‘They Give Birth Astride of a Grave’

Mi, Drury

doi:10.1111/j.1464-5491.1989.tb01167.x

Cited by 14 publications

(5 citation statements)

References 24 publications

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“…6,1990 Birth weith of infants of diabetic mothers It is known that as the human fetus develops during the last third of gestation, glucose responsive insulin secretion and tissue insulin sensitivity increase (13). Moreover, several studies stressed the likelihood that other substances, particularly amino-acids may be strong determinants of higher birth weight in infants of diabetic mothers (2,5,7). Fetal macrosomia may therefore, be the result of fetal hyperinsulinemia during the latter part of the diabetic pregnancy that can be produced either by hyperglycemia or hyl~eraminoacidemia (7,2,13).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, several studies stressed the likelihood that other substances, particularly amino-acids may be strong determinants of higher birth weight in infants of diabetic mothers (2,5,7). Fetal macrosomia may therefore, be the result of fetal hyperinsulinemia during the latter part of the diabetic pregnancy that can be produced either by hyperglycemia or hyl~eraminoacidemia (7,2,13). The results of the present study, although not biochemically oriented, support this possibility.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

et al. 1990

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Maternal diabetes is known to be related to an increase in birth weight of the offspring. However, the mechanism of the association is not entirely clear. In addition, the contribution of the demographic, obstetric and metabolic factors to birth weight in diabetic mothers is not well defined. All the diabetic women (68 requiring insulin-treatment and 403 on diet alone) and a random sample of 1 in 12 of all non-diabetic women (893 women) who delivered in one regional hospital between March 1987 and June 1988 inclusive, were included in the study. Tests for gestational diabetes are routinely performed in our pregnant women population, thus, the study is a population based one. The mean birth weight of infants of diabetic mothers adjusted for gestational age was higher than in those of non-diabetic mothers. However, no relationship was found between maternal glycosylated hemoglobin measured at delivery and the infants birth weight. Furthermore, at each week of gestation, infants born to diabetic mothers were heavier than the infants of non-diabetic mothers (for weeks 37 to 40, p less than 0.05), while no differences were found in glycosylated hemoglobin levels between the two groups at any time. In a multivariate model we showed that after controlling for gestational age, the only factors which independently and significantly affected birth weight in our population were diabetes, ethnic origin, and the parity of the mother. Our findings support the possibility that substances which induce hyperinsulinemia, other than glucose, may be related to the higher birth weight of infants of diabetic mothers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

et al. 1990

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“…The author's aim was to show that the frequency of large for gestational age infants was G. Tchobroutsky: Blood glucose levels in diabetic and non-diabetic subjects conditioned by the metabolic control achieved before week 31 and not by that of the last trimester. Data presented by the late Ivo Drury in his Banting lecture [28], based on glycated haemoglobin values (given along with their reference values) showed that 38% of the women followed in Dublin had HbAlc values within the normal reference range throughout the third trimester. The higher the glyco-haemoglobin values the heavier the children were (birthweight being corrected by gestational age).…”

Section: Blood Glucose Levels In Insulin-treated Patientsmentioning

confidence: 99%

Blood glucose levels in diabetic and non-diabetic subjects

Tchobroutsky¹

1991

Diabetologia

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Most, if not all, diabetologists are convinced, on the basis of indirect evidence which has been accumulated over the decades that the microangiopathic and neurological complications of diabetes are primarily dependent on the duration and extent of chronic hyperglycaemia [1-5]. Hyperglycaemia is the necessary factor in the development of these complications even if other, secondary factors, sometimes responsive to treatment, such as blood pressure levels, smoking, protein intake, with or without genetic predisposition, may modulate its expression [6]. However, as emphasized by Krolewski et al. [7] and Mogensen [8] it is the degree (and duration) of hyperglycaemia which remains the most important aetiological factor in predisposed groups of patients. Before we are able to detect with accuracy on an individual basis the subjects at risk from diabetic complications, blood glucose control will be of paramount importance because, as emphasized by Rothman [9]: "Identification of all the components of a given sufficient cause is unnecessary for prevention, in that blocking the causal role of but one component of a sufficient cause renders the joint action of the other components insufficient and prevents the effect."

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“…Women with insulin dependent diabetes no longer “give birth astride of a grave.”1 By the time of the St Vincent declaration in 1989, with its goal of near normal pregnancy outcomes for diabetic women, non-randomised studies from specialist centres had clearly shown major reductions in fetal and neonatal loss down to 2-4% 1 2. At the time, Drury proclaimed that “malformations constitute the last bastion to be conquered” among pregnant women with insulin dependent diabetes 1.…”

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confidence: 99%

“…At the time, Drury proclaimed that “malformations constitute the last bastion to be conquered” among pregnant women with insulin dependent diabetes 1. Non-randomised studies suggested that, with careful family planning and tight control of preconceptual glycaemia, even malformations could be reduced to near background rates 3.…”

mentioning

confidence: 99%

Persistently poor pregnancy outcomes in women with insulin dependent diabetes

Simmons

1997

BMJ

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‘They Give Birth Astride of a Grave’

Cited by 14 publications

References 24 publications

Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

Blood glucose levels in diabetic and non-diabetic subjects

Persistently poor pregnancy outcomes in women with insulin dependent diabetes

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