Macrosomic Infants Of Diabetic Mothers Research Articles

Comparison of Perinatal Complications in Macrosomic İnfants of Diabetic and Nondiabetic Mothers

Introduction: Metabolic, congenital disorders, and complications seen in infants of diabetic mothers (IDM) are well defined in the literature. We aimed to compare perinatal problems in macrosomic IDM and infants of mothers without diabetes.
 Methods: We included all macrosomic infants admitted to neonatal intensive care unit (NICU) at two centers between 2017-2020. Birth history, anthropometric measurements, gestational age, metabolic and cardiac problems were compared between macrosomic IDMs and infants of non-DMs. The p-value less than 0.05 was considered statistically significant.
 Results: 156 (37 IDM, and 119 non-IDM) macrosomic newborns were included in the study. While the incidence of hypoglycemia, need for mechanical ventilation, respiratory distress syndrome, ventricular septal defect (VSD) and persistent pulmonary hypertension (PPH) were statistically similar, the incidence of cesarean section (p=0.002), myocardial hypertrophy (p=0.001), and polycythemia (p=0.019) was higher in the IDM group. While the incidence of respiratory problems and VSD was similar in both groups, myocardial hypertrophy was found in approximately in one fourth (22.2%) of the non-diabetic group.
 Conclusion: Macrosomic non-IDMs have a similar risk for perinatal-postnatal complications as macrosomic IDMs and should be evaluated accordingly.

Endocrine diseases among macrosomic infants of diabetic mothers: add insult to injury?

While the body of evidence suggests that macrosomic infant are at increased risk of long-term metabolic derangements, it remains unclear to what extent does maternal diabetes mellitus by itself contributes to this association. Therefore, we sought to evaluate the association between diabetes mellitus diabetes mellitus during pregnancy and endocrine morbidity of the macrosomic infant.

Cardiovascular diseases among macrosomic infants of diabetic mothers

While the association between diabetes mellitus during pregnancy and cardiac morbidity of the offspring is well characterized, few existing investigations have assessed the long-term cardiovascular outcomes of macrosomic infants in specific. In this study we have examined the contributory role of diabetes on cardiac disease formation among macrosomic offspring. A population-based cohort analysis including deliveries of macrosomic infants (birthweight above 4 kilograms) between the years 1991 to 2021 at a tertiary referral hospital was conducted. Incidence of hospitalizations due to various cardiovascular conditions was compared between infants of women with and without diabetes. A Kaplan-Meyer survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Of the 16,466 macrosomic infants, 11% were of women with diabetes during pregnancy (pregestational and gestational diabetes mellitus). Offspring of both diabetic and nondiabetic mothers had comparable rates of cardiovascular-related hospitalization during childhood and adolescence (1.5% and 1.1% respectively, p=0.155; Table). Cumulative incidence of hospitalizations was similar, as shown in the Kaplan-Meyer survival curve (log rank p-value=0.246; Figure), and A Cox proportional hazards model found no association as well (adjusted HR = 1.27, 95% CI 0.82–1.95, p=0.284). In our population of macrosomic infants, diabetes mellitus does not seem to be associated with elevated rates of cardiovascular diseases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Significance of neonatal body indices in identifying fetal macrosomia

To explore the significance of neonatal body indices in identifying macrosomic infants, we compared the neonatal birth weight, body length, head circumference, chest circumference, neonatal body indices, Quetelet index (QI), Kaup Index (KI), head circumference to chest circumference ratio (HC/CC) and maternal fasting blood glucose (BG) for both diabetic and healthy mothers. This is a retrospective study of 177 macrosomic neonates, 100 having been born to normal mothers and 77 to diabetic mothers. Multiple regression analyses were done between neonatal body indices and maternal fasting BG. Fetal QI and KI indices of macrosomic infants of diabetic mothers were higher compared with those born to healthy mothers, whereas the HC/CC was the reverse. The multiple regression equation used to compare neonatal physical development indices to maternal fasting BG was BG=6.959+0.031QI-(4.482 × HC/CC). QI and HC/CC had linear relationships to maternal fasting BG (P<0.05). As birth weight had no direct correlation with maternal fasting BG, it was not introduced into the regression equation. Higher QI and KI along with lower HC/CC may be a predictor of macrosomia due to maternal diabetes when compared with birth weight alone.

Absence of Increase in Carotid Artery Intima-Media Thickness in Infants of Diabetic Mothers

Objective: Infants of diabetic mothers (IDM) are considered as a risk group for atherosclerosis. Increased aortic intima-media thickness has been reported in IDM. The purpose of this study was to assess carotid artery intima-media thickness (CA-IMT), left ventricular mass index (LVMI) and atherosclerotic risk factors in IDM. Methods: Thirty IDM and 25 healthy controls were included in the study. Of these infants, 14 were appropriate-for-gestational age (AGA) and 16 were large-for-gestational age (LGA). CA-IMT and LVMI were obtained by M-mode echocardiographic examination. The relationship between parameters of atherosclerosis and echocardiographic measurements was assessed by Pearson’s correlation analysis. Results: LVMI was higher in LGA IDM when compared to AGA IDM and controls. CA-IMT was not significantly different between the groups and was also not related to atherosclerotic risk factors. Serum lipid and insulin levels were higher in LGA IDM when compared with AGA IDM and controls. There were no correlations between CA-IMT, LVMI and atherosclerotic risk factors. Conclusions: In contrast to previous reports indicating an increase in CA-IMT in IDM, no differences were found between IDM and controls in this study. Our results indicate that macrosomic IDM are prone to hypertrophic cardiomyopathy but not to atherosclerotic changes in the blood vessels. Conflict of interest:None declared.

Role of lipids and fatty acids in macrosomic offspring of diabetic pregnancy

Diabetic pregnancy frequently results in macrosomia or fetal obesity. It seems that the anomalies in carbohydrate and lipid metabolism in macrosomic infants of diabetic mothers are due to maternal hyperglycemia, which leads to fetal hyperinsulinemia. We have developed a rat model of macrosomic offspring and assessed the onset of obesity in these animals. The macrosomic offspring born to diabetic mothers are prone to the development of glucose intolerance and obesity as a function of age. It seems that in utero programming during diabetic pregnancy creates a "metabolic memory" which is responsible for the development of obesity in macrosomic offspring. We have demonstrated that the metabolism of lipids, and altered anti-oxidant status and immune system are implicated in the etiopathology of obesity in these animals. We have reported beneficial effects of n-3 polyunsaturated fatty acids (PUFAs) in obese animals, born to diabetic dams.

Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers

To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Student's t tests. The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs.

Implication of lipids in macrosomia of diabetic pregnancy: can n-3 polyunsaturated fatty acids exert beneficial effects?

Macrosomia or fetal obesity is a frequent complication of pregnancy in diabetes mellitus. Several alterations observed in carbohydrate and lipid metabolism in macrosomic infants of diabetic mothers are thought to be a consequence of maternal hyperglycaemia leading to fetal hyperinsulinaemia. Macrosomic infants of diabetic mothers are prone to the development of glucose intolerance, obesity and diabetes during childhood and adulthood. Furthermore, increasing evidence is accumulating regarding the importance of n -3 polyunsaturated fatty acids (PUFAs) in the reduction of plasma lipids and hyperglycaemia. In this review article, we shed light on the abnormalities in lipid metabolism in macrosomia. We also raise the question of the possible beneficial effects of n -3 PUFAs in diabetic pregnancy and in the prevention and treatment of long-term metabolic abnormalities associated with macrosomia.

Fatal Hypertrophic Cardiomyopathy in the Fetus of a Woman With Diabetes

In Brief BACKGROUND Hypertrophic cardiomyopathy is recognized in infants of diabetic mothers, and when it occurs it is generally benign and transient. We describe a case of fetal cardiac death caused by hypertrophic cardiomyopathy in an infant of a diabetic mother. CASE Hydrops fetalis caused by hypertrophic cardiomyopathy resulted in the death of a macrosomic male fetus of a young woman who had well-controlled diabetes mellitus and was treated with insulin therapy during pregnancy. CONCLUSION It is important to monitor fetal heart function in macrosomic infants of diabetic mothers. Hypertrophic cardiomyopathy might explain otherwise unexplained fetal deaths in women with diabetes. Fatal hydrops fetalis was associated with hypertrophic cardiomyopathy in the fetus of a woman with diabetes.

Fatal hypertrophic cardiomyopathy in the fetus of a woman with diabetes

BACKGROUND: Hypertrophic cardiomyopathy is recognized in infants of diabetic mothers, and when it occurs it is generally benign and transient. We describe a case of fetal cardiac death caused by hypertrophic cardiomyopathy in an infant of a diabetic mother. CASE: Hydrops fetalis caused by hypertrophic cardiomyopathy resulted in the death of a macrosomic male fetus of a young woman who had well-controlled diabetes mellitus and was treated with insulin therapy during pregnancy. CONCLUSION: It is important to monitor fetal heart function in macrosomic infants of diabetic mothers. Hypertrophic cardiomyopathy might explain otherwise unexplained fetal deaths in women with diabetes.

Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers.

The objective was to investigate the hypothesis that anthropometric and body composition differences exist between macrosomic infants of diabetic and nondiabetic mothers. Sixteen infants of mothers with diabetes, along with 58 control infants, were studied within 24 hours of delivery. The following measurements were obtained: birthweight, birth length and extremity length; circumferences of the head, chest, shoulders, and extremities; and triceps, subscapular, flank, and thigh skinfolds. Estimation of fat mass and calculation of percent body fat was performed according to the Dauncey method. Macrosomic infants of diabetic mothers were characterized by larger shoulder and extremity circumferences, a decreased head-to-shoulder ratio, significantly higher body fat, and thicker upper extremity skinfolds compared with nondiabetic control infants of similar birthweight and birth length. Differences in body composition and weight distribution may explain the propensity for shoulder dystocia in the diabetic population.

Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers

The objective was to investigate the hypothesis that anthropometric and body composition differences exist between macrosomic infants of diabetic and nondiabetic mothers. Sixteen infants of mothers with diabetes, along with 58 control infants, were studied within 24 hours of delivery. The following measurements were obtained: birthweight, birth length and extremity length; circumferences of the head, chest, shoulders, and extremities; and triceps, subscapular, flank, and thigh skinfolds. Estimation of fat mass and calculation of percent body fat was performed according to the Dauncey method. Macrosomic infants of diabetic mothers were characterized by larger shoulder and extremity circumferences, a decreased head-to-shoulder ratio, significantly higher body fat, and thicker upper extremity skinfolds compared with nondiabetic control infants of similar birthweight and birth length. Differences in body composition and weight distribution may explain the propensity for shoulder dystocia in the diabetic population. J. Matern.–Fetal Med. 7:292–295, 1998. © 1998 Wiley-Liss, Inc.

Sonographic prediction of shoulder dystocia in infants of diabetic mothers

To determine if the difference between the abdominal diameter and biparietal diameter (AD-BPD difference), as measured by ultrasound examination, predicts shoulder dystocia in borderline macrosomic infants of diabetic mothers. A retrospective study was performed of births occurring from January 1990 through June 1995. Eligibility requirements included diabetic pregnancy, ultrasound examination within 2 weeks of delivery, estimated fetal weight of 3800-4200 g, and vaginal delivery. The mean AD-BPD difference was compared in normal deliveries and those complicated by shoulder dystocia, using the Student t test and by multiple regression analysis. A receiver operating characteristic curve was generated to determine if an AD-BPD cutoff value could be used clinically to predict shoulder dystocia. Thirty-one patients, six with dystocia, were eligible for the study. The mean AD-BPD differences for those with and without shoulder dystocia were 3.1 and 2.6 cm, respectively, a statistically significant difference (P = .05). Comparing the groups with and without shoulder dystocia, no significant differences could be found in mean age, parity, weight, birth weight, or gestational age. Shoulder dystocia occurred in six of 20 patients (30%) in whom the AD-BPD difference was at least 2.6 cm but in none of 11 patients in whom it was less than 2.6 cm, also a statistically significant difference (P = .05). The AD-BPD difference was greater in borderline macrosomic fetuses of diabetic mothers who experienced shoulder dystocia than in those who had uncomplicated vaginal deliveries. Applying an AD-BPD cutoff value of 2.6 cm to this population prospectively would have provided excellent sensitivity, specificity, and predictive value in identifying those fetuses at high risk for birth injury.

Insulin-Like Growth Factors I and II Peptide and Messenger RNA Levels in Macrosomic Infants of Diabetic Pregnancies

Fetal macrosomia is a common complication of maternal diabetes mellitus and is associated with substantial morbidity, but the precise cellular and molecular mechanisms that induce fetal macrosomia are not well understood. We hypothesized that the macrosomia or accelerated fetal growth seen in infants of diabetic mothers is due to a perturbation of a putative placental-fetal growth axis involving growth hormone and insulin-like growth factors. Insulin-like growth factors I and II (IGF-I and IGF-II) are ubiquitous peptides that share structural homology with insulin and have been implicated in processes that control fetal growth. Studies of IGF levels in pregnancies complicated by diabetes and macrosomia have shown conflicting results. We set out to resolve these inconsistencies using molecular techniques to measure the placental IGF-I and IGF-II messenger RNA levels in placentas and a specific radioimmunoassay to measure IGF-I and IGF-II peptide levels in cord serum of normal and diabetic pregnancies. Placentas and cord blood were collected immediately after delivery at term from patients from each of three study groups: 1) nonmacrosomic infants of nondiabetic mothers (controls), 2) macrosomic infants of diabetic mothers, and 3) nonmacrosomic infants of diabetic mothers. Both IGF-I and IGF-II levels were measured in cord serum and placental tissue by a specific radioimmunoassay. Total RNA was extracted and analyzed by Northern gels hybridized to IGF-I or IGF-II riboprobes. Levels of IGF-I in cord serum from the macrosomic diabetic group (83 +/- 4.2 ng/mL) were significantly higher than levels from either the nonmacrosomic nondiabetic group (38 +/- 1.9 ng/mL) or the nonmacrosomic diabetic group (13 +/- 3.5 ng/mL). There was a direct linear correlation between cord serum IGF-I and infant birth weight, independent of diabetes (r2 = 0.61, P < .01). On the other hand, IGF-II cord serum levels were elevated in diabetic pregnancies (337 +/- 12.2 ng/mL) compared with nondiabetic women (172 +/- 19.8 ng/mL), but there was no correlation with birth weight (r2 = 0.035, P = .52). In contrast to cord blood levels, IGF-II peptide levels were significantly decreased in the placentas from mothers with diabetes compared with nondiabetic controls (116 +/- 3.2 versus 158 +/- 5.3 ng/mL, respectively). Levels of IGF-I peptide in placentas from both nondiabetic controls and diabetic mothers were below the sensitivity of the assay. Levels of IGF-I and IGF-II mRNA did not differ in placentas from diabetic mothers versus nondiabetic controls. Cord serum IGF-II levels are elevated in diabetic pregnancies without a concomitant increase in placental IGF-II levels. This novel finding, combined with the finding that IGF-I levels are correlated with macrosomia independent of the diabetic state, contributes to our understanding of the possible mechanisms involved in fetal growth in pregnancies complicated by diabetes.

Insulin-Like Growth Factors in Fetal Macrosomia with and without Maternal Diabetes

Insulin-like growth factors (IGFs/somatomedins) have been implicated as regulators of fetal growth. This study investigates whether IGFs are related to macrosomia in infants of normal or insulin-dependent diabetic mothers. Cord concentrations of IGF-I (radioimmunoassay), total IGF (radioreceptor assay) and IGF binding protein (radiobinding assay) were measured in 15 term infants of diabetic mothers (IDM) and 29 term infants of nondiabetic mothers. In infants of control mothers cord IGF and total IGF levels were significantly higher in large-for-gestational-age than appropriate-for-gestational-age infants; but this relationship was lost in IDM, in whom IGF-I concentrations were similar to control infants. IGF binding protein levels were not significantly different in any of these groups. The absence of elevated IGF levels in macrosomic IDM indicates that the pathologic process does not involve a simple increase in these growth factors.

FETAL GROWTH IN DIABETIC RAT PREGNANCY - IN VIVO AND IN VITRO STUDIES

Macrosomic infants of diabetic mothers are the result of an early growth delay and an augmented growth towards term. Early growth delay appears to be associated with the increased malformations of these infants. In rat pregnancy diabetes produces with no exception small fetuses. The response of fetal cells to different growth factors has been poorly defined. Therefore 48 h post conception 65 mg/kg streptozotocin i.v, were injected and on day 20 5μCi 3-H thyraidine i.p.. On day 21 after a 14 h fast fetuses were delivered and blood glucose (mg/dl), body weight (g), length (cm) and thymidine incorporation (cpm/mg rib cartilage) were determined: M ± SEM; (n).

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.