Correlations between antepartum maternal metabolism and newborn behavior

Article Abstract:

Substances needed for metabolic reactions (fuels) reach the fetus in proportion to their concentration in the mother's body, for the most part: thus, fetal nutrition is intimately coupled to maternal metabolism. Since fetal cells are particularly sensitive to changes in the immediate chemical environment, it is possible that neonatal behavior could be affected by the substances to which the fetus was exposed in utero. To evaluate the effects of different metabolic profiles on neonatal behavior, 209 pregnant women and their babies were studied. Seventy-three were diabetic before they became pregnant (pregestational diabetes); 112 had developed gestational diabetes (abnormal glucose metabolism beginning in pregnancy); and 24 had no abnormalities of carbohydrate metabolism. A multidisciplinary team provided prenatal care, which included regular assessment of the levels of glucose, hemoglobin AIC (HbAIC; levels rise when diabetes is poorly regulated), and beta-hydroxybutyrate, also associated with poorly regulated glucose levels. The mothers' health was maintained optimally, with careful blood glucose control, and the group ultimately had low perinatal mortality. Infants were evaluated according to the Brazelton neonatal behavioral assessment scale, which assesses them along four dimensions: interactive, motoric, state control, and physiologic control. Results showed that the women with pregestational diabetes had infants with a lower gestational age at delivery than women in the other two groups, and both diabetic groups had heavier babies than the nondiabetic group. Differences among the groups were found with respect to metabolic variables, mainly in ways that could be anticipated from their physiological characteristics. Of greatest significance was the fact that three of the four Brazelton scores were correlated with the extent of prenatal maternal glucose regulation. Women with poorer control had neonates whose assessment scores were poorer for the interactive, motoric, and physiologic control dimensions. These differences were not the result of ethnic or economic differences. The results support the hypothesis that maternal fuels influence the fetal phenotype; that differences were found among groups of well-controlled, only moderately affected, diabetic mothers, indicates how sensitive developmental variables are to such effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Infants (Newborn), Newborn infants, Glucose metabolism, Behavioral assessment of children, Brazelton Neonatal Behavioral Assessment Scale

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Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience

Article Abstract:

Shoulder dystocia is a complication of labor and delivery in which the baby's shoulder becomes lodged in the birth canal. Because it is more common in diabetic pregnancies, which are often associated with abnormally large babies, some experts recommend cesarean section for diabetic patients whose fetuses are estimated to weigh more than 4,000 grams. However, maternal complications are associated with surgery and it can be difficult to accurately estimate fetal weight. To learn more about the frequency and outcome of shoulder dystocia among patients with gestational diabetes (diabetes first diagnosed during pregnancy), a study was carried out with 210 mother-infant pairs. All infants born to these diabetic mothers weighed at least 3,500 grams. In this hospital setting, all mothers were first allowed to attempt vaginal delivery as long as labor progressed normally. One hundred twenty infants were delivered vaginally. Fifteen cases of shoulder dystocia occurred, but only one infant sustained permanent damage to the brachial plexus (the network of nerves serving the upper extremity). Infants whose delivery had this complication weighed more, but not significantly more, than those with uncomplicated deliveries; in seven cases, the infants weighed less than 4,000 grams. Shoulder dystocia was associated with the use of forceps. If all infants weighing more than 4,000 grams had been delivered by cesarean section, as is often recommended, 98 such procedures would have been performed in this group (instead of 53). This would have prevented 8 of the 15 cases of shoulder dystocia, including the case of permanent brachial plexus injury. Although this was a serious injury, it is not always possible to accurately estimate fetal weight. It is concluded that routine cesarean section for fetuses weighing more than this amount would significantly raise the rate of cesarean sections without providing substantial fetal benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Statistics, Dystocia

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Infants of diabetic mothers with accelerated fetal growth by ultrasonography: are they all alike?

Article Abstract:

Macrosomia (excessive body size) is a characteristic of some infants born to diabetic mothers, and is usually thought to result from the influence of insulin on fetal tissues. Thus, tissues most sensitive to insulin, such as the liver, muscle, and fat, grow more than insensitive tissues (brain, bone). Fetal macrosomia is identified by accelerated growth in the fetal abdominal circumference, which reflects the growth of the insulin-sensitive tissue in that region. However, other factors besides hyperinsulinism (excess insulin), such as the extent to which the mother's diabetes is controlled, may also play a role in fetal macrosomia. To learn more about this issue, 52 pregnant diabetic women were studied; fetal growth patterns were evaluated in the context of the mothers' metabolic status and body measurements (such as height and weight). The levels of insulin, glucose (sugar) and hemoglobin (the molecule in the blood that carries oxygen) were determined for all diabetics and for 19 pregnant women with normal carbohydrate metabolism (controls). All subjects had undergone at least two ultrasonographic examinations (at approximately 24 and 36 weeks' gestation), during which fetal abdominal circumference (AC) and biparietal diameter (BPD, the distance between two bones in the head) were measured. Fetuses were classified as normal, late accelerated (the first AC value at or below the 90th percentile, the second above it), or early accelerated (both AC values above the 90th percentile). Results showed that the early accelerated growth group differed from the others in several ways, the most clear-cut of which was excessive growth in abdominal circumference earlier than 24 weeks' gestation. Many infants in this group did not show signs of fetal hyperinsulinism, and tended to be born to tall, thin mothers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Anthropometry, Birth weight

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