 1 c levels, should be used for assessment of maternal glycaemia during pregnancy.

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Relationship of Fetal Macrosomia to Maternal Postprandial Glucose Control During Pregnancy

Cited by 286 publications

References 20 publications

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy

Effects of gestational diabetes on human placental glucose uptake, transfer, and utilisation

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

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