Infants of diabetic mothers with accelerated fetal growth by ultrasonography: Are they all alike?

Keller, J. D.; Metzger, Boyd E.; Dooley, Sharon L.; Tamura, Ralph K.; Sabbagha, Rudy E.; Freinkel, Norbert

doi:10.1016/0002-9378(90)91091-p

Cited by 34 publications

(21 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a study examining women with type 1 diabetes, neither second nor third trimester glycemic control correlated with an AC Ն90th at 24 or 32 weeks (11) or LGA at birth (13). However, late accelerated growth beginning at ϳ32 weeks was associated with impressively higher fetal insulin levels as compared with earlyaccelerated or normal growth (11). In our study, maternal fasting glycemia during 32 through 35 weeks was the strongest predictor of accelerated growth in the late third trimester.…”

Section: Discussioncontrasting

confidence: 80%

“…It is also unclear when, during gestation, maternal glycemia exerts its strongest effect on fetal growth. In a study examining women with type 1 diabetes, neither second nor third trimester glycemic control correlated with an AC Ն90th at 24 or 32 weeks (11) or LGA at birth (13). However, late accelerated growth beginning at ϳ32 weeks was associated with impressively higher fetal insulin levels as compared with earlyaccelerated or normal growth (11).…”

Section: Discussionmentioning

confidence: 91%

“…A pattern of early accelerated growth in diabetic pregnancies has been identified (11-13). Keller et al (11) found that in infants of women with type 1 diabetes who showed accelerated growth before 24 weeks of gestation, approximately half exhibited symmetrical increased growth of both AC and head circumference in the presence of normal amniotic fluid insulin levels. Our model suggests that early accelerated growth may be less influenced by glycemia and more influenced by genetic and other epigenetic factors.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Schaefer-Graf

Kjos²,

Kilavuz³

et al. 2003

Diabetes Care

103

View full text Add to dashboard Cite

OBJECTIVE -To determine maternal parameters with the strongest influence on fetal growth in different periods of pregnancies complicated by an abnormal glucose tolerance test (GTT).RESEARCH DESIGN AND METHODS -Retrospective study of 368 women with gestational diabetes mellitus (GDM; Ն2 abnormal GTT values, n ϭ 280) and impaired glucose tolerance (IGT; one abnormal value, n ϭ 88) with 869 ultrasound examinations at entry to and during diabetic care. Both groups were managed comparably. Abdominal circumference (AC) Ն90th percentile defined fetal macrosomia. Maternal historical and clinical parameters, and diagnostic and glycemic values of glucose profiles divided into five categories of 4 weeks of gestational age (GA; Ͻ24 weeks, 24 weeks/0 days to 27 weeks/6 days, 28/0 -31/6, 32/0 -35/6, and 36/0 -40/0 [referred to as Ͻ24 GA, 24 GA, 28 GA, 32 GA, and 36 GA categories, respectively]) were tested by univariate and multiple logistic regression analysis for their ability to predict an AC Ն90th percentile at each GA group and large-for-gestational-age (LGA) newborn. Data obtained at entry were also analyzed separately irrespective of the GA.RESULTS -Maternal weight, glycemia after therapy, rates of fetal macrosomia, and LGA were not significantly different between GDM and IGT; thus, both groups were analyzed together.LGA in a previous pregnancy, (odds ratio [OR] 3.6; 95% CI 1.8 -7.3) and prepregnancy obesity (BMI Ն30 kg/m 2 ; 2.1; 1.2-3.7) independently predicted AC Ն90th percentile at entry. When data for each GA category were analyzed, no predictors were found for Ͻ24 GA. Independent predictors for each subsequent GA category were as follows: at 24 GA, LGA history (OR 9.8); at 28 GA, LGA history (OR 4.2), and obesity (OR 3.3); at 32 GA, fasting glucose of 32 GA (OR 1.6 per 5-mg/dl increase); at 36 GA, fasting glucose of 32 GA (OR 1.6); and for LGA at birth, LGA history (OR 2.7), and obesity (OR 2.4).CONCLUSIONS -In the late second and early third trimester, maternal BMI and LGA in a previous pregnancy appear to have the strongest influence on fetal growth, while later in the third trimester coincident with the period of maximum growth described in diabetic pregnancies, maternal glycemia predominates.

show abstract

Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Schaefer-Graf

Kjos²,

Kilavuz³

et al. 2003

Diabetes Care

103

View full text Add to dashboard Cite

show abstract

“…As has been found in past in vivo studies of diabetic embryopathy (8,9), fetal weight in the present investigation was significantly depressed in all diabetic groups. This finding is in contrast to increased fetal weight typically noted in studies of human diabetic pregnancy (48), although decreased fetal weight is seen in diabetic pregnancies complicated with vasculopathy (49). The macrosomia observed in human births and decreased birth weight seen in animal models of maternal type 1 diabetes may be reflective of the relatively large ratio of embryonic versus fetal period in rodents compared with humans (50).…”

Section: Discussioncontrasting

confidence: 67%

Diabetic Embryopathy in C57BL/6J Mice

et al. 2001

View full text Add to dashboard Cite

Maternal diabetes (types 1 and 2) induces a broad array of congenital malformations, including neural tube defects (NTDs), in humans. One of the difficulties associated with studying diabetic embryopathy is the rarity of individual malformations. In an attempt to develop a sensitive animal model for maternal diabetes-induced NTDs, the present study uses chemically induced diabetes in an inbred mouse model with or without the splotch (Sp) mutation, a putatively nonfunctional allele of Pax3. Pax3 deficiency has been associated with an increase in NTDs. Female C57BL/6J mice, either with or without the Sp allele, were injected intravenously with alloxan (100 mg/kg), and plasma glucose was measured 3 days later. A wide range of hyperglycemia was induced, and these diabetic mice were bred to C57BL/6J males, some carrying the Sp allele. Gestational-day-18 fetuses were examined for developmental malformations. Fetuses from matings in which either parent carried the Sp allele were genotyped by polymerase chain reaction. Maternal diabetes significantly decreased fetal weight and increased the number of resorptions and malformations, including NTDs. A significant correlation was found between the level of maternal hyperglycemia and the malformation rate. The sex ratio for live fetuses in diabetic litters was significantly skewed toward male fetuses. Matings involving the Sp allele yielded litters with significantly higher percentages of maternal diabetes-induced spina bifida aperta but not exencephaly, and this increase was shown to be associated with the presence of a single copy of the Sp allele in affected fetuses. Thus, Pax3 haploinsufficiency in this murine model of diabetic embryopathy is associated with caudal but not cranial NTDs.

show abstract

“…Keller et al (18) previously reported that a subset of pregnancies complicated by pre-GDM exhibited accelerated growth of the fetal AC before 24 weeks gestation. Those infants also had elevated amniotic fluid insulin levels, suggesting that the pathophysiology of diabetic fetopathy proposed by Pedersen (19) was operative relatively early in gestation in a subset of infants.…”

Section: Neonatal Outcomementioning

confidence: 99%

A Randomized Controlled Trial Using Glycemic Plus Fetal Ultrasound Parameters Versus Glycemic Parameters to Determine Insulin Therapy in Gestational Diabetes With Fasting Hyperglycemia

et al. 2001

View full text Add to dashboard Cite

OBJECTIVE -To compare management based on maternal glycemic criteria with management based on relaxed glycemic criteria and fetal abdominal circumference (AC) measurements in order to select patients for insulin treatment of gestational diabetes mellitus (GDM) with fasting hyperglycemia. RESEARCH DESIGN AND METHODS-In a pilot study, 98 women with fasting plasma glucose (FPG) concentrations of 105-120 mg/dl were randomized. The standard group received insulin treatment. The experimental group received insulin if the AC, measured monthly, was Ն70th percentile and/or if any venous FPG measurement was Ͼ120 mg/dl. Power was projected to detect a 250-g difference in birth weights.RESULTS -Gestational ages, maternal glycemia, and AC percentiles were similar at randomization. After initiation of protocol, venous FPG (P ϭ 0.003) and capillary blood glucose levels (P ϭ 0.049) were significantly lower in the standard group. Birth weights (3,271 Ϯ 458 vs. 3,369 Ϯ 461 g), frequencies of birth weights Ͼ90th percentile (6.3 vs 8.3%), and neonatal morbidity (25 vs. 25%) did not differ significantly between the standard and experimental groups, respectively. The cesarean delivery rate was significantly lower (14.6 vs. 33.3%, P ϭ 0.03) in the standard group; this difference was not explained by birth weights. In the experimental group, infants of women who did not receive insulin had lower birth weights than infants of mothers treated with insulin (3,180 Ϯ 425 vs. 3,482 Ϯ 451 g, P ϭ 0.03).CONCLUSIONS -In women with GDM and fasting hyperglycemia, glucose plus fetal AC measurements identified pregnancies at low risk for macrosomia and resulted in the avoidance of insulin therapy in 38% of patients without increasing rates of neonatal morbidity. Diabetes Care 24:1904 -1910, 2001G estational diabetes mellitus (GDM) has been linked to a variety of perinatal complications, the most common being fetal hyperinsulinism and accelerated fetal growth (1-3). Because maternal glucose levels have been directly correlated with risk of accelerated fetal growth and neonatal morbidity (3-6), recommendations for the medical management of women with GDM have focused on prevention of perinatal complications by maintaining pre-and postmeal blood glucose concentrations in a low-risk range in all patients (7). The approach of achieving strict glycemia to eliminate excess macrosomia has, in some studies (5,8), resulted in the requirment of insulin therapy for the majority of patients. However, because only a minority of infants are at risk for perinatal complications in pregnancies complicated by GDM (3-6,9 -11), normalizing glucose levels in all patients may result in unnecessary use of insulin treatment in many pregnancies not at risk for fetal complications; in some cases, this may lead to intrauterine growth restriction (5).In a previous study (12), we used a single measurement of the fetal abdominal circumference (AC) early in the third trimester to identify a large proportion of pregnancies at low risk for neonatal macrosomia when maternal fasting p...

show abstract

Infants of diabetic mothers with accelerated fetal growth by ultrasonography: Are they all alike?

Cited by 34 publications

References 12 publications

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance

Diabetic Embryopathy in C57BL/6J Mice

A Randomized Controlled Trial Using Glycemic Plus Fetal Ultrasound Parameters Versus Glycemic Parameters to Determine Insulin Therapy in Gestational Diabetes With Fasting Hyperglycemia

Contact Info

Product

Resources

About