Newborns Of Diabetic Mothers Research Articles

Investigation on serum C-peptide concentrations in pregnant diabetic women and in newborns of diabetic mothers.

Serum C-peptide concentrations at delivery and neonatal complications were investigated in a group of diabetic mothers and in their infants (IDM, n = 29). Furthermore, the changes in B-cell function and in daily insulin demand was followed up in 12 pregnant diabetics (of them 8 with long-term and 4 with short-term and "mild" diabetes) during pregnancy. All these diabetic mothers were under an intensive metabolic control with the aim to achieve normoglycaemia mainly in the second part of pregnancy. Mean cord blood C-peptide level of 29 IDM was 0,58 +/- 0,43 nmol/l, being not significantly higher than either the average C-peptide concentration of our adult control group (0,50 +/- 0,15 nmol/l, n = 24) or that of seven infants born to healthy mothers (0,58 +/- 0,37 nmol/l). Early hypoglycaemia was observed in five, macrosomia in three and IRDS in one neonate, resp. mothers coming to our intensive care after the 13th week of gestation gave birth with a higher incidence of neonatal complications than those controlled already in the first trimester or even preconceptionally. In 20 of 25 mothers studied venous C-peptide concentrations at delivery were undetectably low, in spite of their infants having cord blood C-peptide levels in the measurable range. In 8 of the 12 diabetic mothers with long-term diabetes C-peptide levels remained under the detection limit of the assay throughout pregnancy. In the 4 other cases with "mild" diabetes (and, hence, with a late start of intensive control) C-peptide values increased in the course of pregnancy; however, 3 of the four mothers gave birth with neonatal complications. These results indicate that (1) early--preferably preconceptional--intensive metabolic control of pregnant diabetics may reduce the incidence of neonatal complications; (2) fetal C-peptide can neither during pregnancy nor at birth pass through the placental barrier, and (3) mothers with "mild" diabetes require the same early and strict metabolic control as the more severe cases to avoid neonatal complications.

The newborn of diabetic rat. I. Hormonal and metabolic changes in the postnatal period.

Summary: In this study we investigated the effects of streptozotocin-induced maternal diabetes on fetal body weight and alterations in the plasma concentrations of glucose, insulin, glucagon and catecholamines, and in the concentrations of pancreatic insulin and glucagon and of hepatic glycogen and cAMP in newborn rats during the first 6 h of life. Hyperglycemia was regulated in one group of diabetic pregnant rats by administration of insulin twice a day from day 18 of gestation. On day 22 of gestation the body weight of newborns of the insulin-treated diabetic rats was significantly higher than that of normal rats, whereas untreated maternal diabetes caused a reduction in the body weight of the newborns. The newborns of insulin-treated diabetic rats maintained lower concentrations of plasma glucose for a longer period compared to the age-matched neonates of normal rats. At birth and during the first 6 postnatal h of life, plasma insulin was significantly higher in the neonates of both treated and untreated diabetic rats than the age-matched pups of normal rats. There was an increase in the concentration of plasma pancreatic glucagon in the newborns of normal rats within 30 min after birth, in contrast, a gradual reduction or no change in the concentrations of plasma glucagon was observed in the neonates of both groups of diabetic rats during the 6 h postnatal period. The concentrations of plasma epinephrine and norepinephrine were very high at birth in the three groups of newborns, and declined rapidly during the first postnatal h. Significant secondary increases in the concentrations of these two hormones occurred in the three groups of neonates after the plasma glucose concentration had declined to below 2 mM. Changes in the insulin:glucagon molar ratio was associated with a delay in the postnatal increase in hepatic cAMP concentrations and also in the initiation of hepatic glycogenolysis in the neonates of both groups of diabetic rats compared to normal animals. The findings of macrosomia, postnatal hyperinsulinemia, prolonged lowered plasma glucose and attenuated plasma glucagon observed in the newborns of the insulin-treated diabetic rats are similar to the findings reported in the newborn infants of insulin-dependent diabetic women. Speculation: Diabetes during pregnancy in the rats described in this study is reproducible and can be regulated with insulin administration. This experimental model should prove useful in quantifying alterations in hepatic glycogen metabolism and gluconeogenesis, and the mechanism(s) responsible for the attenuated glucagon secretory response in newborns of diabetic mothers.

Blood viscosity in umbilical cord blood from babies of diabetic mothers

SummaryCompared with normal babies, whole blood viscosity and packed cell volume were significantly higher in cord blood from the newborn of diabetic mothers. The differences were most marked in macrosomic diabetic babies. Whole blood viscosity and packed cell volume are suggested as retrospective fetal markers of the quality of diabetic control in pregnancy. The concept of hyperviscosity in utero as a cause of intra-uterine death in infants of diabetic mothers is discussed

Cord blood C-peptide: Glucose ratio in the newborn of diabetic mothers

SummaryCord blood C-peptide and glucose have been measured in 32 babies of non-diabetic mothers and 40 babies of diabetic mothers. A significant correlation was found between cord blood C-peptide and glucose in babies of poorly controlled diabetic mothers. A positive correlation was also found between the cord blood C-peptide: glucose ratio and the birth weight ratio in the same group of newborn. The cord blood C-peptide and C-peptide: glucose ratio was raised in nearly half of the babies of poorly controlled diabetic mothers and was frequently associated with neonatal hypoglycaemia

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.

Hypoglycemia in Newborns of Diabetic Mothers and the CPR Levels of Cord Blood

Hypoglycemia in Newborns of Diabetic Mothers and the CPR Levels of Cord Blood

The assessment of lung maturity in infants of diabetic mothers, by means of L/S ratio determination in tracheo-pharyngeal aspirate.

The respiratory distress syndrome is more common in the newborns of diabetic mothers. The comparatively high rate of incidence of this syndrome depends neither on gestational age nor delivery route. In view of these facts, the evaluation of fetal lung maturation of diabetic mothers seems to be of the utmost importance. The methods usually employed for the determination of fetal lung maturation are of limited value, because occasionally L/S ratio values, which usually indicate fetal lung maturation, may fall to below critical levels. It is, therefore, extremely important to assess lung maturity in the newborn of a diabetic mother at the time of delivery. In 15 pregnancies complicated by diabetes mellitus of all degrees of severity (A-D), according to the classification of P. WHITE, L/S ratio in amniotic fluid prior to delivery was determined. L/S ratio was determined in tracheopharyngeal aspirate, as well, soon after delivery. In all cases the foam stability test was done in the amniotic fluid before delivery and, when there was a sufficient quantity, also in the tracheo-pharyngeal aspirate. According to the foam test and L/S ratio in the amniotic fluid, all fetuses supposedly had normally matured lungs. Nevertheless, according to these two tests in the tracheopharyngeal aspirate, results indicate lack of full lung maturity in four cases. In fact, all these four newborns developed the respiratory distress syndrome. This test appears to be reliable, simple and non-invasive, and is therefore recommended in babies with diabetes of all degrees of severity, and in all gestational ages.

Effect of human chorionic gonadotropin on blood free fatty acids, glucose and on the release of free fatty acids from subcutaneous adipose tissue in various groups of newborn and adults.

After administration of human chorionic gonadotropin (HCG; 500 IU/kg intramuscularly), the blood concentration of free fatty acids increases within 30 min in 1-day-old full-term, premature and small-for-data newborns. This effect does not appear in 1-day-old newborns of diabetic mothers with insulin-dependent diabetes, in 7-day-old newborns nor in adults. Glucose concentration rises in all groups of newborns, and no effect is observed in adults. In the in vitro study, HCG increases lipolysis in newborns' adipose tissue. This effect was not observed in adults.

The effect of maternal diabetes on adipose tissue cellularity in man and rat.

It is well recognised that the newborn of diabetic mothers may be overweight and obese, presumably due to excessive glucose and insulin levels in the fetus. Since recent evidence indicates that the number of fat cells is established early in life, we studied the effect of intrauterine hyperglycaemia and hyperinsulinaemia on adipose tissue cellularity. Six men (age range 21–26 years) and six women (age range 18–24 years) were investigated. Their weights at birth generally exceeded the average value by 2 S.D. As a group they were not obese at the time of the investigation and neither total number of fat cells, average cell size nor body fat differed significantly from controls of the same age. There was no correlation between the number of fat cells and the weight at birth. The adipose tissue cellularity in the offspring of alloxan-diabetic rats (AX) and in controls (C) of equal weight was also studied. When sacrificed (after 40 days) body weights and the weights of the epididymal and retroperitoneal fat pads were similar in the AX and C groups. However, the number of fat cells of the retroperitoneal fat pad was significantly increased in the AX group, while the cell size was slightly diminished. Cell data of the epididymal fat pads were not significantly different. The results indicate that excessive glucose and insulin levels in utero may influence the number of fat cells, but, in man, they do not seem to lead to a permanent hyperplasia of the adipose tissue.

Plazentabefunde bei Neugeborenen diabetischer Mütter mit einem Geburtsgewicht unter 3000 g

From a material of 250 newborns of diabetic mothers we have selected 45 cases with a birthweight of less than 3,000 g. Among those, there were 14 doubtful and positively growth-retarded newborns. Retardation is supposed to be due to maternal diabetes, malformations of the umbilical cord and of the newborns, abuse of nicotine during pregnancy, and postmaturity and toxaemia. In the light of all our investigation results it seems likely that intrauterine somatic retardation is caused by maternal diabetes <i>per se.</i>

Errors in the treatment of diabetes mellitus in pregnancy

Out of 248 newborns of diabetic mothers 40 were lost in the period 1952–1963. All losses were analyzed from the point of view whether every single loss was avoidable or unavoidable. It was concluded that 22 children could have been saved if no errors in the medical care happened. The errors were:

The Significance of Hypoglycaemia in the Newborn Infant of the Diabetic Woman

Newborn infants of diabetic mothers commonly develop remarkably low concentrations of sugar in the blood within a few hours after birth. This has led many to believe that the high morbidity and mortality in these infants might be due to hypoglycaemia. The present study concerns 90 infants born to diabetic women. The frequent occurrence of hypoglycaemia in the newborn of diabetic mothers was confirmed. However, it was found that there was no relationship between the development of a morbid neonatal course and the concentration of sugar in the blood at time, or the extent and rapidity of the decrease in concentration. No correlation existed between the degree of hypoglycaemia and abnormal incidents in the first 2 weeks of life. The authors agree with the opinion held by most investigators, that there is no need to administer glucose to infants born of diabetic women. In these infants, oral administration of glucose is hazardous and administration of glucose solutions subcutaneously or intravenously only serves to increase the abnormal volume of body water, and may embarrass the heart. The authors advise that all fluid should be withheld from these infants until time fourth or fifth day of life. They found no evidence that the period of hypoglycaemia in the neonatal period was followed by subnormal intelligence in later childhood.

The newborn of diabetic mothers

The newborn of diabetic mothers