Infants Of Non-diabetic Mothers Research Articles

Plasma noradrenaline and adrenaline in newborn infants of diabetic mothers: relation to plasma lipids.

No significant differences in plasma noradrenaline and adrenaline concentrations were found between 14 infants of diabetic mothers (IDMs) and 7 infants of non-diabetic mothers at birth or at 2 hours of age, although the mean values were higher in the IDMs. The mean blood glucose concentration declined from birth to 2 hours of age and it was lower at 2 hours of age in the IDMs although only one IDM became hypoglycaemic. Plasma non-antibody bound insulin concentrations were approximately 12 fold higher at birth and at 2 hours of age in the IDMs than in the control infants. Similar increases in plasma free fatty acids and free glycerol concentrations from birth to 2 hours of age were observed in the 2 groups. At 2 hours of age positive correlations were found between plasma noradrenaline and free fatty acids (r = 0.85, p less than 0.01) and free glycerol (r = 0.65, p less than 0.05) and between plasma adrenaline and free glycerol (r = 0.71, p less than 0.05) and the rise in free glycerol from birth to 2 hours of age (r = 0.65, p less than 0.05) in the IDMs. At birth positive correlations between plasma free fatty acids and plasma noradrenaline (r = 0.69, p less than 0.02) and plasma adrenaline (r = 0.88, p less than 0.01) were found in the IDMs. No correlations were found in the control infants. These findings indicate that the catecholamines counteracts the inhibitory effect of insulin on lipolysis in IDMs.

1238 BONE MINERAL CONTENT (BMC) OF INFANTS OF DIABETIC MOTHERS (IDMS)

Infants of diabetic mothers have a higher incidence of neonatal hypocalcemia and hypomagnesemia. Decreased BMC has been reported in diabetic patients, with bone mineralization of IDM has not been; systematically evaluated. The present study was done to test the hypothesis that decreased neonatal BMC in IDMs is correlated with poor control of diabetes during pregnancy & with the development of neonatal hypocalcemia. 54 fullterm IDMs & 55 normal fullterm controls, infants of non-diabetic mothers were prospectively studied. Mothers of IDMs were classified prospectively in 3 groups: group 1-strict control of diabetes from the first trimester: group 2-customary control from the first trimester: group 1 & 2 were randomized; group 3-late entry (after first trimester) in the study. Maternal BMC was measured prior to delivery. Infant serum calcium was measured at age 24 & 72 hours, & infant BMC at age 3 days. Multiple regression analysis shows that: 1) infant's BMC is not correlated with maternal BMC, neonatal hypoglycemia, neonatal hypocalcemia & infant weight percentile; 2) IDMs from group 2 & 3 had significantly lower BMC than IDMs from group I (p<0.02); 3) IDMs from group 1 & controls had similar BMC. It appears that decreased BMC is observed in IDMs & may be prevented by strict control of diabetes during pregnancy. Decreased BMC in IDMs does not seem to play a role in the pathogenesis of neonatal hypocalcemia. We speculate that decreased BMC in IDMs might be in the diabetic pregnancy inappropriate calcium supply through the placenta.

Infant adiposity and maternal energy consumption in well-controlled diabetics.

This study was designed to determine the relationship of maternal diet and infant adiposity in well-controlled diabetics. The relationship between the fat consumption pattern of the pregnant diabetic and the adiposity of her infant was investigated. Length, weight, and head circumference; triceps, subscapular, and anterior thigh skinfolds; and subcutaneous fat layer were obtained on ten infants of diabetic mothers and ten infants of nondiabetic mothers. Measurements were taken at 48 h, 2 weeks, and 1 month postpartum. Maternal dietary intakes were recorded for 6 days during the third trimester of pregnancy. Infants of diabetic mothers and infants of nondiabetic mothers exhibited differences in birth length, 2-week and 1-month head circumference, 2-week triceps skinfold thickness, and fat layer. However, measurements differing at birth were not consistant with those differing at repeated measurements throughout the first month of life. Only the dietary intake of linoleic acid as a percentage of energy intake differed between the two groups of women. The diabetic women consumed more linoleic acid. The fat consumption pattern in the pregnant diabetic was unrelated to the subsequent anthropometric measurements of her infant. The well-controlled diabetics in this study did not have large-for-gestational-age infants.

Maternal diabetes and neonatal macrosomia. III. Neonatal body water estimates.

Body water estimates were obtained within 12 h of birth in 52 infants of non-diabetic mothers and 61 infants of diabetic mothers. Neonates were grouped as normally-grown or macrosomic. Total body water and extracellular water were estimated from antipyrine space and corrected bromide space, respectively. Intracellular water was assumed to be the difference between total and extracellular water. Infants of diabetic mothers, whether normally-grown or macrosomic, had markedly less mean total body water than normally-grown neonates of non-diabetic mothers. No effect of neonatal macrosomia or maternal diabetes on extracellular and intracellular water estimates could be detected with the techniques used. It is suggested that changes in total body water occur as a result of excessive fat accretion during fetal life.

Fingernail nitrogen content in infants of diabetic mothers and in macrosomic neonates.

Fingernail nitrogen content (FNC) was determined on nail trimmings obtained within 24 h of birth from 21 infants of diabetic mothers and 82 infants of nondiabetic mothers. Macrosomic infants of nondiabetic mothers had higher mean FNC than their normally grown peers. Both normally grown and macrosomic infants of diabetic mothers had higher mean FNC than normally grown infants of diabetic mothers. These data suggest that fetal macrosomia and maternal diabetes may independently increase the rate of nitrogen accretion in fingernails.

Hyperbilirubinemia in Infants of Diabetic Mothers

Large for gestational age (LGA) infants of insulin-dependent diabetic mothers (IDM), appropriate for gestational age (AGA) IDM, and infants of nondiabetic mothers were compared for the incidence of neonatal hyperbilirubinemia and related etiologic factors. At 60 hours of age, LGA IDM had significantly higher serum bilirubin concentrations (12.3 +/- 2.1 mg/100 ml) than AGA IDM (7.6 +/- 3.9 mg/100 ml) or control infants (7.8 +/- 2.8 mg/100 ml) (P < .001). Peak serum bilirubin concentrations were also significantly higher in LGA IDM (14.4 +/- 2.1 mg/100 ml) than in AGA IDM (8.4 +/- 3.7 mg/100ml) or control infants (8.6 +/- 3.3 mg/100 ml) (P < .001). Mean percent of carboxyhemoglobin was used as an indicator of hemolysis and showed a significant elevation in LGA IDM (1.51 +/- 0.19) when compared to AGA IDM (1.10 +/- 0.27) and control infants (1.19 +/- 0.33) (P < .05). No significant differences were found among the three groups with respect to mode of delivery, frequency of pitocin administration, 5-minute Apgar scores, incidence of isoimmunization, incidence of enclosed hemorrhage, hemoglobin concentration, bilirubin concentrations at 12 hours, and percent of weight loss. Our data suggest that only LGA IDM are at increased risk for hyperbilirubinemia and that increased heme turnover is a significant factor in the pathogenesis.

Development of adipose tissue in newborns of gestational-diabetic and insulin-dependent diabetic mothers.

Some parameters of adipose tissue development have been studied in normal, full-term infants of gestational-diabetic mothers (GDM) and insulin-dependent diabetic mothers (IDDM). Values of skinfold thickness, body fat mass, and fat cell weight in full-term newborns of GDM and IDDM are greater than in infants of nondiabetic mothers. Fat mass enlargement in newborns of diabetic mothers seems to be caused almost exclusively by an increase in the triglyceride content of the single adipocytes. Results of determinations of fat cell weight are in fact significantly higher in newborns of GDM and IDDM and correlate closely with skinfold thickness and body fat mass: No differences resulted in the approximate estimate of fat cell number. Neither maternal weight gain during pregnancy nor pregravidic overweight seem to be directly related to the expansion of adipose tissue observed in newborns of diabetic mothers. Maternal blood glucose levels and neonatal IRI levels in cord blood significantly correlated with fat cell weight. Maternal FFA levels are not related to parameters of adipose tissue development in newborns of normal, GD, and IDD mothers. In conclusion, enlargement of body fat mass in full-term infants of GDM and IDDM is dependent on glucose availability and, thus, on the insulin-induced enhancement of triglyceride synthesis and storage in single adipocytes. Free fatty acids do not seem to play an important role in regulating the triglyceride content of fat cells in newborns of gestational-diabetic or insulin-dependent diabetic mothers.

High Plasma Norepinephrine Concentrations at Birth in Infants of Diabetic Mothers

Analysis of plasma norepinephrine (NE) concentrations in umbilical artery and vein from infants of diabetic and nondiabetic mothers revealed high plasma NE values in those of diabetic mothers. While birth weight and arterial plasma NE did not correlate in infants of nondiabetic mothers (r = 0.07, NS), birth weight and plasma NE were related inversely in infants of diabetic mothers (r = -0.73, P less than 0.05).

Association between maternal diabetes and the respiratory-distress syndrome in the newborn.

Perinatal data on 805 infants of diabetic mothers and 10,152 infants of nondiabetic mothers were examined for a relation between maternal diabetes and respiratory-distress syndrome of the newborn. The syndrome occurred in 23.4 per cent of the diabetic vs. 1.3 per cent of the nondiabetic group. The risk of the syndrome in an infant of a diabetic mother was 23.7 times greater than that for an infant of a nondiabetic mother (P less than 0.00001). Further analysis to control for features associated with diabetes but also in themselves risk factors, such as gestational age and route of delivery, showed that respiratory-distress syndrome in infants of diabetic mothers was 5.6 times as likely to develop as in infants of nondiabetic mothers (P less than 0.00001). Thus, maternal diabetes mellitus per se predisposes to newborn respiratory-distress syndrome.

THE ENDOCRINE RESPONSE TO THE FIRST FEED OF BREAST MILK IN THE HUMAN NEWBORN

Postnatal feeding in animals stimulates the maturation of pancreatic insular hormone secretion. Little is known on the effect of the first feeds on entero-insular hormone secretion in man. We have measured the levels of several hormones in arterial blood after the first feed of 5 ml/kg breast milk in infants of diabetic mothers (IDM, n:7) and in infants of non-diabetic mothers (INDM, n:12) suffering from mild respiratory distress. IDM had significantly lower basal blood glucose levels, but a rise occurred in both groups 25 min. after BM. Mean peak insulin increment in INDM was only 8 μU/ml. IDM had significantly lower basal glucagon levels (mean 15.0±17.6 fm/ml v. 65.2±11.7 fm/ml, p < 0.05) with a rise after 55 min, (mean 28.5±5.4 fm/ml). INDM showed a rise in enteroglucagon levels after BM (basal 145±130 fm/ml, peak 305±60 fm/ml, p<0.05). IDM had lower basal gastrin levels (4.8±1.7 pg/ml v, 10.9±1.3 pg/ml, p < 0.01), but a significant rise after BM occurred in both groups (mean at 55 min. 18.8±3.1 pg/ml and 26.1±1.9 pg/ml in IDM and INDM respectively). Entero-insular hormones are secreted after the first feed of breast milk in the human neonate.

RISK OF RESPIRATORY DISTRESS SYNDROME RELATED TO GESTATIONAL AGE, ROUTE OF DELIVERY AND MATERNAL DIABETES

Abstract From this analysis, respiratory distress syndrome appears to be a condition related to prematurity, exacerbated by cesarean section delivery, and unaffected by maternal diabetes. The incidence and mortality rate are inversely related to gestational age with the syndrome probably rarely, if ever, occurring after 38 weeks. Cesarean section is associated with a markedly increased incidence and mortality rate. The incidence of respiratory distress syndrome in infants of diabetic mothers is the same as in infants of nondiabetic mothers when delivered at the same gestational age and by the same route. When premature delivery is considered for maternal or fetal complications, it should, whenever possible, be effected vaginally rather than by cesarean section.

Risk of respiratory distress syndrome related to gestational age, route of delivery, and maternal diabetes

From this analysis, respiratory distress syndrome appears to be a condition related to prematurity, exacerbated by cesarean section delivery, and unaffected by maternal diabetes. The incidence and mortality rate are inversely related to gestational age with the syndrome probably rarely, if ever, occurring after 38 weeks. Cesarean section is associated with a markedly increased incidence and mortality rate. The incidence of respiratory distress syndrome in infants of diabetic mothers is the same as in infants of nondiabetic mothers when delivered at the same gestational age and by the same route. When premature delivery is considered for maternal or fetal complications, it should, whenever possible, be effected vaginally rather than by cesarean section.

Insulin, insulin antibody and glucose in plasma of newborn infants of diabetic women.

ABSTRACT The venous plasma insulin and glucose concentration was investigated in 15 diabetic and 13 non-diabetic women at birth; in the umbilical cord blood of their infants at birth; 1.5 to 6 hours after birth in the fasting state; and 5 and 30 minutes after a glucose load injected through a catheter inserted in the umbilical vein. Insulin antibodies were estimated at birth. Antibodies were found in the maternal and the umbilical cord blood in 13 diabetic mothers who had had insulin treatment for 2–20 years, but not in 2 diabetics with, respectively, no insulin treatment, and treatment for a few days only. In infants of non-diabetic mothers, the insulin concentration at birth was lower than that of their mothers. In infants of diabetic women the insulin concentration was much higher than that of the control infants. After glucose injection a rapid increase of the insulin concentration in the umbilical vein was demonstrated in infants of diabetic women, whereas the rise was slow in infants of non-diabetics, thus indicating a greater reactivity of insulin secretion or release in infants of diabetic women. After glucose injection, the plasma glucose concentration in the umbilical vein rose and fell rapidly without any difference being found between the two groups, in contrast to the great differences in their insulin concentration.

THROMBOSIS IN THE NEWBORN

Venous thrombosis was present in 45 newborn infants in a series of 4,000 cases reviewed. The incidence in infants of diabetic mothers was 15.8 per cent (13 of 82 cases), compared to an incidence of less than 1 per cent in the remaining cases. The adrenal and renal veins were most frequently involved, each comprising one third of the cases. Thrombosis was associated with hydramnios, toxemia, birth trauma, sepsis, and recent surgery. Infection and surgery were contributing factors in infants of nondiabetic mothers, whereas a history of hydramnios and toxemia occurred more frequently in infants born to diabetic women. The latter survived for shorter periods, and the thrombus in these cases showed more frequent organization and calcification, suggesting intrauterine formation.

Thrombosis in the newborn: Comparison between infants of diabetic and nondiabetic mothers

Venous thrombosis was present in 45 newborn infants in a series of 4,000 cases reviewed. The incidence in infants of diabetic mothers was 15.8 per cent (13 of 82 cases), compared to an incidence of less than 1 per cent in the remaining cases. The adrenal and renal veins were most frequently involved, each comprising one third of the cases. Thrombosis was associated with hydramnios, toxemia, birth trauma, sepsis, and recent surgery. Infection and surgery were contributing factors in infants of nondiabetic mothers, whereas a history of hydramnios and toxemia occurred more frequently in infants born to diabetic women. The latter survived for shorter periods, and the thrombus in these cases showed more frequent organization and calcification, suggesting intrauterine formation.

Urinary constituents of infants of diabetic and nondiabetic mothers: I. 17-hydroxycorticosteroid excretion in premature infants

Urinary total chloroform-extractable 17-hydroxycorticosteroids were measured serially during the first week of life in 41 premature infants. Well premature infants of nondiabetic and diabetic mothers had lower excretion values of urinary 17-hydroxycorticoids than normal full-term infants. These two groups of premature infants responded differently to the respiratory distress syndrome; infants of diabetic mothers had a significant increase in urinary 17-OHCS, whereas infants of nondiabetic mothers did not. Several possible explanations for these observations are discussed.