Psychomotor Development in the Children of Mothers with Type 1 Diabetes Mellitus or Gestational Diabetes Mellitus

Kowalczyk, Mariusz; Ircha, Grażyna; Zawodniak-Szałapska, Małgorzata; Cypryk, Katarzyna; Wilczyński, Jan

doi:10.1515/jpem.2002.15.3.277

Cited by 15 publications

(23 citation statements)

References 14 publications

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“…One study suggested that the rate of perinatal mortality in women with type 2 DM might be higher than that of women with type 1 [3]. It is well documented that children of mothers with insufficiently treated DM have a much higher risk of developing juvenile DM, obesity and hypertension and have reduced psychomotor and intellectual development [4][5][6]. It is therefore essential to achieve good metabolic control from before conception to the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

Severe diabetic fetopathy despite strict metabolic control

Leipold

Worda

Schwindt

et al. 2005

Wien Klin Wochenschr

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In pregnant women, diabetes mellitus (DM) can cause severe complications for both mother and child during pregnancy and delivery; for example, hypertension, pre-eclampsia, macrosomia or intrauterine fetal death. It is therefore essential to achieve good metabolic control in the mother from before conception to the postpartum period. A 35-year-old primipara with type 2 DM presented herself at our outpatient department at 21 weeks of gestation. Until this time her DM had been treated with oral antidiabetic drugs; these were withdrawn and conventional insulin therapy was initiated. Except for the first two weeks after insulin adjustment, blood glucose values were within the required range. Biometric tests performed until week 30 of gestation showed discreet fetal growth. In the week 31, fetal abdominal girth near the 95% limit was observed for the first time; this was soon followed by an explosion-like enlargement of the abdomen along with glycemic values at the lower limit. A cesarean section was performed in week 35 of gestation because of the excessive macrosomia. The female newborn had a birth weight of 4920 g and, one hour after delivery, a blood glucose of 10 mg/dl requiring an intravenous glucose bolus. In addition, the child needed oxygen and also needed both an enteral and a parenteral supply of glucose until day 7 after delivery. Mother and child were discharged from the clinic 19 days postpartum in good general condition. This case illustrates the complexity of treatment of glucose-tolerance disturbances during pregnancy and underlines the importance of fetal monitoring by ultrasound, given that measurement of maternal blood glucose does not always provide sufficient information on the metabolic situation of the fetus.

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Section: Introductionmentioning

confidence: 99%

Severe diabetic fetopathy despite strict metabolic control

Leipold

Worda

Schwindt

et al. 2005

Wien Klin Wochenschr

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“…However, all of these studies were performed in healthy, nondiabetic mothers and their children. ODM have delayed neuropsychological and cognitive development (7)(8)(9)(10). Most interestingly, delayed speech development in ODM has been described (10).…”

Section: Discussionmentioning

confidence: 99%

“…Offspring of diabetic mothers (ODM) have delayed psychomotor and cognitive development (7)(8)(9)(10). Pathophysiologic mechanisms remain unknown.…”

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confidence: 99%

Impact of Early Neonatal Breast-Feeding on Psychomotor and Neuropsychological Development in Children of Diabetic Mothers

et al. 2005

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OBJECTIVE -In general, breast-feeding positively influences development of psychomotor function and cognition in children. Offspring of diabetic mothers (ODM) have delayed psychomotor and cognitive development. Recently, we observed a dose-dependent negative effect of early neonatal ingestion of breast milk from diabetic mothers (diabetic breast milk [DBM]) on the risk of overweight during early childhood. Here, we investigated the influence of early neonatal intake of DBM on neurodevelopment in ODM. RESEARCH DESIGN AND METHODS-A total of 242 ODM were evaluated for age of achieving major developmental milestones (Denver Developmental Scale) according to the volume of DBM ingested during the first week of life, using Kruskal-Wallis and Kaplan-Meier analysis.RESULTS -Children in the upper tertile of early neonatal ingestion of DBM achieved early psychomotor developmental milestones ("lifting head while prone," "following with eyes") earlier than those in lower tertiles (P ϭ 0.002). In contrast, a delay in the onset of speaking was observed in children who had ingested larger volumes of DBM compared with those with lower DBM intake (P ϭ 0.002). This negative impact of DBM ingestion was not confounded by birth characteristics, total milk intake, or socioeconomic/educational status. CONCLUSIONS -Our data indicate differential effects of early neonatal DBM ingestion on psychomotor and cognitive development. Ingesting larger compared with smaller volumes of DBM may normalize early psychomotor development in ODM but delays onset of speaking as a parameter indicative of cognitive development. This effect may result from qualitative alterations in the composition of DBM. Further studies are urgently recommended on the benefits and harms of breastfeeding in ODM. Diabetes Care 28:573-578, 2005B reast-feeding is the best way to nurture healthy-term offspring of healthy mothers. It is well known to have positive short-and long-term effects, e.g., decreased risk of obesity or type 2 diabetes (1,2). Furthermore, evidence exists of a positive influence of breast feeding on psychomotor and cognitive development (3,4), persisting into adult age (5).Positive long-term effects of breastfeeding have been attributed to the composition of breast milk, including factors promoting neurodevelopment, such as long-chain polyunsaturated fatty acids (6). However, it has rarely been considered so far whether breast-feeding is still of advantage if the mother is affected by a noncommunicable disease, e.g., a metabolic disease, which may alter the composition of breast milk.Offspring of diabetic mothers (ODM) have delayed psychomotor and cognitive development (7-10). Pathophysiologic mechanisms remain unknown. Recently, we showed that early neonatal intake of breast milk from diabetic mothers may dose-dependently lead to an increased risk of overweight and impaired glucose tolerance during early childhood (11). Here, we evaluated whether the early neonatal intake of diabetic breast milk (DBM) may also influence cognitive and psychomotor developm...

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“…226 Rapid eye movements, a surrogate of brain maturation, were also found to be reduced in offspring of diabetic mothers. 237,238 Additional studies have demonstrated a high rate of inattention, hyperactivity and fine and gross motor impairment in OT1DM. 229,230 In contrast, some more recent series have not found similar IQ impairment 231,233 or relationships to acetonuria.…”

Section: Neurological Developmentmentioning

confidence: 99%

Type 1 Diabetes in Pregnancy; Influences on Mother and Fetus

Nelson

Lindsay

2009

Fet. Matern. Med. Rev.

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Type 1 diabetes complicates around 1 in 200 to 300 pregnancies in the United Kingdom. Historically maternal type 1 diabetes carried very high risks for mother and child. Introduction of insulin led to an immediate, marked decline in the previously very high rates of maternal mortality; in contrast an improvement in perinatal outcomes occurred more slowly but was nevertheless dramatic. This is strikingly demonstrated by the temporal decline in perinatal mortality in offspring of mothers with type 1 diabetes which was virtually universal before use of insulin in the 1920's, likely remained in excess of 20% even in the 1960's and fell to under 4% by the 1990's. The reasons for this more gradual improvement in perinatal outcomes cannot be defined with precision but will have been influenced by improved glycaemic management with use of intensive, multiple dose insulin treatment and home glucose monitoring; improvements in obstetric and neonatal management, and better management of complications of diabetes before and during pregnancy. In 1989 the St Vincent declaration proposed that pregnancy outcomes in women with type 1 diabetes should approximate those of the non-diabetic population. While the long term improvements in fetal outcomes have been dramatic, contemporary surveys confirm a persistent doubling or more of rates of congenital anomaly and a three to four fold increase in perinatal mortality in the UK and other European countries which will require further clinical innovation to overcome.

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Psychomotor Development in the Children of Mothers with Type 1 Diabetes Mellitus or Gestational Diabetes Mellitus

Cited by 15 publications

References 14 publications

Severe diabetic fetopathy despite strict metabolic control

Severe diabetic fetopathy despite strict metabolic control

Impact of Early Neonatal Breast-Feeding on Psychomotor and Neuropsychological Development in Children of Diabetic Mothers

Type 1 Diabetes in Pregnancy; Influences on Mother and Fetus

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