The Infant of the Diabetic Mother

Gellis, Sydney S.; Hsia, David Yi‐Yung

doi:10.1001/archpedi.1959.02070010003001

Cited by 69 publications

(41 citation statements)

References 150 publications

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“…As a result, the intrauterine environment in gestational diabetes is characterized by increased concentrations of glucose, amino acids and lipids in the maternal circulation, greater delivery of these nutrients to the fetus, raised fetal insulin secretion, and accelerated fetal growth [11,12]. Because differentiation of adipose tissue and storage of triglycerides begins during the third trimester of pregnancy [13], the effect of diabetes at this point in fetal development is to hasten the accumulation of fat in the fetus and results in infants that are both heavier and fatter than infants born to nondiabetic women [14].…”

Section: : 1157±1162]mentioning

confidence: 99%

Maternal diabetes status does not influence energy expenditure or physical activity in 5-year-old Pima Indian children

et al. 1998

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The Pima Indians of Arizona have the world's highest reported prevalence of diabetes [1,2]; after 35 years of age, 50 % of the population is reported to have diabetes [1]. We have found that at each age, both the prevalence and incidence of diabetes is higher than earlier in our studies, resulting in more people with diabetes at earlier ages. As the age of onset of diabetes decreases, more women of childbearing age have Type II (non-insulin-dependent) diabetes or are at risk of developing gestational diabetes, which results in larger babies at birth [3±5]. Obesity, in turn, predisposes the children of women with diabetes to developing diabetes themselves, thus resulting in a ªcross-generational vicious cycleº [6] whereby successive generations of women are at greater risk of already being obese and having diabetes at childbearing age than the preceding generation.In healthy, nondiabetic women, normal pregnancy is associated with insulin resistance, hyperinsulin- Diabetologia (1998) Summary Children of women who have diabetes during pregnancy are more likely to become obese by early adulthood than those of women with normal glucose tolerance during pregnancy. Obesity can result from either excess food intake, low levels of energy expenditure or both. In our study, we tested whether maternal diabetes status influences total energy expenditure (TEE by doubly labelled water), resting metabolic rate (RMR by ventilated hood) and physical activity level (PAL = TEE/RMR and assessed by activity questionnaire). Measurements were taken in 88 5-year-old Pima Indian children, 24 children of women with diabetes (2-h plasma glucose ³ 11.1 mmol/l) diagnosed before or during pregnancy and 64 children of women with normal glucose tolerance (2-h plasma glucose < 7.8 mmol/l during pregnancy and no prior history of abnormal glucose tolerance). Although birth weight was higher in children of diabetic than of nondiabetic women (mean ± SD; 3.8 ± 0.6 vs 3.5 ± 0.4 kg, p < 0.03), there were no differences in weight (26.4 ± 6.9 vs 24.2 ± 5.6 kg) or per cent body fat ( 18 O dilution; 33 ± 8 vs 31 ± 8 %) between the groups at 5 years of age. There was no difference in TEE (6508 ± 1109 vs 6175 ± 942 kJ/d) or in RMR (4674 ± 786 vs 4483 ± 603 kJ/d) expressed as absolute values or after adjustment for weight and sex (TEE) or fat-free mass, fat mass, and sex (RMR). Physical activity level was also similar between the groups (1.40 ± 0.12 vs 1.38 ± 0.12). These results suggest that maternal diabetes status does not influence energy expenditure in the children by 5 years of age. Thus the greater obesity seen at older ages in the children of women with diabetes could be due to excess energy intake. Alternatively, if energy expenditure does have a role in the aetiology of obesity in these children, perhaps it does so only in older children. [Diabetologia (1998

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Section: : 1157±1162]mentioning

confidence: 99%

Maternal diabetes status does not influence energy expenditure or physical activity in 5-year-old Pima Indian children

et al. 1998

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“…In an extensive review of the problem it has already been emphasized, many years ago [10], that unfavourable development of pregnancy and high perinatal mortality are associated specially with pregnant women lacking a good metabolic balance. These findings were subsequently confirmed [16,23] so that one may wonder whether in cases, considered to have been compensated for but still showing a high perinatal mortality rate, an actual optimal compensation had been obtained or whether its further improvement might have ameliorated fetal prognosis.…”

Section: The Problem Of Metabolic Balancementioning

confidence: 99%

The intensive care of perinatal risk in pregnant diabetics (136 cases): A new therapeutic scheme for the best control of maternal disease

Roversi¹,

Canussio²,

Gargiulo³

et al. 1973

Journal of Perinatal Medicine

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k Fifty years have elapsed since the discovery of insulin; however, pregnancy is still far from being sufficiently safe in diabetic women. The most convincing proof is given by the high perinatal mortality ranging from 10 to 15% in specialized departments [16], which would be even higher if therapeutic abortion was not performed in numerous cases of severe maternal disease [3,11,23], On the other hand, äs far äs the mother is concerned, insulin therapy has deeply changed the prognosis of pregnant diabetic patients compared with the preinsulin era. However, severe complications such äs toxemia, urinary tract infections, aggravation of vascular diseases and so forth contribute to maintain the death rate at about 1% [16, 23], The problem of metabolic balanceIn an extensive review of the problem it has already been emphasized, many years ago [10], that unfavourable development of pregnancy and high perinatal mortality are associated specially with pregnant women lacking a good metabolic balance. These findings were subsequently confirmed [16,23] so that one may wonder whether in cases, considered to have been compensated for but still showing a high perinatal mortality rate, an actual optimal compensation had been obtained or whether its further improvement might have ameliorated fetal prognosis. As a matter of fact, the treatment of pregnant or non-pregnant diabetic patients is carried out everywhere by regulating the inCürriculum vitae GIAN sulin dosage on the basis of glycemia and glycosuria. The difficulties found in establishing the degree of metabolic compensation by means of these indices caused a considerable discrepancy of opinion äs to the optimal values for the best therapeutical approach [6,16,19,23,35,37]. On the other hand, it may be debatable whether such a criterion represents an "optimum" for the feto-placental unit in considering that the features of newborns of diabetic mothers frequently appear even in newborns of prediabetic mothers, where blood sugar levels show little or no alteration; interesting results were obtained by insulin therapy in these cases [14,22,25,41]. On the basis of the aforesaid considerations we began our investigations for a stricter control of diabetes mellitus in pregnancy in 1963. There-J. Perinat. Med. l (1973)

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“…In spite of extensive investigations of the physiologic and biochemical status of the infant, 1 ' 4 approximately 35 per cent die either in utero or in the neonatal period. Prematurity and anomaly are increased in prevalence, albeit to what degree has not been established.…”

Section: Infants Of Diabetic Mothersmentioning

confidence: 99%

“…1 The most successful results have been reported from centers where therapy is characterized by collaboration between diabetician, obstetrician, and pediatrician. Factors related to unsatisfactory outcome have been: long duration of known diabetes, complicating vascular disease, and uncontrolled diabetes.…”

Section: Infants Of Diabetic Mothersmentioning

confidence: 99%

“…It is generally believed that delivery should be made not earlier than the thirty-fifth week, and preferably near the thirtyseventh week. 1 A trial of labor is desirable, followed by cesarean section when the labor is unsuccessful. It is advisable to employ short acting insulin and intravenous glucose on the day of delivery because of the marked drop in insulin requirement following delivery.…”

Section: " 21mentioning

confidence: 99%

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