Does intensive glycemic control in diabetic pregnancies result in normalization of other metabolic fuels?

Article Abstract:

Fuel metabolism is frequently abnormal in persons with insulin-dependent diabetes treated by conventional insulin replacement therapy, usually because replacement is inadequate. Pregnancy further complicates the picture because hormones that are antagonists of insulin are produced in greater quantities. The fetus can be adversely affected when glycemic (blood sugar) control in the mother is poor. Pregnant women with diabetes are often encouraged to undergo strict insulin therapy to keep blood glucose levels low during pregnancy. This has been shown to have a beneficial effect on the fetus. Strict insulin therapy can have negative effects on the mother, specifically peripheral hyperinsulinemia (too high insulin), which can affect metabolism. This study examined if nonglucose metabolic fuels available to the fetus were affected by strict insulin control and resulting hyperinsulinemia in the mother. Fifteen diabetic pregnant women were enrolled in the study, and seven nondiabetic pregnant women were used as controls. The diabetic subjects received intensive insulin therapy during pregnancy, seven receiving multiple daily injections and eight receiving continuous subcutaneous (under the skin) infusions. Metabolic measurements were taken before and after a prescribed meal. Results showed that in the diabetic women, blood glucose levels were well controlled, with fasting levels averaging 87 mg/dl and levels averaging 112 mg/dl 150 minutes after a prescribed meal. Plasma insulin levels were significantly higher in the diabetic women than in the normal women. This did not adversely affect the metabolism of nonglucose metabolic fuels. Circulating lipid and amino acid levels were similar in both groups, both before and after the meal. Cholesterol levels were also similar in both groups. These results indicate that intensive glycemic control during pregnancy normalizes nonglucose metabolic fuel levels. This may contribute to a healthy infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diabetes, Diabetes mellitus, Metabolic diseases

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Absence of evidence of pulmonary maturity at amniocentesis in term infants of diabetic mothers

Article Abstract:

Maternal diabetes is associated with impaired maturation of the fetal lungs, and infants born to mothers who are diabetic have a higher incidence of respiratory distress syndrome (RDS), a condition in which breathing is severely impaired. The absence of one substance, phosphatidylglycerol (a phospholipid), in amniotic fluid (in which the fetus floats) is associated with RDS, and its levels are often measured in diabetic pregnancies to evaluate fetal lung maturation. To evaluate the frequency of phosphatidylglycerol-negative results at different stages of gestation, the charts of 153 diabetic mothers were reviewed. Fifty women had overt diabetes and 103 had gestational diabetes. All had undergone amniocentesis (aspiration of a small amount of amniotic fluid) at a gestational age of at least 37 weeks, and then the test was repeated weekly until delivery. At the time of the first test, phosphatidylglycerol was present in the amniotic fluid of 130 mothers and absent in the fluid of the remaining 23. In each woman, labor was induced soon after it was determined that the substance was present. For the remaining women, phosphatidylglycerol began to appear as pregnancy progressed until, at 40 weeks' gestation, it was detected in all samples. No infant developed RDS. It is concluded that in the pregnant diabetic patient, phosphatidylglycerol may be absent until late in gestation. Clinicians who decide on the time for induction of labor according to this marker should be aware of these findings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Measurement, Testing, Phospholipids, Amniotic fluid, Respiratory distress syndrome

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Synchronization of the factors critical for diabetic teratogenesis: an in vitro model

Article Abstract:

Pregnancies complicated by diabetes may result in fetal birth defects only if poor blood sugar control occurs at specific times of fetal development. Researchers induced high blood sugar levels in pregnant rats to determine their effect on fetal development. High blood sugar levels caused defects in fetal development during days 10 and 11 of the rat pregnancy. A 20% rate of defects occurred at blood sugar levels double the normal concentration, a 50% rate of defects at blood sugar levels four times the norm, and a 100% rate of defects at blood sugar levels six times the norm. High blood sugar levels had to be sustained for at least two hours for defects to occur. Defects may not occur if high blood sugar levels are not present during critical periods of development.

Risk factors, Birth defects

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