Presence Of Maternal Diabetes Research Articles

Neonatal Outcome of Pregnancies with Oligohydramnios and Polyhydramnios

Objective: To asses’ factors associated with neonatal outcome of pregnancies with oligohydramnios and polyhydramnios.
 Study Design: Comparative Cross-sectional Study.
 Place and Duration of Study: Department of Pediatrics and Gynecology, Fauji Foundation Hospital, Lahore Pakistan, from Oct 2020 to Sep 2021
 Methodology: A prospective comparative study was conducted on the babies born to mothers diagnosed witholigohydramnios and polyhydramnios during the course of pregnancy. Neonates were evaluated by neonatologist within first 24 hours of birth. The cases were admitted and well babies were handed over to parents. The neonatal outcome parameters were observed in all these babies for first two weeks of life. Those who lost follow up they were excluded from study. Age of mother, gestational age of baby, maternal hypertension and maternal diabetes were associated with presence of complications among these babies.
 Results: Two thousand One hundred and Twenty-nine deliveries took place in given duration. About 322 had either polyhydramnios or oligohydramnios. About 150 cases could be followed completely. Fifty-five (36.7%) showed presence of one or more complications, of which 29(41.4%) cases had oligohydramnios and 26(32.5%) had polyhydramnios. Maternal age and presence of maternal diabetes and maternal hypertension had statistically significant association with complications in neonates (p-value <0.005).
 Conclusion: Complications rate was high among neonates born to mothers with oligohydramnios or polyhydramnios. Advanced maternal age, presence of diabetes mellitus and hypertension were factors association with presence of complications in neonates included in our study.

Normative echocardiography data of myocardial adaptation to extrauterine life: a review of prospective studies.

Recent research has increased focus and interest in characterizing the physiology of the transition circulation using echocardiography. Critique of published normative neonatal echocardiography data among healthy term neonates has not been performed. We have performed a comprehensive literature review using the key terms: cardiac adaptation, hemodynamics, neonatal transition, term newborns. Studies were included if they had reported echocardiography indices of cardiovascular function in the presence of maternal diabetes, intrauterine growth restricted newborns and prematurity and had a comparison group of healthy term newborns within first seven postnatal days. Sixteen published studies evaluating transitional circulation in healthy newborns were included. There was marked heterogeneity in the methodologies used; specifically, inconsistency in time of evaluation and imaging techniques used makes it challenging to determine specific trends of expected physiologic changes. Some studies revealed nomograms for echocardiography indices, though limitations persist in terms of sample size, number of reported parameters and consistency of measurement technique. A comprehensive standardized echocardiography framework which includes consistent techniques for assessment dimensions, function, blood flow, pulmonary/systemic vascular resistance, and shunts pattern is warranted to ensure consistency in the use of echocardiography to guide care of healthy and sick newborns.

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..

Echocardiographic findings in infants of diabetic mothers and their relation to maternal glycemic control

Background Diabetes mellitus during pregnancy is a common risk factor for both mothers and infants. Prediction of cardiac problems in infants of diabetic mothers is challenging. Aim The purpose of the study is to determine the type and incidence of congenital heart diseases in infants whose mothers are diabetic in the NICU of Alexandria university maternity hospital, as well as to evaluate functional and morphological changes in the myocardium and its relationship to maternal glycemic control. Patients and methods A case-control study was conducted in the NICU of Alexandria University Hospital. Thirty-five infants of diabetic mothers (IDM) were compared to 37 healthy control infants. All diabetic mothers had their HBA1C levels measured before delivery. Therefore, the infants of diabetic mothers were further divided into 22 infants whose mothers had controlled diabetes (controlled DMM group; controlled diabetes mellitus mothers group) during pregnancy (predelivery HBA1C≤6.5) and 13 infants whose mothers had uncontrolled diabetes during pregnancy (uncontrolled DMM group). All studied infants were scanned for the presence of congenital heart diseases. Right and left ventricular systolic functions were assessed, and septal and left ventricular dimensions were measured using functional echocardiography (FE). Followup scans were done 1–2 months later. This work was registered on clinical trial.gov NCT05050058 Results Incidence of congenital heart diseases is significantly increased in infants of diabetic mothers compared to healthy control group with P value =0.008. Intraventricular septal thickness and left ventricular posterior wall during systole and diastole (IVSs, IVSd, LVPWs, LVPWd and IVSd/ LVPWd ratio) significantly increased in IDM group. Patients whose mothers had uncontrolled diabetes had their IVSd and IVSd/ LVPWd ratio markedly increased over the uncontrolled group. After 45–60 days the septal and posterior wall measures during systole and diastole decreased significantly. Tricuspid regurge (TR) gradient is markedly increased in IDM in the first 24 h after birth, specifically in infants with mothers with poor glycemic control during pregnancy. Conclusion Infants of diabetic mothers were significantly more likely to suffer from ASD, VSD, and complex heart disease. Complex heart diseases were significantly associated with pregestational maternal diabetes. Infants of diabetic mothers with poor glycemic control have affected IVSd and IVSd/LVPWd ratios. Ventricular septal and LVPW measures were markedly improved after 45–60 days of age .Neither the presence of maternal diabetes nor the diabetic control of mothers affected the right and left ventricular functions of their infants.

Risk Factors and Outcome of Neonatal Hyperbilirubinemia: A Case Control Study in a Tertiary Level Paediatric Hospital

Introduction: Neonatal jaundice is one of the most common morbidities observed during the neonatal period. Several risk factors are responsible for this condition.
 Objective: This study was aimed to determine the possible risk factors and immediate outcome for jaundice in newborns.
 Methods: This case control study was performed over a period of 18 months (March 2019 -August 2020) in the Special Care Newborn Unit (SCANU) of Dr. M R Khan Shishu Hospital & Institute of Child Health (ICH). Risk factors for jaundice were evaluated by comparing cases with jaundice and controls having no jaundice.
 Results: A total of 230 neonates with jaundice and 250 neonates having no jaundice were enrolled. Maternal age between 31-40 years, less than 4 antenatal visits, primi, presence of maternal diabetes, babies born via caesarian section, small for gestational age, prematurity and intra-uterine growth restriction were significantly associated with jaundice in neonates (p value < 0.05). Multi-variate analysis revealed, babies with mothers having <4 antenatal visits were found to have 13 times more risk of developing jaundice than their matched controls (p= 0.00, CI= 0.78-14.9). Mean duration of phototherapy was longer for babies having jaundice due to blood group incompatibilities (4.82 ± 1.94). Most of the patients (91%) were discharged to home.
 Conclusion: Less than four antenatal visit is a significant risk factor for neonates to develop significant jaundice requiring treatment. Babies with blood group incompatibilities tend to require longer duration of phototherapy wherever most of the babies discharged to home with good recovery.
 DS (Child) H J 2021; 37(2): 109-115

Percent error of ultrasound examination to estimate fetal weight at term in different categories of birth weight with focus on maternal diabetes and obesity

BackgroundSonography based estimate of fetal weight is a considerable issue for delivery planning. The study evaluated the influence of diabetes, obesity, excess weight gain, fetal and neonatal anthropometrics on accuracy of estimated fetal weight with respect to the extent of the percent error of estimated fetal weight to birth weight for different categories.MethodsMulticenter retrospective analysis from 11,049 term deliveries and fetal ultrasound biometry performed within 14 days to delivery. Estimated fetal weight was calculated by Hadlock IV. Percent error from birth weight was determined for categories in 250 g increments between 2500 g and 4500 g. Estimated fetal weight accuracy was categorized as accurate ≤ 10% of birth weight, under- and overestimated by > ± 10% – ± 20% and > 20%.ResultsDiabetes was diagnosed in 12.5%, obesity in 12.6% and weight gain exceeding IOM recommendation in 49.1% of the women. The percentage of accurate estimated fetal weight was not significantly different in the presence of maternal diabetes (70.0% vs. 71.8%, p = 0.17), obesity (69.6% vs. 71.9%, p = 0.08) or excess weight gain (71.2% vs. 72%, p = 0.352) but of preexisting diabetes (61.1% vs. 71.7%; p = 0.007) that was associated with the highest macrosomia rate (26.9%). Mean percent error of estimated fetal weight from birth weight was 2.39% ± 9.13%. The extent of percent error varied with birth weight with the lowest numbers for 3000 g–3249 g and increasing with the extent of birth weight variation: 5% ± 11% overestimation in the lowest and 12% ± 8% underestimation in the highest ranges.ConclusionDiabetes, obesity and excess weight gain are not necessarily confounders of estimated fetal weight accuracy. Percent error of estimated fetal weight is closely related to birth weight with clinically relevant over- and underestimation at both extremes. This work provides detailed data regarding the extent of percent error for different birth weight categories and may therefore improve delivery planning.

Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease.

The study was designed to assess the impact of socioeconomic barriers on the rate of prenatal diagnosis of critical congenital heart disease (CCHD). This was a retrospective review of the Medicaid analytic extract (MAX) dataset, a national Medicaid administrative claims database with linked maternal-infant claims, from 2007 to 2012. Infants with CCHD were identified by searching for International Classification of Diseases (ICD) 9 codes and Procedural Coding System (PCS) codes for CCHD within the first 6 months after the delivery date. Multivariate logistic regression was used to evaluate the effect of maternal and socioeconomic factors on the prenatal diagnosis rate. There were 4702 mother-infant dyads included in the analysis. The prenatal diagnosis rate of CCHD was 27.9%. Factors independently associated with odds of prenatal diagnosis of CCHD were presence of maternal diabetes (OR, 2.055; P < .001), ZIP code level median household income (OR, 1.005; P = .015), sonographer labor quotient (OR, 1.804; P = .047), the year of the delivery (OR, 1.155; P < .001), and needing a view other than a 4 chamber or outflow tract view to obtain the diagnosis (OR, 0.383; P < .001). Maternal health, diabetes, socioeconomic factors, and access to sonographers impacts prenatal diagnosis of CCHD.

1347-P: Contraception Preferences in Women with Diabetes

Objective: Effective contraception use in women with diabetes until glucose control is achieved is one of the key factors for optimizing pregnancy outcomes in this high-risk population. The objective of this analysis was to examine whether contraception utilization varied by presence of maternal diabetes. Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women age 18-44 were included in the analysis. Maternal diabetes was defined as either the presence of pre-gestational diabetes or diagnosis of gestational diabetes. Bivariate and multivariable logistic regression analyses were run to evaluate the association between the use of contraception by contraception type (sterilization, long-acting reversible contraception (LARC), other hormonal method, barrier method and none) and maternal diabetes status. Results: A total of 28,454 women were included in the analysis, with 3,003 (10.5%) women with diabetes during pregnancy. Women with diabetes were less likely to use LARC (7.2% vs. 10.7%) or barrier methods (14.4% vs. 17.6%) compared to controls (p&amp;lt;0.001 for both comparisons). The utilization rates of sterilization and other hormonal methods did not differ between the groups. In multivariable logistic regression, controlling for maternal age, race/ethnicity, body mass index, insurance, education, marital status, family income and diagnosis of sexually transmitted infection, maternal diabetes remained to be significantly associated with lower utilization rates of LARC (aOR=0.73, 95% CI 0.55-0.97) and barrier methods (aOR=0.76, 95% CI 0.59-0.97). Conclusions: In this cohort, women with diabetes were less likely to choose LARC and barrier methods for contraception. As LARC is one of the more effective and safest options of contraception in this high-risk population, further research is required to understand the causes behind this variation in contraception utilization. Disclosure S.L. Walker: None. R. Anguzu: None. L.E. Egede: None. A. Palatnik: None.

Risk Factors and Complications of Newborns with Birth Defect: A Hospital based Case-Control Study

Background: Birth defect is one of the most important causes of neonatal mortality worldwide. In a developing country like Bangladesh many possible factors for birth defects are present which should be identified. This study was performed to determine those risk factors of birth defect and complications associated with it.&#x0D; Materials and Methods: A hospital based matched case-control study was conducted from August 2015 to July 2016 in department of Neonatology along with Obstetrics and Gynecology at BSMMU. A total of 98 mother-infant pair (49 babies with birth defect as cases and 49 healthy babies without any birth defects as controls) was included in the study. For each case, a gestational age, sex and post-natal age matched control was taken. Data was collected by face to face interview. Univariate and multivariate conditional logistic regression models were computed to examine the effect of independent variables on outcome variable using SPSS 23.0. Variables with p-value &lt;0.05 were considered statistically significant.&#x0D; Results: The mean (± SD) birth weight for cases and controls were 2718.37 (±756.9) grams, and 2617.14 (±978.8) grams respectively. Cardiovascular system was the predominant system (21%) involved in birth defects. Maternal age between 20-29 years (AOR: 4.69; 95% CI 1.078, 20.448), less than four antenatal care visits (AOR: 10.07; 95% CI 2.816, 36.0), no multivitamin intake (AOR: 7.38; 95% CI 1.791, 30.365) and presence of maternal diabetes (AOR: 0.194; 95% CI 0.047, 0.799) were significantly associated with birth defects among newborns. Sepsis, asphyxia, hypoglycemia and dyselectrolytemia were the most prevalent problems among these babies. The need of intravenous fluid, thermal care, antibiotics and mechanical ventilation was also high among the cases.&#x0D; Conclusion: Birth defect is an upcoming issue in current newborn health situation which need to be prioritized. Significant risk factors should be addressed timely for early diagnosis and proper management of these babies can help in reduction of mortality.&#x0D; Bangladesh Journal of Medical Science Vol.19(1) 2020 p.133-140

1392-P: The Potential Role of Placental α2-Adrenergic Receptors in the High Risk of Preeclampsia in Diabetes

Preeclampsia is a life-threatening complication of pregnancy that occurs four times more frequently in the presence of maternal diabetes. The anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt1), released from the placenta, plays a crucial role in PE development. Alpha 2-adrenoceptor (A2AR) dysfunction has been reported in diabetes, and is implicated in the development of vascular complications. Furthermore, A2AR agonist antihypertensive agents are frequently used to treat patients with preeclampsia, whether they have a disease-modifying role is unclear. We hypothesized that A2AR dysfunction could underlie up-regulation of placental sFlt1 expression, thus ‘driving’ preeclampsia in diabetes. We treated cultured human trophoblasts (HTR8/SVneo) with a stressor often present in the diabetic vasculature, ‘heavily oxidized, glycated’ low-density lipoproteins (HOG-LDL), vs. native LDL (at 100 µg protein/ml) with or without the A2AR agonist, clonidine, and antagonist, yohimbine (24h; both drugs at 10 μM and 100 μM). We determined α2A-, α2B- and α2C-AR mRNA expression (RT-PCR) and immunostaining; sFlt1 mRNA expression and protein release (ELISA); and cell viability (Cell Counting Kit-8 assay). Experiments were repeated three times independently. We found that all three A2AR subtypes were expressed in human trophoblasts. HOG- vs. N-LDL increased sFlt1 mRNA expression (2.0-fold, p&amp;lt;0.001) and protein release (2.5-fold, p&amp;lt;0.01), but neither clonidine nor yohimbine had any effect at either dose. Neither HOG- nor N-LDL altered A2AR expression or cell viability. Overall, the data confirm that modified lipoproteins may promote PE development in women with diabetes via upregulation and release of sFlt1, but do not provide clear evidence that A2ARs are implicated in this process. Further work will investigate whether A2ARs may be modified by other stressors of diabetes, and whether they may affect non-sFlt1 mechanisms for PE. Disclosure R.P. Chow: None. J. Zhao: None. T. Curtis: None. T. Lyons: None. J. Yu: None.

Differential Effects of Birth Weight on Early-Onset Type 2 Diabetes in Adolescents and Young Adults

Background: Type 2 diabetes mellitus (T2DM) is increasingly diagnosed in adolescents and young adults. However, the impact of birth weight (BW) on this early onset T2DM is not well quantified. Methods: A longitudinal study of Southwestern American Indians, aged ≥ 5 years, was conducted from 1965-2007. Subjects who had a recorded BW and at least one research exam that included an OGTT were followed until they developed T2DM or their last exam before the age of 40 years, whichever came first. Age-sex-adjusted incidence rate of T2DM was computed and Poisson regression models were used to estimate the effect of BW on the incidence of T2DM, adjusted for sex, BMI z-score (fitted as time-varying), and maternal variables, such as the presence of diabetes during pregnancy. The effect of BW on T2DM was non-proportional over time, and in some regression models, the effect was non-linear (quadratic). Therefore, all analyses were stratified by decade of age at follow-up and BW was analyzed as quintiles. Results: Among 4,275 subjects (52% females, median BW 3.45 kg), there were 728 incident cases of T2DM over a median follow-up of 20.6 years (7.5 cases per 1000 person-years). Incidence rates, stratified by decade of age at follow-up, were greater in females and in older age groups. In multivariable regression analyses, the effect of BW on T2DM risk varied by age group, showing a quadratic (U-shaped) effect at 10-19 years (P&amp;lt;0.05) and a negative linear effect at older age intervals (20-29 years, P=0.015; 30-39 years, P&amp;lt;0.001). We could not reliably estimate risk at 0-9 years because of few cases. Female sex, greater BMI z-score, and the presence of maternal diabetes in pregnancy added to the effect of BW on T2DM risk in all age groups. Conclusions: Both low and high BWs increased the risk of T2DM in adolescence, but only the effect of low BW persisted into young adulthood. Effects of female sex, accelerated growth, or being the offspring of a diabetic pregnancy added to the effect of BW on the risk of early onset T2DM. Disclosure M.T. Olaiya: None. M. Sinha: None. R.L. Hanson: None. S. Kobes: None. R. Nelson: None. W.C. Knowler: None.

Maternal Diabetes as an Independent Risk Factor for Retinopathy of Prematurity in Infants With Birth Weight of 1500 g or More

To evaluate the relationship between maternal diabetes and the development of retinopathy of prematurity (ROP) in infants with a birth weight of 1500g or more. Retrospective case-control study. Data of 78 premature infants from diabetic mothers were compared with data of 258 controls. We examined the relationship between maternal diabetes and the development of ROP and type 1 ROP, adjusting for multiple risk factors. Multivariable logistic regression analysis was used to identify the risk factors of outcome variables. Prior to multivariable logistic regression analysis, the association of each independent variable with the outcome variables, a univariate estimate was performed. The crude and adjusted odds ratio (OR) values and their 95% confidence intervals (CI) were given. Main outcome measures were the development of ROP and the development of type 1 ROP. The study was conducted on 336 preterm infants; 78 were from diabetic mothers and 258 were from nondiabetic mothers. The rate of ROP (78.2% in case group and 14.7% in control group) and the rate of type 1 ROP (20.5% in case group and 4.7% for controls) were found significantly higher in the case group (P= .001 for both). Maternal diabetes was shown to be an independent risk factor for both ROP and type 1 ROP (OR with 95% CI: 25.040 [12.728-49.264]; 6.311 [2.647-15.048], respectively, and P < .001 for both). Our data suggest that the presence of maternal diabetes is significantly associated with the development of ROP and type 1 ROP in premature infants with a birth weight of 1500g or more.

Breast-Feeding and Risk for Childhood Obesity

We read with great interest the recent study by Mayer-Davis et al. (1) on the impact of breast-feeding on childhood obesity risk in the presence of maternal diabetes or obesity. The authors drew conclusions that seem to directly oppose previous observations from our group (2,3). However, we would like to deliver three arguments suggesting that the presented data can also be interpreted in a completely different manner and in no way exclude, but rather support, a …

Is Severe Perineal Damage Increased in Women With Prior Anal Sphincter Injury?

Edwards, Heather MD; Grotegut, Chad MD; Harmanli, Ozgur H. MD; Rapkin, David MD; Dandolu, Vani MD Author Information

Is severe perineal damage increased in women with prior anal sphincter injury?

Objective. There is conflicting data in the literature regarding the risk of obstetric anal sphincter laceration in patients with a prior laceration. This retrospective chart review seeks to examine the risk of recurrence of obstetric anal sphincter lacerations.Methods. Patients who sustained anal sphincter laceration at delivery during a 13-year time period from January 1991 to December 2003 were identified from the medical records database at Temple University Hospital. All subsequent deliveries in this group of patients were extracted from the database. Chart review was performed on all subsequent deliveries with specific attention to demographic factors such as age, race, parity, etc., maternal weight, fetal weight, presence of maternal diabetes, and labor characteristics such as induction or augmentation of labor, instrumentation at delivery (vacuum or forceps), use of episiotomy, and degree of perineal laceration.Results. There were 23 451 vaginal deliveries at Temple University Hospital between January 1, 1991 and December 31, 2003. Anal sphincter laceration was noted in 778 subjects. Subsequent deliveries among the group of patients with prior sphincter tears numbered 271. Six (2.4%) patients had recurrence of anal sphincter lacerations, and five of them were third degree lacerations. The rate of recurrent lacerations was not significantly different from the rate of initial lacerations (2.4% vs. 3.3%; odds ratio 0.72, 95% confidence interval 0.33–1.59; p = 0.4). Women who sustained recurrent lacerations were older, more obese (mean weight 92 kg vs. 82 kg), had larger babies (3506 g vs. 3227 g), and were more likely to have episiotomies (66.7% vs. 7%) or instrumental deliveries (33.3 vs. 6.5%).Conclusion. Prior anal sphincter laceration does not result in an increased rate of recurrence. Operative vaginal delivery particularly with episiotomy is a risk factor for both initial and recurrent laceration.

Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino

To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. Data from 12,311 LN were entered into the database; 11,182 (90.8%) were AGA, 743 (6.1%) were LGA and 386 (3.1%) were SGA. There were 52.58% boys and 47.42% girls, and 5.5% of LN had macrosomia (birth weight > 4,000 g). A total of 0.39% of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89% of all LN and 2.63% died (SGA 25% and AGA 75%). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates.

Adiponectin is present in cord blood but is unrelated to birth weight.

In adults, adiponectin is reduced in association with excess adiposity, type 2 diabetes, and hyperinsulinemia. We assessed whether adiponectin was 1) present in the fetal circulation, 2) altered in the fetal circulation in the presence of maternal diabetes, and 3) had relations to fetal cord blood insulin or adiposity. We assessed adiponectin in cord blood in a large cohort of singleton offspring of diabetic mothers (ODM; n = 134) and control mothers (n = 45). Adiponectin was present in cord blood and, in ODM, was higher in those delivered at later gestational ages (Spearman r = 0.18, P = 0.03). Adiponectin was slightly lower in ODM than control subjects (ODM 19.7 +/- 6.1 vs. control 21.8 +/- 5.3 micro g/ml; P = 0.04), although this difference could potentially reflect different gestational ages in the two groups (ODM 37.6 +/- 1.5 and control 40.1 +/- 1.1 weeks). In contrast to adults, adiponectin levels in the fetus were unrelated to the degree of adiposity, blood insulin, or leptin in either control subjects or ODM. Adiponectin is present in cord blood but does not show expected physiological relations with adiposity as observed in adults.

The effect of clinical characteristics on the lecithin/sphingomyelin ratio and lamellar body count: a cross-sectional study

Objective: To study the changes in the lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC) during pregnancy and to study the effect of clinical characteristics on these measurements.Methods: We reviewed in retrospect the amniotic fluid samples for the assessment of fetal lung maturity of consecutive women between January 1996 and December 2000. We evaluated the effect of antenatal administration of glucocorticoids, the presence of diabetes, fetal growth restriction and the amount of amniotic fluid on the L/S ratio and LBC. We then constructed normal curves, by relating the L/S ratio and LBC to gestational age in the cases without respiratory distress syndrome (RDS). Data from the literature were added to these curves.Results: From the 334 included women, 64 infants (19%) developed RDS. The LBC was lower in women withpolyh ydramnios (p = 0.04), and similar in women witholigoh ydramnios. Administration of glucocorticoids, the presence of maternal diabetes or fetal growth restriction did not affect the L/S ratio or the LBC. The median L/S ratio in cases without RDS showed a constant increase from a gestational age of 28 weeks onwards. The median LBC increased slowly between a gestational age of 28 weeks and 34 weeks, to increase more steeply thereafter.Conclusion: The amount of amniotic fluid affects the LBC, but not the L/S ratio. Since the L/S ratio and the LBC increase with gestation, differences in gestational age should be taken into account in the interpretation of these fetal lung maturity tests.

The effects of diabetes on placental aromatase activity

Diabetes complicates 2–3% of all pregnancies and is associated with an increase in both perinatal morbidity and mortality, though reasons for these adverse outcomes are unknown. Estrogen biosynthesis is a critical factor during pregnancy and is carried out in the placenta via aromatase (cytochrome P450 19A1), which catalyzes the conversion of C-19 androgens to C-18 estrogens. Previous studies have shown that hormones such as insulin-like growth factors and insulin regulate aromatase activity when studied in vitro. Interestingly, levels of these hormones are altered in patients with diabetes. Thus, we hypothesized that the presence of maternal diabetes may alter placental aromatase activity and thus estrogen biosynthesis, possibly serving as one factor in the adverse outcomes of babies born to mothers with diabetes. To this end, we measured the production of 19-hydroxyandrostenedione, 19-oxoadrostenedione and estrone in 30 placental tissues from diabetic patients, using [7- 3H]androst-4-ene-3,17-dione as a model substrate for aromatase (P450 19A1). A statistical difference was detected in the percentage of 19-oxoandrostenedione formed between the overt and control groups ( P < 0.05). Additionally, NADPH P450-reductase levels were measured in these same tissues to determine whether alterations in this enzyme necessary for aromatase activity could be affected by diabetes. No differences in reductase levels were detected among the patient groups. However, a statistical correlation was found between NADPH P450-reductase activity and the formation velocities of all three estrogen products ( P < 0.05). Thus, it appears that the presence of diabetes does not affect placental aromatase activity.

Amniotic fluid insulin and C peptide levels in diabetic and nondiabetic women during early pregnancy.

Thanks to the widespread use of amniocentesis, glucose, insulin, and C peptide have often been measured in amniotic fluid (AF) during late gestation, but little is known about their concentrations during early pregnancy. To better understand early fetal beta-cell function under normal conditions and in the presence of maternal diabetes, we measured glucose, insulin, and C peptide in the AF collected during weeks 15-22 in 77 healthy and 9 diabetic women undergoing amniocentesis for clinical indications and compared the results with those obtained during late pregnancy (weeks 34-36). The AF C peptide concentration was higher in diabetic women (102 +/- 53 vs. 38 +/- 2 pmol/L), in the women with a family history of diabetes (41 +/- 6 vs. 35 +/- 2 pmol/L), after the 19th week of gestation (46 +/- 5 vs. 35 +/- 2 pmol/L; in the presence of lower glucose concentrations), and in the presence of maternal plasma glucose levels greater than 5.56 mmol/L (42 +/- 3.5 vs. 34 +/- 2 pmol/L). The comparison between early and late gestation showed decreasing glucose and increasing C peptide concentrations in both healthy and diabetic women (in the latter, C peptide values were always 3 times higher), whereas the insulin concentration was increased in late gestation only in diabetic women. The AF C peptide/insulin molar ratio increased throughout pregnancy in both healthy (from 0.97 +/- 0.06 to 4.3 +/- 1.2) and diabetic (from 2.9 +/- 1.1 to 13.2 +/- 1.6) women. These parallel changes suggest that the fetal clearance and/or degradation of insulin and C peptide may greatly change during both normal and diabetic gestation.