Abstract
(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal magnetocardiography with electro-physiologically-based beat-to-beat heart rate recording for analysis of heart rate variability (HRV) and the ‘fetal movement index’ (FMI) was performed. Data were compared to 167 healthy pregnant women retrieved from our pre-existing study database. (3) Results: Fetal vagal tone was increased with gestational diabetes compared to controls, whereas sympathetic tone and FMI did not differ. Within the diabetic population, sympathetic activation was associated with higher maternal blood-glucose levels. Maternal blood-glucose levels correlated positively with birth weight z scores. FMI showed no correlation with birth weight but attenuated the positive correlation between maternal blood-glucose levels and birth weight. (4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls.
Highlights
Gestational diabetes mellitus (GDM), defined as any glucose tolerance disorder diagnosed during pregnancy for the first time, affects more than five percent (5.38%) of pregnant women in Germany, with a steep increase being observed during the past 15 years [1]
(4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls
The interaction between fetal movement index (fMI) and mean maternal blood-glucose seemed to attenuate the effect glucose levels had on birth weight in our sample
Summary
Gestational diabetes mellitus (GDM), defined as any glucose tolerance disorder diagnosed during pregnancy for the first time, affects more than five percent (5.38%) of pregnant women in Germany, with a steep increase being observed during the past 15 years [1]. Hyperinsulinemia may lead to growth stimulating effects resulting in macrosomic fetal development [2] Both perinatal complications and long term metabolic and cardiovascular risk are increased in the offspring of diabetic mothers [3,4]. Zisser et al observed differences during movement counts and associated low activity in the fetuses to a tendency for macrosomic development [5] This so-called fidgety hypothesis was not proven in further studies or using alternative technology. Fehlert et al performed an fMCG study during a 75 g-oral glucose challenge at 27 weeks of gestation When retrospectively dividing their collective in women with GDM and no-GDM, they observed differences in the fetal autonomic response to maternal glucose load between both groups [6]
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