Fetal macrosomia related to maternal poorly controlled type 1 diabetes strongly impairs serum lipoprotein concentrations and composition

Abstract

Aims-To determine the eVects of fetal macrosomia related to maternal type 1 diabetes on the lipid transport system. Methods-Serum lipoprotein concentrations and composition and lecithin:cholesterol acyltransferase (LCAT) activity were investigated in macrosomic newborns (mean birth weight, 4650 g; SEM, 90) and their mothers with poorly controlled type 1 diabetes, in appropriate for gestational age newborns (mean birth weight, 3616 g; SEM, 68) and their mothers with well controlled type 1 diabetes, and macrosomic (mean birth weight, 4555 g; SEM, 86) or appropriate for gestational age (mean birth weight, 3290 g; SEM, 45) newborns and their healthy mothers. Results-In mothers with well controlled type 1 diabetes, serum lipids, apolipoproteins, and lipoproteins were comparable with those of healthy mothers. Similarly, in their infants, these parameters did not diVer from those of appropriate for gestational age newborns. Serum triglyceride, very low density lipoprotein (VLDL), apolipoprotein B100 (apo B100), and high density lipoprotein (HDL) triglyceride concentrations were higher, whereas serum apo A-I and HDL 3 concentrations were lower in mothers with diabetes and poor glycaemic control than in healthy mothers. Their macrosomic newborns had higher concentrations in all serum lipids and lipoproteins, with high apo A-I and apo B100 values compared with appropriate for gestational age newborns. In macrosomic infants of healthy mothers, there were no significant diVerences in lipoprotein profiles compared with those of appropriate for gestational age infants. LCAT activity was similar in both groups of mothers and newborns. Conclusion-Poorly controlled maternal type 1 diabetes and fetal macrosomia were associated with lipoprotein abnormalities. Macrosomic lipoprotein profiles related to poor metabolic control of type 1 diabetes appear to have implications for later metabolic diseases. (J Clin Pathol 2000;53:917-923)

Lipid Profile, Glucose Homeostasis, Blood Pressure, and Obesity-Anthropometric Markers in Macrosomic Offspring of Nondiabetic Mothers

“…Studies of macrosomic newborns of diabetic or obese mothers have shown higher serum lipids and apolipoproteins compared with AGA newborns of healthy mothers (8,9). These data suggest that the synthesis of fat and protein might be increased in these fetuses (8,9). However, in macrosomic newborns of nondiabetic and nonobese mothers, serum lipid and apolipoprotein values did not differ significantly from those in AGA newborns (8,11).…”

“…This difference became greater with increasing birth weight. Studies of macrosomic newborns of diabetic or obese mothers have shown higher serum lipids and apolipoproteins compared with AGA newborns of healthy mothers (8,9). These data suggest that the synthesis of fat and protein might be increased in these fetuses (8,9).…”

“…Moreover, these studies refer to neonatal or infantile agegroups and pay only restricted attention to childhood (8,11,12). It is important to determine whether being the macrosomic offspring of a mother without detected glucose intolerance during pregnancy has an impact on the lipid profile, insulin secretion, and glucose homeostasis during childhood.…”

“…Macrosomic infants of diabetic mothers are prone to glucose intolerance, obesity, and diabetes during childhood and adulthood (2,4 -6). Disturbances not only in the metabolism of carbohydrates but also in lipids observed at birth in newborns of diabetic mothers may influence the metabolic profile later in life (2,5,(7)(8)(9)(10).…”

Goals of Metabolic Management of Gestational Diabetes

“…GDM patients with macrosomic fetuses have been associated with high triacylglycerol, VLDL, and low HDL levels (78). Moreover, macrosomic newborns of poorly controlled GDM patients have higher lipid and lipoprotein concentrations than those found in control subjects (79).…”