Factors affecting fetal weight distribution in women with type I diabetes

Johnstone, Frank D.; Mao, Jian‐Hua; Steel, Judith; Prescott, R. J.; Hume, Robert

doi:10.1111/j.1471-0528.2000.tb10403.x

Cited by 41 publications

(42 citation statements)

References 24 publications

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“…As previously reported [26], this effect was partially related to metabolic control during pregnancy. Our data and previous data on much fewer subjects [27] indicate that metabolic control as measured by HbA 1c during the final trimester is an important contributor to the increased birthweight in children of mothers with diabetes. The mechanism of this phenomenon is not completely understood, but elevated levels of fetal insulin, leptin and lipids are potentially responsible [28].…”

Section: Discussionsupporting

confidence: 70%

Fetal growth is increased by maternal type 1 diabetes and HLA DR4-related gene interactions

et al. 2007

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Aims/hypothesis Intrauterine growth in non-diabetic pregnancies is reported to be influenced by type 1 diabetes susceptibility genes. In particular, the high-risk HLA DR4_DQB1*0302 haplotype is associated with increased birthweight. The aim of this study was to determine whether HLA DR4 was associated with increased birthweight in a maternal diabetes environment and whether effects persisted during early childhood. Subjects and methods Birthweight and gestational age were obtained in singleton births from mothers with type 1 diabetes (n=1161) or whose fathers or siblings have type 1 diabetes (n=872). Weight and height at ages 2 and 5 years were obtained from paediatric records. Data were adjusted for (gestational) age and sex and expressed as percentiles of German reference data. HLA DR typing was obtained for all children and 1090 children also had insulin gene (INS) variable number of tandem repeats (VNTR) typing. Results Maternal type 1 diabetes was associated with increased birthweight, gestational age and birthweight percentiles (all p<0.0001). In children of mothers with type 1 diabetes, birthweight percentile was further related to maternal HbA 1c during pregnancy (r=0.26; p<0.0001) and was independently increased if children had HLA DR4 alleles (76th vs 64th percentile; p<0.0001). HLA DR4 was not associated with birthweight in children of non-diabetic mothers. Birthweight was not associated with INS VNTR genotypes. High birthweight, but not HLA DR4 was associated with increased weight and BMI at ages 2 and 5 years (p<0.0001). Conclusions/interpretation Our findings are consistent with the hypothesis that a diabetic intrauterine environment interacts with gene(s) marked by the type 1 diabetes susceptibility HLA DR4 alleles to increase fetal growth.

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Section: Discussionsupporting

confidence: 70%

Fetal growth is increased by maternal type 1 diabetes and HLA DR4-related gene interactions

et al. 2007

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“…It has proved difficult to establish a clear relationship between HbA 1 c levels and infant birthweight. Positive [18,20] and negative [19,21] correlations have been reported between first trimester HbA 1 c levels and infant birthweight, while other studies have shown that third trimester HbA 1 c levels are positively related to infant birthweight [1,2]. A constant finding of these studies is that the relationship between HbA 1 c levels and infant birthweight is weak.…”

Section: Introductionmentioning

confidence: 97%

“…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%

“…A constant finding of these studies is that the relationship between HbA 1 c levels and infant birthweight is weak. HbA 1 c levels account for <10% of the variance in the birthweight of infants of mothers with type 1 diabetes [2,19]. This raises questions concerning the usefulness of HbA 1 c levels for the prediction of foetal macrosomia in pregnant women with type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Hyperglycaemia is considered a determinant of excessive foetal growth, although the relationship between glycaemic control during pregnancy and the occurrence of macrosomia is lower than might be expected. Differences in HbA 1c explained only 6 to 23% of the variance in birth weight [5,11,12], whereas 1 h postprandial blood glucose values predicted 28.5% of the macrosomic infants born to diabetic mothers [13]. This relatively weak relationship could be due to the use of inadequate markers of (overall) glycaemic control or due to other yet unknown factors.…”

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confidence: 99%

Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands

et al. 2002

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Aims/hypothesis. To investigate the incidence of foetal macrosomia (i.e. birth weight >90th percentile) in a nonselected nationwide cohort of women with Type I (insulin-dependent) diabetes mellitus in The Netherlands and to identify risk indicators predictive for macrosomia. Methods. We conducted a prospective nationwide cohort based survey regarding the outcome of Type I diabetic pregnancy in The Netherlands. Data of 289 women who gave birth to a live singleton infant without major congenital malformations at more than or equal to 28 weeks of gestation are shown.Results. The incidence of foetal macrosomia was very high (48.8%), with 26.6% of infants weighing more than 97.7th percentile. Glycaemic control during pregnancy was good (i.e. mean HbA 1c ≤7.0%), in almost all (84%) women. Multiple logistic regression analysis resulted in a predictive model for macrosomia that incorporated five variables: third trimester HbA 1c (Odds Ratio [95% Con- . Third trimester HbA 1c was the most powerful predictor for the occurrence of macrosomia, but its predictive capacity was weak (explained variance <5%). Conclusion/interpretation. Despite apparent good glycaemic control, the incidence of foetal macrosomia in this non-selected prospective nationwide cohort of 289 Type I diabetic women was very high. Third trimester HbA 1c was the most powerful predictor, but its predictive capacity was weak. Thus, future research should focus on new more detailed glucose monitoring techniques (such as a continuous glucose monitoring system) as well as to alternative factors to reduce macrosomia. [Diabetologia (2002) rosomia is related to an increased risk for "unexplained" death in utero and shoulder dystocia during labour, the latter being related to asphyxia, clavicle fracture and/or Erbs palsy [1,2,3]. During the neonatal period macrosomic infants are at increased risk for hypoglycaemia, infant respiratory distress syndrome (IRDS), hyperbilirubinaemia and hypertrophic cardiomyopathy [4,5,6]. A number of long-term population studies have shown that macrosomic newborns of women with diabetes have a higher risk to develop obesity and Type II (non-insulin-dependent) diabetes mellitus at a young age [7,8,9].Foetal growth depends on foetal, placental and maternal factors. Determinants affecting foetal growth are genetic factors, fetal hormones (insulin, insulinPrevention of foetal macrosomia in pregnancies with Type I (insulin-dependent) diabetes mellitus would reduce serious perinatal morbidity and mortality. Mac-

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Factors affecting fetal weight distribution in women with type I diabetes

Cited by 41 publications

References 24 publications

Fetal growth is increased by maternal type 1 diabetes and HLA DR4-related gene interactions

Fetal growth is increased by maternal type 1 diabetes and HLA DR4-related gene interactions

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

Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands

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