Non-diabetic Mothers Research Articles

PL.53 A Retrospective Analysis on Complications and Management of Macrosomic Babies

IntroductionConsiderable disparity has been noticed in macrosomic deliveries due to lack of recognised guideline in the management of macrosomia. In this study, we determined risk factors predicting macrosomia and associated...

Adipokines vaspin and omentin-1 are up-regulated in large for gestational age infants at term

ObjectiveLarge- (LGA) and appropriate-for-gestational age (AGA) infants differ in body fat mass and metabolic/endocrine mechanisms. We aimed to investigate in LGA and AGA infants possible alterations in cord blood levels of insulin and the adipokines vaspin and omentin-1 which are secreted by the adipose tissue and are implicated in insulin resistance/metabolic syndrome. MethodsCord blood vaspin, omentin-1 and insulin levels were prospectively measured in 61 LGA and 36 AGA singleton full-term infants. Of the LGA group 13 infants were born from diabetic and 48 from non-diabetic mothers. ResultsCord blood vaspin and omentin-1 levels were significantly higher in LGA compared with AGA neonates (p=0.021 and b=0.115, SE 0.037, p=0.002, respectively). Umbilical cord omentin-1 levels were significantly decreased in neonates delivered vaginally (b=−0.075, SE 0.031, p=0.016), after controlling for group. Insulin levels increased in proportion to the customized centiles of the infants (b=0.004, SE=0.001, p=0.009). Finally, in the LGA group vaspin levels correlated with omentin-1 serum levels (r=0.318, p=0.013). ConclusionsThe increased levels of vaspin observed in LGA infants compared with AGA ones, possibly represent a defensive mechanism against insulin/glucose dysregulation, commonly seen in the former. In addition, the increased omentin-1 levels in the LGA group could possibly reflect the amount of developing adipose tissue in the early stages of life in this group. Alternatively, these levels could reflect the growth-promoting effect of omentin-1 in the fetus. The inflammation associated with vaginal deliveries may account for the lower cord blood omentin-1 levels in neonates delivered by this mode.

Neonatal Morbidity in Macrosomic Newborns Born to Diabetic and Nondiabetic Mothers

Aim: To compare the early neonatal problems of macrosomic babies born to diabetic and nondiabetic mothers . Methods: The files of 220 babies born in the past 3 years with a birthweight ≥4000 g were analysed retrospectively, and babies with missing data were excluded from the analysis (n=61). The data of 63 babies born to diabetic mothers and 96 babies born to nondiabetics were analysed (n=159). Maternal age, gravidity, parity, method of delivery, babies’ gestational age, gender, anthropometric measurements, birth traumas, cord blood gases, Apgar scores, respiratory problems, hypoglycemia, polycythemia, hyperbilirubinemia, pathological weight loss and duration of hospitalization were recorded. Statistical analyses were performed by Windows SPSS program, with a p<0.05 as a criteria for significance. Results: Gravidity was higher in the diabetic group (2.8 vs 2.2), while parity was the same. Gestational age (39 vs 39 5/7 wks) and pH was lower (7.29 vs 7.31), and hematocrit was higher in the diabetic group (59 % vs 56 %). Pathological weight loss was more frequent in the nondiabetic group (42 % vs 27 %). Hypoglycemia was seen more often in the diabetic group (31 % vs 15 %). There were no significant differences in other variables between the two groups. Conclusion: Hypoglycemia is more frequent in macrosomic babies born to diabetic mothers compared with babies of nondiabetics, while macrosomic babies of nondiabetics experience hypoglycemia more often than babies with normal birthweights. There are no differences for other complications between two groups. Thus, the follow-up principles of macrosomic infants should be the same, independent of the mother’s diabetic status.

Gut hormone activity of children born to women with and without gestational diabetes

What is already known about this subject Children born to women with gestational diabetes have greater risk for obesity. Obesity in adults and children is associated with blunted postprandial gut hormone responses. What this study adds Children of women with gestational diabetes have a blunted postprandial response of GLP-1. Children of women with gestational diabetes have high fasting PYY concentrations. Intrauterine exposure to gestational diabetes mellitus (GDM) increases risk for obesity. Obesity is associated with a blunted postprandial gut hormone response, which may impair satiety and thereby contribute to weight gain. The postprandial response of gut hormones among children of women with GDM has not previously been investigated. To examine whether children of women with GDM have suppressed peptide-tyrosine-tyrosine (PYY) and glucagon-like-peptide-1 (GLP-1), and higher concentrations of ghrelin, following a meal challenge. A secondary objective was to investigate associations of these hormones with children's free-living energy intake. Children (n = 42) aged 5-10 years were stratified into two groups: offspring of GDM mothers (OGD) and of non-diabetic mothers (CTRL). Body composition was measured by dual-energy X-ray absorptiometry, and circulating PYY, GLP-1 and total ghrelin were measured during a liquid meal challenge. Energy intake was assessed by three 24-h diet recalls. Between-groups analyses of fasting and incremental area under the curve (AUC) found no differences in ghrelin. Incremental AUC for GLP-1 was greater among the CTRL vs. OGD (P < 0.05), and fasting PYY, but not incremental AUC, was higher among OGD vs. CTRL (P < 0.01). Associations of fasting and incremental AUC for each gut hormone with children's usual energy intake did not differ significantly by group. Further research is needed to more fully examine the potential role of postprandial GLP-1 suppression and high-fasting PYY concentrations on the feeding behaviour and risk for obesity among children exposed to GDM in utero.

Short Term Outcome Of Macrosomic Neonates Of Diabetic &amp; Non-Diabetic Mothers

Background: Big birth weight is one of the important factors affecting the perinatal morbidity &amp; mortality. It may result in an irreversible squeal because of birth trauma &amp; fetal asphyxia.Patients &amp; Methods: This is a prospective study of 50 singleton macrosomic newborns weighting 4000 g &amp; more aged 1-3 days admitted in the neonatal care unit of Children Welfare Teaching Hospital &amp; Baghdad Teaching Hospital during a 6 months period from 1st of March to 1st of September 2010. The maternal &amp; neonatal records were reviewed &amp; infant morbidities including hypoglycemia, respiratory distress, feeding intolerance, birth injury &amp; associated anomalies were discussed. All the infants were followed until they were discharged from the hospital.Objectives: to compare the short term outcomes of macrosomic infants born to diabetic and non-diabetic mothers.&#x0D; Results: Infants of diabetic mothers (52%) were more likely to develop neonatal morbidity compared to infants of non diabetic mothers (48%), these include hypoglycemia (76.9% vs. 8.3%), Respiratory distress (61.5% vs. 37.5%), and birth injury (7.7% vs. 4.2%) &amp; nearly equal incidence of feeding intolerance (11.5% vs. 12.5%). Associated anomalies especially congenital heart disease (10%) found in infant of diabetic mothers only.&#x0D; Conclusions: Most of birth weight variation remains unexplained &amp; most non-IDM macrosomic infants do not have identifiable risk factors. Macrosomia is generally associated with neonatal morbidity &amp; neonatal injury. The potential dangers of birth injury in vaginal delivery have increased the rates of cesarean section to (68%). Infants of diabetic mothers have a higher rate of neonatal morbidity overall including hypoglycemia, respiratory distress, birth injury &amp; congenital heart disease.

2-Hour postload serum glucose levels and maternal blood pressure as independent predictors of birth weight in "appropriate for gestational age" neonates in healthy nondiabetic pregnancies.

Introduction. Increased neonatal birth weight (NBW), often associated with diabetic pregnancies, is a recognized indicator of childhood obesity and future metabolic risk. Predictors of NBW in healthy non-diabetic pregnancies are not yet established. Here, we investigated the association of maternal parameters of healthy non-diabetic mothers with NBW of their “appropriate-for-gestational age” neonates. Methods. The study involved 36 healthy mother/infant pairs. Examined parameters included NBW, maternal age, first and last trimester (BMI), weight gain, fasting serum lipids and glucose, 2-hour postload glucose levels and blood pressure. Results. Postload-glucose levels were significantly higher in mothers of heavier neonates. ANOVA results indicated that 15% increase in postload-glucose levels corresponded to more than 0.5 Kg increase in NBW in the third tertile. NBW correlated positively with postload glucose levels, and negatively with systolic blood pressure. Regression analysis showed that the main predictors of NBW were postload-glucose levels (B = 0.455, P = 0.003), followed by systolic blood pressure (B = −0.447, P = 0.004), together predicting 31.7% NBW variation. Conclusion. This study highlights that increased maternal postload sugar levels and blood pressure, within the normal range, highly predicts NBW of healthy mothers. These findings may provide focus for early dietary intervention measures to avoid future risks to the mother and baby.

261: Cord serum C peptide levels in large-for-gestational age infants in diabetic and non-diabetic mothers

261: Cord serum C peptide levels in large-for-gestational age infants in diabetic and non-diabetic mothers

Cord blood nesfatin-1 in large for gestational age pregnancies

ObjectiveTo investigate possible alterations in cord blood levels of adipokine nesfatin-1 (secreted by adipose tissue and pancreatic β-cells and implicated in glucose metabolism and insulin resistance), as well as insulin, in large (LGA) and appropriate for gestational age (AGA) pregnancies, granted that these groups differ in body fat mass and metabolic/endocrine mechanisms. Materials and methodsCord blood nesfatin-1 and insulin concentrations were prospectively measured in 40 LGA (9 born from diabetic and 31 from non-diabetic mothers) and 20 AGA singleton full-term infants as well as their mothers. ResultsCord blood nesfatin-1 concentrations were significantly lower in LGA compared to AGA neonates (b=−0.206, SE 0.07, p=0.005). However, cord blood nesfatin-1 concentrations were elevated in infants born from mothers with gestational diabetes mellitus (GDM), compared to those born from non-diabetic mothers, after controlling for group (b=0.190, SE 0.10, p=0.05). Finally, cord blood nesfatin-1 concentrations were lower in cases of vaginal delivery (b=0.11, SE 0.05, p=0.042). Insulin levels were significantly elevated, as customized centiles increased (b=0.004, SE=0.002, p=0.016). No significant correlation was found between insulin and nesfatin-1 in maternal and umbilical cord levels. ConclusionsIn this study nesfatin-1 levels are decreased in LGA compared to AGA fetuses. Fetal nesfatin-1 concentrations are higher in cases of GDM and cord blood nesfatin-1 concentrations are lower in cases of vaginal delivery.

Cord blood chemerin and obestatin levels in large for gestational age infants

Objective: To investigate possible alterations in cord blood levels of adipokines, chemerin and obestatin (secreted by adipose tissue and associated with later development of insulin resistance/metabolic syndrome), as well as insulin, in large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies, granted that these groups differ in body fat mass and metabolic/endocrine mechanisms. Methods: Cord blood chemerin, obestatin, and insulin concentrations were prospectively measured in 40 LGA (9 born from diabetic and 31 from nondiabetic mothers) and 40 AGA singleton full-term infants. Results: Cord blood chemerin concentrations were significantly higher in LGA compared with AGA neonates (b = 38.91, SE 9.29, p < 0.001). In contrast, no significant differences in obestatin concentrations were observed between groups. Insulin levels were significantly elevated as customized centiles increased (b = 0.003, SE = 0.001, p = 0.032). Conclusions: Higher chemerin concentrations in LGA neonates possibly reflect the increased adipose tissue in this group. Lack of difference between the two groups in circulating levels of obestatin–possibly a sensitive marker of insulin resistance–might be due to development of metabolic disorders later in life.

351 Differential Regulation of Cord Blood Nesfatin-1 in Large for Gestational Age Pregnancies

Background and AimsLarge-for-gestational-age (LGA) infants are at increased risk for developing alterations in metabolic programming, which may lead to impaired glucose homeostasis during infancy, childhood and adulthood. Adipocytokines play an...

1350 Low 25-Hydroxyvitamin D Level and Adiponectin is Associated with Insulin Sensitivity in Large Gestational Age Infants

ObjectiveTo investigate the relationship between adipokines (visfatin, adiponectin) and 25-hydroxyvitamin D (25(OH)D), and markers of insulin sensitivity in large for gestational age (LGA) infants.Patients and MethodsForty LGA infants (25 LGA...

984 Population-Based Study to Evaluate the Neonatal Morbidity and Mortality in Maternal Diabetes

AimThe aim of the study is to determine any connections between maternal diabetes and the pregnancy outcome of mothers and newborns.MethodsFrom 03/2003 to 11/2008 in local and university hospitals in...

354 Adipocytokines Omentin and Vaspin are Upregulated in Large for Gestational Age Fetuses at Term

Background and AimsFetal macrosomia is associated with significant perinatal and long-term complications, including higher risk for later development of insulin resistance/metabolic syndrome. Besides regulating whole body metabolism, adipocytokines have been...

220 Cord Blood Chemerin and Obestatin in Large for Gestational Age Infants

Background and aimsIncreased neonatal adiposity is associated with childhood obesity and subsequent development of adult diseases. Chemerin was recently introduced as a novel adipocytokine inducing insulin resistance and regulating maternal-fetal...

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case–Control Study

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women. A case-control study with 286 cases and 292 age-matched controls was conducted for a period of 11months (August 2007-June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India. Universal screening was applied by means of glucose challenge test (GCT) using 50g of glucose. If GCT >130mg%, the patients were subjected to oral glucose tolerance test with 100g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed. Univariate analysis was done by means of t test, Odd's ratio, Chi-square test, and Fisher Exact test. P<0.05 was taken as significant. The frequency of induction of labor was significantly higher than spontaneous labor (OR=1.84, P=0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR=1.66, P=0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR=2.3, P=0.007). Hypoglycemia was the most common neonatal complication (OR=11.97, P<0.001) and nine babies of diabetic mothers were macrosomic (OR=5.2, P=0.02). Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.

Decelerated Early Growth in Infants of Overweight and Obese Mothers

To investigate the relationship between maternal prepregnancy body mass index and early infant growth and body composition. Prospective cohort study performed at a university hospital/surrounding community. Ninety-seven nondiabetic mothers with singleton, term, healthy infants completed study visits at 2 weeks and 3 months of age. Before pregnancy, 59 mothers were normal weight, 18 were overweight, and 20 were obese. Infant anthropometrics and body composition via air-displacement plethysmography were measured. Infant feeding information and maternal prepregnancy weight were self-reported. Additional data were obtained via self-report and the medical record. Main outcome measures were change in weight, length, fat-free mass, and fat mass from 2 weeks to 3 months of age. Analysis was done via multivariate linear regression. At 2 weeks, anthropometrics and body composition did not differ across maternal body mass index groups. At 3 months, infants of overweight or obese mothers had gained less weight (P = .02), grew less in length (P = .01), and gained less fat mass (P = .01). Adjustment for breastfeeding status and regression to the mean via conditional change variables did not alter the results. The results were not altered after adjusting for maternal glucose values from a 50-g glucose challenge and for maternal smoking in a subset including 80% of the women. Maternal overweight/obesity is associated with early deceleration in linear growth and adipose tissue accrual; replication of these findings is needed.

Seroconversion to Islet Autoantibodies After Enterovirus Infection in Early Pregnancy

Gestational enterovirus (EV) infections have been associated with an increased risk for type 1 diabetes in the offspring. We therefore analyzed non-diabetic mothers for EV exposure in early pregnancy in relation to type 1 diabetes HLA-DQ risk genotypes and seroconversion to islet autoantibodies during pregnancy. Non-diabetic mothers who had islet autoantibodies (n=365) against glutamic acid decarboxylase (GADA), islet antigen-2 autoantibodies (IA-2A), or insulin autoantibodies (IAA), in early pregnancy and at delivery were compared to islet autoantibody-negative mothers (n=1457) matched for age and sampling date. Mothers were genotyped for HLA-DQ and analyzed for both EV-RNA and EV-IgM. EV-IgM, but not EV-RNA, was detected during early pregnancy in 12% of islet autoantibody-positive mothers compared to 11% of the controls. In early pregnancy, mothers with HLA-DQ 2/2 or 2/X genotypes showed an increased risk for islet autoantibodies at delivery (OR 1.85; p=0.001). After adjusting for parity, maternal age, year of birth, and season of early pregnancy, early pregnancy EV-IgM combined with DQ2/2 or 2/X increased the risk for islet autoantibodies (OR 3.10; 95% CI 1; p=0.008). EV-IgM in early pregnancy increased the risk for islet autoantibodies at delivery in non-diabetic mothers with HLA-DQ 2/2 or 2/X type 1 diabetes risk genotypes.

Low 25-hydroxyvitamin D level and adiponectin is associated with insulin sensitivity in large gestational age infants

ObjectiveTo investigate the relationship between adipokines (visfatin, adiponectin) and 25-hydroxyvitamin D (25(OH)D), and markers of insulin sensitivity in large for gestational age (LGA) infants. Patients and methodsForty LGA infants (25 LGA born to diabetic mothers and 15 LGA born to non-diabetic mothers) and 34 appropriate for gestational age (AGA) infants were recruited. ResultsFGIR, QUICK-I, adiponectin and 25(OH)D levels were significantly lower in LGA with diabetic mother group than AGA and LGA with non-diabetic mother group. HOMA-IR, fasting insulin, visfatin and parathormone (PTH) levels were significantly higher in LGA with diabetic mother group than AGA and LGA with non-diabetic mother group. ConclusionBased on the findings of this study, visfatin, adiponectin and 25(OH)D levels can be used as specific markers for insulin sensitivity and may help advance new therapies for glucose intolerance spectrum.