Noninsulin dependent diabetes mellitus and pregnancy in Mexico

Abstract

We analyzed 215 consecutive patients with diabetes mellitus and pregnancy, 118 (54.83%) with noninsulin dependent diabetes mellitus (NIDDM), 90 (41.86%) with gestational diabetes mellitus (GDM) and 7 (3.26%) with insulin dependent diabetes mellitus (IDDM). NIDDM and GDM patients had no significant difference in age and body mass index. There were no maternal deaths, nor episodes of ketoacidosis. Maternal and neonatal complications occurred with a similar frequency in NIDDM and GDM. We concluded that in our population, diabetes associated with insulin-resistance occurred in over 96% of our pregnant diabetic patients and was associated with an increased prevalence of maternal and neonatal complications. Earlier perinatal care has to be established in NIDDM patients, and obese young women should be screened to detect GDM from early gestation and advised to reduce weight before pregnancy ensues.

Perinatal mortality in Type 2 diabetes mellitus

“…In these, the rates vary between 4 and 81 per 1000 (although the lowest figure, from Japan[18], does not count early neonatal death). In two of the four series that report such data the perinatal mortality data for Type 1 and Type 2 DM is similar[14–18], but in the present series and one other[17] it appears higher for Type 2 DM. Interestingly, there is a strong relationship between the perinatal mortality rate and maternal body mass index in the groups with Type 2 DM, where this data is reported, with the lowest perinatal mortality being seen in the non‐obese Japanese population.…”

“…Although Type 2 DM is now more common than pregnancy in Type 1 DM in many countries, there is surprisingly little published about pregnancy outcome, with only five reports found of perinatal mortality in series of over 100 patients[14–18] ( Table 3). In these, the rates vary between 4 and 81 per 1000 (although the lowest figure, from Japan[18], does not count early neonatal death).…”

Maternal Hyperglycemia Leads to Gender-Dependent Deficits in Learning and Memory in Offspring

“…In response to elevated glucose levels, the fetus produces excess insulin, resulting in fetal hyperinsulinemia. Although previous studies reported evidence against the involvement of insulin in phenotypic abnormalities other than macrosomia (41,42), it is not known whether fetal hyperinsulinemia can result in altered hippocampal development, one area known to be involved in learning and memory. Previous studies have provided evidence that fetal hyperinsulinemia present at birth may be related to alterations in the number of neurons in and hormonal output from the arcuate nucleus, paraventricular nucleus, and ventromedial hypothalamus, findings that were also apparent in the adult offspring of diabetic mothers (43,44).…”