OBJECTIVE -To determine if insulin sensitivity is altered in prepubertal offspring exposed to a diabetic intrauterine environment.RESEARCH DESIGN AND METHODS -Fifteen control children, 17 offspring of type 1 diabetic women, and 10 offspring of type 2 diabetic women, aged between 5 and 10 years, underwent a frequently sampled intravenous glucose tolerance test (FSIGTT). Weight and height were measured, and body composition was calculated using bioelectrical impedance. Bergman's minimal model was applied to the glucose and insulin measurements to obtain values for insulin sensitivity (S i ), acute insulin response (AIR), and glucose effectiveness (S g ). RESULTS-S i was lowest in the offspring of type 2 diabetic mothers, and AIR was highest in this group, although neither of these changes reached significance (S i , P ϭ 0.2, and AIR, P ϭ 0.3). Offspring of type 2 diabetic mothers had higher BMI SD scores (P ϭ 0.004) and percentage fat mass (P ϭ 0.002) than the children in the other two groups. The BMI SD score and percentage fat mass in the subjects, as well as maternal insulin dose, were negatively correlated with offspring insulin sensitivity.CONCLUSIONS -Intrauterine exposure to hyperglycemia by itself was not associated with alterations in glucose regulation in prepubertal offspring. Children of mothers with type 2 diabetes, however, were overweight, and they had a tendency for a reduced S i . The combined effect of genetic and postnatal environmental factors, rather than prenatal exposure to hyperglycemia, may place this group at risk for developing impaired glucose tolerance in later life.

In order to evaluate the galactopoietic response to rhGH in mothers of normal babies with idiopathic lactation insufficiency arising in the early postpartum period, we performed a preliminary, randomised, single blind trial of 3 different doses of hGH: either 0.05, 0.1, or 0.2 IU/kg/day to a maximum of 16 IU/day, for 7 days. Total 24-hour milk production was determined in each mother 1 day prior to initiating therapy and on the last day of therapy. Milk production rose by 36.0 ± 12.6% in the group receiving 0.2 IU/kg/day (n = 6) but by only 4.7 ± 9.7%, (p < 0.04) in the combined lower dose group (n = 10). In conclusion, these data suggest that moderate dose hGH therapy in mothers with lactation insufficiency can improve galactopoiesis.

Aims. To determine the galactopoietic response to recombinant human growth hormone (hGH) in mothers of premature infants with inadequate lactation. Study Design. Prospective placebo-controlled, double-blind trial. Subjects. Twenty healthy mothers on no concurrent medication, with infants born between 26 and 34 weeks' gestation with insufficient milk production for their infants' needs. Interoentions. Ten mothers received hGH, .2 IU/kg/day subcutaneously to a maximum of 16 IU/day, for 7 days, while 10 mothers received the same volume of placebo. One mother from each group withdrew from the study. Outcome Measures. Maternal milk production and plasma concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and growth hormone (GH) were determined before starting treatment and 1 day after stopping therapy. A nurse measured the amount of milk expressed (5 to 6 times daily) plus, if the infant was suckling, weighed the infant before and after feeding. Results. The mothers were enrolled 35 ± 26 days after birth; at this time the infants weighed 1.89 ± .64 kg. Milk production in hGH-treated mothers increased from 139 ± 49 mL/day to 175 ± 46 mL/day after 7 days of treatment (arise of 31%). Placebo-treated mothers showed no significant change from 93 ± 50 mL/day to 102 ± 69 mL/day (arise of 7.6%, not significant). Milk production increased in all treated mothers but decreased in 4 of 9 placebo mothers. Plasma concentrations of IGF-1 and IGFBP-3 increased in hGH-treated mothers but not placebo-treated mothers; there was no change in plasma GH levels in either group. No adverse effects were seen with hGH treatment in the mothers or infants. Conclusions. hGH therapy in mothers with lactational insufficiency can improve breast milk volumes.