SAT-307 NORMAL FETAL KIDNEY VOLUME AND INFANT URINALYSIS IN OFFSPRING OF WOMEN TREATED FOR GESTATIONAL DIABETES

Abstract

The worldwide prevalence of gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is increasing, and affects up to 20% of pregnancies. Evidence from animal studies indicate that maternal hyperglycemia can be detrimental to renal development and kidney function in exposed offspring. In humans, renal dysfunction and disease has been reported in adults whose mothers had Type 1 or Type 2 diabetes, suggesting that pre-gestational maternal diabetes influences kidney development and the risk of renal dysfunction in adulthood. Despite its high prevalence, few studies have examined kidney development or renal function in offspring of women with GDM. The aim of this study was to evaluate the impact of treated GDM on fetal kidney size and infant renal physiology. A prospective cohort study was conducted between June 2013 and August 2016 in Melbourne, Australia. Participants were recruited at a large public university teaching hospital and clinical data were collected from women without GDM (n=82) and women diagnosed and treated for GDM (n=76). GDM was diagnosed by routine screening at 26-28 weeks gestation. Women with GDM received specialist support for glucose monitoring, diet and exercise in addition to routine antenatal care. One-third of women with GDM also required insulin therapy. Participants underwent an obstetric ultrasound at 32-34 weeks gestation for fetal biometry and fetal kidney volume measurement. Quantitative urinalyses were performed in infant urine samples at 3 months of age for analysis of protein and electrolytes. Maternal age, weight and body mass index were similar in no-GDM and GDM women. Estimated fetal weight and birth weight were also similar in no-GDM and GDM pregnancies. There were no differences in fetal kidney dimensions, total kidney volume, infant urinary albumin or electrolyte levels. Fetal kidney size did not differ by mode of GDM treatment (i.e. diet and exercise alone, or diet and exercise with insulin therapy). There were no associations between maternal glucose levels at screening and fetal total kidney volume or infant urine albumin in multivariable regression analyses. Findings suggest that a limited period of hyperglycemia prior to diagnosis and treatment of GDM in women attending a large metropolitan public hospital in Australia does not alter fetal kidney volume at 32-34 weeks gestation or urinalysis in 3-month-old infants, a favourable finding considering the increasing number of women diagnosed with GDM.