Diabetic Mothers Research Articles

Intracranial hemorrhages in infants of diabetic mothers: A national cohort study

ObjectiveTo assess the association of maternal diabetes mellitus (DM) with intraventricular hemorrhage (IVH) and other intracranial hemorrhages (ICH) in newborns. Study designWe analyzed the National Inpatient Sample dataset and compared prevalence of IVH and other subtypes of ICH in infants of diabetic mothers (IDMs) vs. those born to mothers without DM. Regression models were used to control for demographic and clinical confounding variables. ResultA total of 11,318,691 infants were included. Compared to controls, IDMs had increased prevalence of IVH (aOR = 1.18, CI: 1.12–1.23, p < 0.001) and other ICH (aOR = 1.18, CI: 1.07–1.31, p = 0.001). Severe IVH (grades 3 & 4) was encountered less frequently in IDMs (aOR = 0.75, CI: 0.66–0.85, p < 0.001) than controls. Gestational DM was not associated with increased IVH after controlling for the demographic, clinical and perinatal confounders in the logistic regression model (aOR = 1.04, CI: 0.98–1.11, p = 0.22). ConclusionChronic maternal DM is associated with increased neonatal IVH and other ICH but not severe IVH. This association needs to be confirmed in further studies.

Call for a More Specific Diagnosis of Infant of a Diabetic Mother to Optimize Neonatal Care

Hyperglycemia is the diagnostic feature of diabetes mellitus (DM), and during pregnancy, hyperglycemia has numerous serious implications for organogenesis and fetal growth. Each type of DM has different neonatal implications based on pathogenesis, length of disease, and comorbidities. Currently, limited attention is given to the woman’s type of DM when evaluating risks for neonates. The diagnosis of infant of a diabetic mother is not sufficient because of the varying pathophysiology of diabetes classifications and associated neonatal outcomes. By expanding the diagnosis to include the woman’s classification and glucose control, maternity and neonatal care providers could develop plans of care based on potential neonatal outcomes, including anticipatory guidance for families. In this commentary, we propose a more specific diagnosis, rather than infant of a diabetic mother, to better serve these infants.

Influence of maternal hyperglycemia on rat daughters and granddaughters

This study evaluated the influence of maternal diabetes on the reproductive outcomes of adult daughters during full-term pregnancy in rats. The local ethics committee approved all experimental protocols. The adult female pups of nondiabetic (control – CP) and diabetic (DP) mothers were subjected to mating with healthy male rats for reproductive analysis. On day 17 of pregnancy, both groups underwent an oral glucose tolerance test (OGTT) to evaluate glucose tolerance. At the end of pregnancy, the rats were anesthetized for laparotomy and exposure of maternal organs. Uterine horns, ovaries, fetuses, and placentas were weighed to classify fetal weight and placental efficiency. P&lt;0.05 was considered a statistically significant limit, and Pearson's correlation was used. Higher maternal fasting blood glucose was correlated with a lower number of live fetuses and, consequently, with a lower litter weight. Thus, maternal fasting glucose during pregnancy is a relevant biomarker related to the poor reproductive outcome of daughters of rats. Furthermore, these findings show the detrimental effects of fetal programming induced by maternal diabetes in adulthood in the subsequent generation.

Frequency of Cyanotic Heart Disease in Infants of Diabetic Mothers

Aim: To determine the frequency of cyanotic heart disease in infants born to diabetic mothers referred to Tertiary Care Hospital. Materials: This Cross-Sectional Study was conducted in the Pediatrics Department of Hayatabad Medical Complex, Peshawar from July 2021 to July 2022. In this study, a total of 262 patients were to determine the frequency of cyanotic heart disease in infants born to diabetic mothers referred to the Pediatrics Department of Hayatabad Medical Complex, Peshawar. The sampling technique was non-probability consecutive sampling. Results: The age of the participants among 262 patients was analyzed as n= 1-15 Days was 170(64.9%) 16-28 Days was 92(35.1%). The mean age was 9±1.87 days. The distribution of gender among 262 patients was analyzed as n= Male was 142(54.2%) and Female was 120(45.8%).The distribution of weight among 262 patients was analyzed as n= less than or Equal to 4.5 kg was 126(48.1%) and More than 4.5 kg was 136(51.9%). Mean weight 5.1±1.87kg. Distribution of Duration of diabetes in mothers (years) among 262 patients was analyzed as n= 1-5 Years was 135(51.5%) and More than 6 Years was 127(48.5%). Mean duration was7.1±1.12 years. The distribution of Cyanotic Heart Disease among 262 patients was analyzed as n= Yes was 48(18.3%) and No was 214(81.7%). Practical implication: To determine the frequency of cyanotic heart diseases in children born of a diabetic mother, its prompt diagnosis and management to reduce neonatal morbidity and mortality. Conclusion: In this high-risk population useful assessment and early CHD diagnosis are strongly suggested, and echocardiography is advised as soon as feasible for all newborns of diabetes mothers. Prenatal CHD screening program for neonates of diabetes moms are required in our setup. Therefore, additional confirmation is anticipated in a study of a larger diabetic population. Keywords: Gestational diabetes mellitus, Congenital heart diseases, pre-gestational diabetes mellitus, Diabetic mothers

Maternal diabetes decreases the expression of GABAAα1, GABAB1, and mGlu2 receptors in the visual cortex of male rat neonates

AimsThis study examines the impact of maternal diabetes on the expression of GABAB1, GABAAα1, and mGlu2 receptors in the primary visual cortex layers of male rat newborns.Main Methods: In diabetic group (Dia), diabetes was induced in adult female rats using an intraperitoneal dose of Streptozotocin (STZ) 65 (mg/kg). Diabetes was managed by daily subcutaneous injection of NPH insulin in insulin-treated diabetic group (Ins). Control group (Con) received normal saline intraperitoneally rather than STZ. Male offspring born to each group of female rats were euthanized via CO2 inhalation at P0, P7, and P14 days after delivery and the expression of GABAB1, GABAAα1, and mGlu2 receptors in their primary visual cortex was determined using immunohistochemistry (IHC).Key Findings: The expression of GABAB1, GABAAα1, and mGlu2 receptors increased gradually with age in the male offspring born to Con group while the highest expression was detected in layer IV of the primary visual cortex. In Dia group newborns, the expression of these receptors was significantly reduced in all layers of the primary visual cortex at every three days. Insulin treatment in diabetic mothers restored the expression of these receptors to normal levels in their newborns. SignificanceThe study indicates that diabetes reduces the expression of GABAB1, GABAAα1, and mGlu2 receptors in the primary visual cortex of male offspring born to diabetic rats at P0, P7, and P14. However, insulin treatment can counteract these effects.

The Association of Maternal Glycemic Control with Hypertrophic Cardiomyopathy in Infants of Diabetic Mothers

Background: Infants of Diabetic Mothers (IDMs) are at known risk for the development of hypertrophic cardiomyopathy (HCM). Echocardiography is essential for the diagnosis of HCM, to assess the left ventricular function, and the degree of left ventricle obstruction, and to rule out structural cardiac malformations.&#x0D; Objective: To study the association of maternal third-trimester glycemic level with HCM in IDMs.&#x0D; Study Design: Observational cross-sectional study.&#x0D; Participants: 108 diabetic mothers and IDMs.&#x0D; Intervention: Third-trimester Glycosylated hemoglobin (HbA1c) levels were measured and Echocardiography was done for IDMs in their first week of life. Data were analyzed for correlations between various parameters.&#x0D; Outcomes: HCM was diagnosed when the absolute value of Inter Ventricular Septum (IVS) was ≥ 2SD from the mean (5mm) and Asymmetrical Septal Hypertrophy (ASH) was diagnosed when the IVS: LVPW ratio was ≥ 1.3.&#x0D; Results: 85% of the study population had gestational diabetes, and 55.6% of them were on diet control only. The mean HbA1c was 6.69%. The mean birth weight was 3.1 kg. The most common complication observed was hypoglycemia (19.4%). Asymptomatic HCM was seen in 52% and ASH in 25.9% of the study population. HCM was found to be significantly associated with maternal HbA1c levels, birth weight and hypoglycemia.&#x0D; Conclusion: HCM is a frequent finding in IDMs when routinely screened by echocardiography. A significant positive association of HCM with maternal glycemic control was seen in our study and hence strict glycemic control during pregnancy is of paramount significance.

Exploring Molecular Interactions between Human Milk Hormone Insulin and Bifidobacteria.

Multiple millennia of human evolution have shaped the chemical composition of breast milk toward an optimal human body fluid for nutrition and protection and for shaping the early gut microbiota of newborns. This biological fluid is composed of water, lipids, simple and complex carbohydrates, proteins, immunoglobulins, and hormones. Potential interactions between hormones present in mother's milk and the microbial community of the newborn are a very fascinating yet unexplored topic. In this context, insulin, in addition to being one of the most prevalent hormones in breast milk, is also involved in a metabolic disease that affects many pregnant women, i.e., gestational diabetes mellitus (GDM). Analysis of 3,620 publicly available metagenomic data sets revealed that the bifidobacterial community varies in relation to the different concentrations of this hormone in breast milk of healthy and diabetic mothers. Starting from this assumption, in this study, we explored possible molecular interactions between this hormone and bifidobacterial strains that represent bifidobacterial species commonly occurring in the infant gut using 'omics' approaches. Our findings revealed that insulin modulates the bifidobacterial community by apparently improving the persistence of the Bifidobacterium bifidum taxon in the infant gut environment compared to other typical infant-associated bifidobacterial species. IMPORTANCE Breast milk is a key factor in modulating the infant's intestinal microbiota composition. Even though the interaction between human milk sugars and bifidobacteria has been extensively studied, there are other bioactive compounds in human milk that may influence the gut microbiota, such as hormones. In this article, the molecular interaction of the human milk hormone insulin and the bifidobacterial communities colonizing the human gut in the early stages of life has been explored. This molecular cross talk was assessed using an in vitro gut microbiota model and then analyzed by various omics approaches, allowing the identification of genes associated with bacterial cell adaptation/colonization in the human intestine. Our findings provide insights into the manner by which assembly of the early gut microbiota may be regulated by host factors such as hormones carried by human milk.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

Breast milk is the best and principal nutritional source for neonates and infants. It may protect infants against many metabolic diseases, predominantly obesity and type 2 diabetes. Diabetes mellitus (DM) is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood. Breastfeeding protects against infant mortality and diseases, such as necrotizing enterocolitis, diarrhoea, respiratory infections, viral and bacterial infection, eczema, allergic rhinitis, asthma, food allergies, malocclusion, dental caries, Crohn's disease, and ulcerative colitis. It also protects against obesity and insulin resistance and increases intelligence and mental development. Gestational diabetes has short and long-term impacts on infants of diabetic mothers (IDM). Breast milk composition changes in mothers with gestational diabetes. To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers. We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15, 2022, in this review. Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms. Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM. Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term, the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies. We need more comprehensive research to prove these effects. Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding, every effort should be made to encourage them to breastfeed.

Cardiac Hypertrophy in Neonates Born to Diabetic Mothers at Farhat Hached of Sousse University Hospital

<i>Introduction:</i> The association between cardiac hypertrophy and hyperinsulinism is mainly observed in the newborn, although the onset in older infants has also been described. The aim of our study is to research a cardiac hypertrophy in newborns of diabetic mothers. <i>Methodology</i>: This was a cross-sectional study, involving one hundred and twenty (120) newborns of diabetic mothers from August 1^stto November 30, 2020. These newborns of diabetic mothers had received an echocardiographic examination at the laboratory of the FARHAT HACHED University Hospital in Sousse (Tunisia) regardless of the associated cardiac or extracardiac pathology, during the study period, to detect cardiac hypertrophy. <i>Results:</i> The sex ratio was in favor of the female gender at 0.90. The average weight was 3554.04 g, with extremes ranging from 1,600 g to 5,200 g. Twelve (12) newborns had a weight greater than or equal to 4,000 g (10.00% of macrosomes). Among mothers, there were 03 types of diabetes: type 1 diabetes (2.65%), type 2 diabetes (0.88%) and gestational diabetes (96.46%). Echocardiography was normal in 91 neonates (75.83%) and abnormal in 29 neonates (24.17%). The prevalence of cardiac hypertrophy was 09.17% and that of other associated cardiac abnormalities was 21.66%. There were 11 cases of patent foramen ovale, 11 cases of patent ductus arteriosus, 02 cases of ostium secundum atrial septal defect, 01 case of interrupted aortic arch, 01 case of pulmonary stenosis. These abnormalities were associated on the one hand with the septal hypertrophy and on the other hand, associated with each other in the same newborn. Left ventricular ejection function was normal in all neonates with an average of 66% and extremes between 59% and 76%. <i>Conclusion:</i> Cardiac hypertrophy described in the newborn of diabetic mother is characterized by hypertrophy of the ventricular walls more often predominating over the septum. Transthoracic echocardiography is the reference (non-invasive) technique for diagnosing and monitoring these hypertrophies.

The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats' inferior colliculi.

Few studies have examined the molecular alterations in the auditory pathway of infants of diabetic mothers, notwithstanding the fact that maternal diabetes may have an impact on the development of the neonatal peripheral and central nervous systems. Male newborn rats were studied to determine how maternal diabetes affected the expression of gamma-aminobutyric acid (GABAAα1 and GABAB1) and metabotropic glutamate (mGlu2) receptors in the inferior colliculus (IC) in this research. Female rats were given a single intraperitoneal injection of streptozotocin (STZ) at a 65 mg/kg dose to develop a model of diabetic mothers. The study population was split into sham, diabetes without treatment, and diabetes with insulin groups. Their male neonatal rats were anesthetized on P0, P7, and P14 after mating and delivery. The receptors' distribution pattern was studied using immunohistochemistry (IHC). Pairwise comparison in the groups revealed that the GABA receptors (Aα1 and B1) were significantly downregulated in the diabetes without treatment group (p<0.001). Furthermore, pairwise comparison in the groups indicated significant mGlu2 upregulation in the diabetes without treatment group (p<0.001). Regarding the concentration of all receptors, there was no discernible distinction between the diabetes with insulin and sham groups. This investigation showed that the concentration of GABAAα1 and GABAB1 receptors decreased significantly over time, whereas the concentration of mGlu2 receptors increased significantly over time in male neonatal rats born to streptozotocin-induced diabetic mothers.

The response of fetal sheep cardiomyocytes to intralipid infusion

Introduction: The developing heart undergoes changes in metabolic substrates parallel with perinatal developmental stages. The preferred substrates for fetal hearts are carbohydrates, which transitions to a preference for fatty acids postnatally. The underdevelopment of lipid metabolism mechanisms in preterm infants cause imbalances or dysfunction in uptake, cellular processing, and storage of fatty acids; and increase the risks for long term cardiovascular and metabolic diseases. It is unknown whether the heart can process fatty acids before birth, and how it affects cardiomyocyte growth. The aim of this study was to determine the effects of Intralipid infusion on fetal sheep cardiac myocyte growth. We hypothesized that the size of cardiomyocytes would remain unchanged, however we expected an increase in maturity. Methods: Intralipid 20® was infused into instrumented fetal sheep (IL, 0.4 ml/kg/hr for 8 days, n=4F/7M); the contralateral twin received saline at a comparable rate (CON, n=7F/4M). Hearts were collected at 133 days gestational age (dGA; term is 147 dGA), and enzymatically dissociated, then myocytes fixed in paraformaldehyde. The length and width were measured in 100 myocytes using a wet mount, under calibrated light microscopy (40x, Zeiss Axiophot), and analyzed with Image Pro 6.3. Nucleation was determined in 500 cells; percentage binucleation is a surrogate measure of maturation. Data are presented as mean ± standard deviation. Groups were compared by t-test. Results: Body weight (IL, 4.2 ± 0.6 vs. CON, 4.1 ± 0.6kg) and heart weight (IL, 29.9 ± 4.1 vs. CON, 27.2 ± 4.6g) were not different between the lipid and control fetuses. Interim results indicate no differences in length or diameter in cardiomyocytes of the left and right ventricle (IL, N=3-7; CON, N=7-9). We found no differences in cardiomyocyte length in the septum, but Intralipid (N=10) increased the diameter of mononucleated (+12%, P=0.016) and binucleated (+11%, P=0.012) myocytes (vs. CON, N=7). In the septum, Intralipid treatment increased binucleation (P&lt;0.02; 69.2 ± 8.0% vs 60.8 ± 9.7%). In the RV, increased binucleation was only a tendency (P&lt;0.06; 70.7 ± 6.4% vs 60.8 ± 9.9%; IL n=6). Binucleation was unaffected in the LV (67.1 ± 9.9%). Summary/Conclusion: The increase in diameter of fetal cardiomyocytes in the septum could reflect different regional regulation of growth to the infused intralipid. Interestingly, parallels could be made between the septal hypertrophy described in offspring from diabetic mothers. This study is funded by NIH R01HL146997 and R01HL142483. KI is funded by a NIH supplement to R01HL142483. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Frequency of Hypomagnesemia in Neonates presenting with Hypocalcemia in a Tertiary Care Hospital

Background: Hypocalcemia is a common neonatal occurrence, especially in neonates with high-risk including those babies born to diabetic mothers, neonates with perinatal asphyxia and premature babies. High calcium consumption can reduce magnesium absorption, while low magnesium intake can boost calcium absorption. Aim: To assess the frequency of hypo-magnesemia in neonates presenting with hypocalcemia in a tertiary care hospital. Design study: Cross sectional study. Methodology: Total 160 fulfilling the inclusion criteria at Services Hospital, Lahore were enrolled through non-probability convenience sampling. Gestational age, birth weight, gender and feeding pattern) were noted. Blood sample was obtained by using 3cc BD syringe and 20G butterfly needle with the help of a nurse under sterile measures. All clotted samples were stored and sent to the Pathology lab for the assessment of magnesium level. Reports were assessed and if magnesium level&lt;0.7mmol/L, then hypomagnesemia was labeled. Data was evaluated by using SPSS v.24. Quantitative data was presented as mean±SD. Qualitative data was presented as frequency and percentage. Chi-square test was applied with P-value ≤0.05 taken as significant. Results: In this study, there were 75 (46.9%) male and 85 (53.1%) female neonates. The mean gestational age of neonates was 39.20±1.63weeks. The mean birth weight of neonates was 2.5±3.0kg. There were 46 (28.8%) who were on exclusive breast feeding, 55 (34.4%) were on formula feed while 59 (36.9%) were on both; breast and formula feed. The mean magnesium level of neonates was 0.90±0.63mmol/L. There were 113(70.6%) neonates with hypomagnesemia while 47 (29.4%) had normal magnesium level. Practical Implication: Literature has reported that the frequency of hypomagnesemia is high in neonates with hypocalcemia. In Pakistan there is little local evidence available in this regard. The information gained through this study will help to improve our clinical practice and to update guidelines for early screening and management of infants with hypocalcemia with co-existence hypomagnesemia. Conclusion: It was concluded that the frequency of hypo-magnesemia was high in neonates with hypo-calcemia in local population. Keywords: Prevalence, Calcium, Electrolytes Imbalance and Neonates.

Assessment of fetal thymus size and BMI in pregnant women with diabetes.

The purpose of this study is to demonstrate whether diabetes during pregnancy affects the development of the fetal immune system. The background: evaluation of potential complications in diabetic pregnancy. The objective is evaluation of the significance of a new ultrasound method of thymus size in pregnancies complicated by diabetes. The analysis was performed with the use of IBM SPSS Statistics 25.0 software. The Mann-Whitney U test was used for comparison of two groups, i.e., diabetic pregnancies and non-diabetic pregnancies, whereas Kruskal-Wallis H test was used to compare multiple groups. A linear regression model was used to determine the correlation between the type of diabetes and fetal thymus size as well as between maternal body mass index (BMI) and fetal thymus size. The significance level α was set at 0.05. A comparison between diabetic and non-diabetic pregnancies was made with the use of Kruskal-Wallis H test. The compared groups included women without gestational diabetes, with pre-gestational diabetes, gestational diabetes managed by diet and gestational diabetes treated with insulin and diet. The analysis revealed significant differences between the compared groups, H (3) = 23.06; p < 0.001; ƞ2 = 0.04. The additional post hoc Dunn's test with Bonferroni correction of the significance level was used to explore specific differences between group means. The results of this detailed analysis indicated that foetuses of diabetic mothers treated with diet had smaller thymus than foetuses of non-diabetic mothers (p = 0.001). Linear regression analysis was used to establish whether maternal BMI (defined as the body mass divided by the square of the body height and expressed in units of kg/m²) affects fetal thymus size. The analysis found no correlation between maternal BMI divided into the following categories: 18.5-24.99 normal weight, 25-29.99 overweight, 30.00-34.99 obese class I, 35.00-39.99 obese class II and ≥ 40.00 very severely obese, and fetal thymus size, b = -1.82; SE = 2.17; t = -0.84; p = 0.405; R2 < 0.01. Thymus size is statistically smaller in foetuses of diabetic mothers when compared to healthy controls. Overweighted and obese pregnancy is not a factor affecting fetal thymus size.

Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy.

The present study aimed to evaluate the performance of QuantusFLM® software, which performs quantitative ultrasound analysis of fetal lung texture, in predicting lung maturity in fetuses of diabetic mothers. The patients included in this study were between 34 and 38weeks and 6days gestation and were divided into two groups: (1) patients with diabetes on medication and (2) control. The ultrasound images were performed up to 48 h prior to delivery and analyzed using QuantusFLM® software, which classified each fetus as high or low risk for neonatal respiratory morbidity based on lung maturity or immaturity. A total of 111 patients were included in the study, being 55 in diabetes and 56 in control group. The pregnant women with diabetes had significantly higher body mass index (27.8 kg/m2 vs. 25.9 kg/m2, respectively, p=0.02), increased birth weight (3,135 g vs. 2,887 g, respectively, p=0.002), and a higher rate of labor induction (63.6 vs. 30.4 %, respectively, p<0.001) compared to the control group. QuantusFLM® software was able to predict lung maturity in diabetes group with 96.4 % accuracy, 96.4 % sensitivity and 100 % positive predictive value. Considering the total number of patients, the software demonstrated accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 95.5 , 97.2, 33.3, 98.1 and 25 %, respectively. QuantusFLM® was an accurate method for predicting lung maturity in normal and DM singleton pregnancies and has the potential to aid in deciding the timing of delivery for pregnant women with DM.

Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy.

Infants of diabetic mothers (IDM) are at higher risk of perinatal morbidities and glycemic instability, but the impact of maternal diabetes on neonatal and neurological short-term outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) remains poorly described. Our objective was to determine the impact of maternal diabetes on neonatal and neurological short-term outcomes following neonatal HIE. This was a retrospective single-center study including 102 term neonates with HIE who received therapeutic hypothermia (TH) treatment between 2013 and 2020. Multiple regression analysis was used to assess the relationship between the presence of maternal diabetes and short-term outcomes. Neonates with HIE and maternal diabetes exposure had a significantly lower gestational age at birth (38.6 vs. 39.7 weeks of gestation, p = 0.005) and a significantly higher mean birth weight (3,588 ± 752 vs. 3,214 ± 514 g, p = 0.012). IDM with HIE were ventilated for longer duration (8 vs. 4 days, p = 0.0047) and had a longer neonatal intensive care unit (NICU) stay (18 vs. 11 days, p = 0.0483) as well as took longer time to reach full oral feed (15 vs. 7 days, p = 0.0432) compared with neonates of nondiabetic mother. Maternal diabetes was also associated with an increased risk of death or abnormal neurological examination at discharge in neonates with HIE (odds ratio: 6.41 [1.54-26.32]). In neonates with HIE, maternal diabetes is associated with an increased risk of death or short-term neonatal morbidities, such as longer duration of ventilation, prolonged neonatal stay, greater need for tube feeding, and being discharged with an abnormal neurological examination. Strategies to prevent, reduce, or better control maternal diabetes during pregnancy should be prioritized to minimize complications after perinatal asphyxia. · Maternal DB is associated with unfavorable outcomes.. · IDM have longer ventilatory support and tube feeding.. · IDM have higher risk of abnormal neurological examination..

Is There Any Correlation Between QT Dispersion and Echocardiographic Indices in Term Neonates with and Without Maternal Gestational Diabetes Mellitus?

Background: Gestational diabetes mellitus (GDM) can cause diastolic dysfunction and asymmetric ventricular septal hypertrophy in infants of gestational diabetic mothers (IGDMs). Ventricular thickness can affect QT interval and other QT parameters. Objectives: This study aimed to evaluate and compare the duration of QT, corrected QT (QTc), QT dispersion (QTD), and echocardiographic indices in two groups of neonates of mothers with and without GDM. Methods: In this case-control study, 76 term neonates were enrolled. The case group (n = 38) included IGDM, and the control group (n = 38) included neonates born to healthy mothers. The QT, QTD, and QTc were calculated based on electrocardiographic results. Ejection fraction (EF), interventricular septal thickness at the end of diastole (IVSTD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular posterior wall thickness (LVPWT) were evaluated by performing echocardiography, and the two groups were compared regarding them. Data were analyzed using SPSS version 21. Results: In this study, neonates' mean age and weight were 4.18 ± 1.3 days and 3418.16 ± 549.24 grams, respectively. As for the gender of neonates, 68.4% in the case group and 47.4% in the control group were female. The two groups had no significant difference regarding age, weight, and sex (P &gt; 0.05). Minimum QTc (QTc min) was significantly higher in the case group (P = 0.046). Considerably lower EF and higher IVSTD were found in the case group (P = 0.011 and P = 0.05 respectively). In univariate analysis, echocardiographic parameters were not the predictors of QTD (P &gt; 0.05); in multivariate analysis, however, QTD was significantly correlated with LVEDD (P = 0.001) and LVESD (P = 0.015). Conclusions: A higher proportion of septal hypertrophy was detected in IGDMs compared to infants of the healthy mothers without any correlation with ECG indices. This involvement was accompanied by relatively decreased EF verified by echocardiography. Most ECG findings, including QTD values, had no linear relationship with echocardiographic parameters except for LVEDD and LVESD.

Comparison of toxic heavy metals in the breast milk of diabetic and non-diabetic postpartum mothers in Yenagoa, Nigeria.

Breast milk is the main source of neonatal nutrition. It is not known whether diabetes increases the excretion of toxic heavy metals in the breast milk of postpartum mothers. We compared the concentration of toxic heavy metals in breast milk between diabetic and non-diabetic postpartum mothers in Yenagoa. A cross-sectional design was utilized on a purposive sample of 144 consenting postpartum mothers (72 diabetic and 72 non-diabetic mothers) from three public hospitals. Breast milk samples were collected at 5-6 weeks postpartum between 1st November 2020 and 30th April 2021. Atomic-Absorption-Spectrophotometer and Direct-Mercury-Analyzer were used to analyze the breast milk samples. A data collection form (proforma) was used and data were analyzed at a 5% significance level with IBM-SPSS 25 software. High levels of Arsenic (63.9% vs. 62.5%), Lead (95.8% vs. 95.8%), Mercury (68.1% vs. 72.2%), and Cadmium (84.7% vs. 86.1%) were detected in the breast milk of the diabetic and non-diabetic groups respectively. The mean concentrations for Arsenic (0.6 vs. 0.6 ng/mL), Lead (13.2 vs. 12.2 ng/mL), Mercury (2.9 vs. 3.0 ng/mL), and Cadmium (3.3 vs. 3.2 ng/mL) were above the WHO permissible limits, thus showing evidence of risk to the health of the mother and neonate. There was no significant difference in the concentration of toxic heavy metals in breast milk between the groups (p = > 0.585). Diabetes did not seem to increase the concentration of toxic heavy metals expressed in breast milk. More rigorous studies are needed to confirm these findings.

418 A CTS Team Approach to Fetal Hyperinsulinemia in Diabetic Pregnancy and its Effects on Vasculature and Early Life Metabolism

OBJECTIVES/GOALS: Fetal glucose dynamics mediate many of the adverse outcomes seen in infants of diabetic mothers (IDM). The goals of this study are to identify: (1) rates of blood glucose change in normoglycemic and hypoglycemic IDM; (2) their relation to in-utero insulin exposure; and (3) their transcriptional impacts on placental and umbilical vasculature. METHODS/STUDY POPULATION: Using a longitudinal prospective study design, placental/umbilical cord tissue and maternal hemoglobin A1c (HbA1c) are being collected from mothers diagnosed with Type 1, Type 2, or gestational diabetes mellitus. Blood glucose levels are also collected from their infants at birth, and every 3-4 hours for up to 9 hours to determine the rate of change. Linear regression modeling will be used to determine associations between placental and umbilical endothelial RNA expression, umbilical cord insulin levels, and maternal HbA1c within each diabetic sub-type. Gene expression from endothelial specimens will be compared between diabetic sub-types and between normoglycemic and hypoglycemic infants via paired t-tests using Benjamini-Hochberg procedure for false discovery rate correction. RESULTS/ANTICIPATED RESULTS: We hypothesize the following; (1) glucose levels will have a steeper rate of change in hypoglycemic infants; (2) maternal HbA1c and in-utero insulin levels will correlate with the level of transcriptional change identified in placental and umbilical endothelial samples; (3) a negative association will exist between cord insulin levels and the rate of change in infant glucose levels; and (4) a positive association will exist between cord insulin level and transcriptional change on the placental and umbilical endothelium. DISCUSSION/SIGNIFICANCE: Identifying gene expression changes in diabetic placental/umbilical endothelium, and the role of insulin/glucose in these changes, is key to managing diabetic vasculopathy and its adverse outcomes. Understanding infant insulin response may also guide management of hypoglycemia and decrease the risk for neonatal intensive care unit admission.

Calcium Supplementation on Glucose Tolerance, Oxidative Stress, and Reproductive Outcomes of Diabetic Rats and Their Offspring.

Diabetes mellitus increases the risk of obstetric complications, morbidity, and infant mortality. Controlled nutritional therapy with micronutrients has been employed. However, the effect of calcium (Ca2+) supplementation on diabetic pregnancy is unclear. We aimed to evaluate whether diabetic rats supplemented with Ca2+ during pregnancy present better glucose tolerance, redox status, embryonic and fetal development, newborn weight, and the prooxidant and antioxidant balance of male and female pups. For this, newborn rats received the beta-cytotoxic drug streptozotocin for inducing diabetes on the day of birth. In adulthood, these rats were mated and treated with Ca2+ twice a day from day 0 to day 20 of pregnancy. On day 17, the pregnant rats were submitted to the oral glucose tolerance test (OGTT). At the end of pregnancy, they were anesthetized and killed to collect blood and pancreas samples. The uterine horns were exposed for an evaluation of maternal reproductive outcomes and embryofetal development, and the offspring's liver samples were collected for redox status measurement. Nondiabetic and diabetic rats supplemented with Ca2+ showed no influence on glucose tolerance, redox status, insulin synthesis, serum calcium levels, and embryofetal losses. The reduced rate of newborns classified as adequate for gestational age (AGA) and higher rates of LGA (large) and small (LGA) newborns and higher -SH and GSH-Px antioxidant activities in female pups were observed in diabetic dams, regardless of supplementation. Thus, maternal supplementation caused no improvement in glucose tolerance, oxidative stress biomarkers, embryofetal growth and development, and antioxidants in pups from diabetic mothers.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study.

Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.