Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women

A study was undertaken to define an appropriate marker of lactogenesis II (the onset of copious milk secretion) in mothers, and to determine the effect of diabetes on this marker. Changes in the concentrations of three milk components--lactose, citrate, and glucose--were measured in 38 normal mothers and 6 type I diabetic mothers up to 10 days after birth. Milk yield was measured in 12 of the normal mothers, and all mothers were asked to note the time of milk "coming in" (the feeling of overfullness of the breasts). The average concentrations of lactose, citrate, and glucose in milk were low for the first 24 h after birth, then between 24 and 48 h after birth there was a rapid increase in the concentrations of lactose and citrate, and this transitional period was followed by a plateau period that began between 60 and 84 h after birth. For individual mothers the transitional period for citrate began 32 +/- 9 h (n = 13) and finished 77 +/- 10 h (n = 17) after birth, and for lactose the transitional period finished at 53 +/- 12 h (n = 29) after birth. For diabetic mothers these times were significantly later. The average 24-h milk intake by infants increased from 82 to 556 ml/24 h between 24 and 144 h after birth. Milk intakes were correlated with the concentration of lactose (r = 0.52, n = 51, p less than 0.001), citrate (r = 0.47, n = 47, p less than 0.001), and glucose (r = 0.69, n = 50, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Surfactant proteins in the diagnosis of fetal lung maturity. II. The 35 kd protein and phospholipids in complicated pregnancy

The major surfactant protein with a molecular weight of 35 kd and also saturated phosphatidylcholine and phosphatidylglycerol were analyzed in specimens of amniotic fluid; 68 were from cases of maternal diabetes, 41 from preeclampsia or maternal hypertension, 26 from premature rupture of the fetal membranes, and 45 from normal pregnancies. The relationship between the individual surfactant components was studied after covariance adjustment for the length of gestation. In severe early-onset preeclampsia, the 35 kd surfactant protein/saturated phosphatidylcholine ratio was significantly higher than in the other pregnancies. In diabetic pregnancies (classes B to D without preeclampsia), the phosphatidylglycerol/saturated phosphatidylcholine ratio was lower than in the other pregnancies. Isolated surfactant complex showed similar abnormalities. In severe early-onset preeclampsia and insulin-dependent diabetes without vascular disease, the phosphatidylglycerol/saturated phosphatidylcholine ratio correlated negatively with fetal growth. In four samples of amniotic fluids from cases of severe early-onset preeclampsia, the 35 kd protein falsely predicted lung maturity. All had abnormally high 35 kd protein/saturated phosphatidylcholine ratios (greater than 2 SD of controls). According to the present results, the 35 kd protein may give a false mature test result in severe preeclampsia.

Increased hexokinase activity in fetuses of rats developed under maternal hyperglycemia

Hepatic and diaphragmatic hexokinase (HK) activities increased in fetuses of rats developed under maternal hyperglycemic conditions, compared to those in normal controls. In those organs, Type I and Type II hexokinase isozymes were detected by electrophoresis and densitometry with a chromatoscanner. Densitometric peak that corresponded to hepatic and diaphragmatic Type II hexokinase was also increased in the fetuses developed under hyperglycemia, compared to that of normal fetuses. These findings suggest that in the fetal liver, where significant activity of Type IV was absent, activity of Type II hexokinase varied depending on physiological state such as maternal hyperglycemia.

Phosphatidylglycerol, lecithin/sphingomyelin ratio and respiratory distress syndrome in diabetic and non-diabetic pregnancies

Samples of amniotic fluid from 514 non-diabetic and 69 diabetic patients were analyzed for phospholipid content. Results were correlated with incidence of respiratory distress syndrome (RDS) in the neonate. The incidence of RDS was 4.5% among diabetics and 5.3% among non-diabetics. In the presence of phosphatidylglycerol (PG), no infant developed RDS while in the absence of PG the incidence of RDS was 16.7% and 14.4%, respectively. In the presence of a mature lecithin/sphingomyelin (L/S) ratio the respective incidence of RDS was 1.6 and 1.8, while with an immature L/S ratio the incidence of RDS was 28.6% and 29%. The incidence of RDS after 37 weeks gestation was 0% among diabetics and 0.6% among non-diabetics. We conclude that amniotic fluid phospholipids are equally predictive of risk for RDS in diabetics as among non-diabetic patients. We suggest that in patients with accurate gestational dating, amniotic fluid analysis for phospholipids might not be necessary to establish fetal lung maturity.

Oxygen consumption and guanosine diphosphate binding by fetal brown adipose tissue in diabetic pregnancy

Oxygen consumption and 3H-guanosine diphosphate (GDP) binding were determined in brown adipocytes and mitochondria from 28-day gestation fetuses of alloxan-diabetic rabbit does and saline-injected controls. Maternal diabetes was classified as severe or mild determined by whether maternal blood glucose values were greater or less than 200 mg/dL, respectively, at death. Basal oxygen consumption and adipocyte diameters did not vary among groups. A significant reduction in maximal norepinephrine (NE) stimulated O2 consumption by fetal brown adipose tissue (BAT) cells was seen in offspring of severely diabetic pregnancies when compared with control values (248 +/- 53 +/- v482 +/- 32 microL O2/10(6) cells/h; P less than .005). In contrast, a significant increase in maximal NE-stimulated O2 consumption by fetal BAT cells occurred in offspring of mild diabetic pregnancies (807 +/- 60, P less than .001 v controls). A highly significant inverse correlation between serum glucose levels and maximal O2 consumption by fetal BAT was observed in fetuses from mild and severe diabetic pregnancies (r = -.98, P less than .005), and there was no correlation between these two parameters in offspring of normal pregnancies. A significant inverse correlation was observed between maximal O2 consumption by fetal BAT cells and serum insulin levels in offspring of both control and diabetic pregnancy (r = -.74; P less than .02). Tissue cytochrome oxidase activity was lower in offspring of severely affected diabetic does, indicating a reduction in BAT mitochondrial content compared with controls. BAT mitochondria from fetuses of severely diabetic does exhibited reduced 3H-GDP capacity, which was 2.5-fold lower than controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal, amniotic fluid and cord blood metabolic profile in normal pregnant and gestational diabetics during recurrent withholding of food

In order to advise regarding the religious practice of withholding food, we studied the metabolic changes after successive 15 days of recurrent fasting of 13 hours every day in maternal plasma and liquor amnii of obese normal gravids and gestational diabetics in their third trimester. There were no significant differences between those who fasted that period for one day prior to elective cesarean section (CS) and those who fasted the same period repeatedly for 15 days. The fasted gravids had significant rises in glycerol, beta-hydroxybutyrate (BOHB) and nonesterified fatty acids (NEFA) (P less than 0.0001, P less than 0.005 and P less than 0.01, respectively) in maternal plasma, compared to unfasted gravid groups and ungravid fasted group. No significant metabolic difference was found in the liquor amnii withdrawn from fasted and unfasted groups. The influence of such short term of starvation on the fetal metabolic profile was studied in the cord blood during cesarean section (CS). Glucose, glycerol and NEFA were significantly lower in arterial than in venous cord plasma (P less than 0.05, P less than 0.01 and P less than 0.01, respectively) indicating that the fetus could utilize these substrates. Positive correlation was found between the levels of BOHB in the mother and venous cord plasma on the one hand and their levels in the arterial cord plasma and liquor amnii on the other hand implying that this substrate passes unutilized through the fetus to the liquor amnii. A pregnant woman in the third trimester should not withhold food for long periods.

[Diabetes mellitus and pregnancy]

The author presents a review of the metabolic alterations occurring during pregnancy and of the maternal and fetal risks of diabetes pregnancy. The problems of diabetic patients who become pregnant are discussed as well as gestational diabetes and its diagnostic criteria.

[Homocarnosine of the amniotic fluid as an indicator of fetal cerebral lesions]

The authors stated the correlation between the levels of homocarnosine in the amniotic fluid, fetal encephalopathy and the degree of fetal neurologic symptomatology.

Oestrogen and progestogen receptors in endometrium and myometrium at the time of blastocyst implantation in pregnant diabetic rats

A suitable hormonal environment is a prerequisite for blastocyst implantation. Experimental diabetes was previously shown to modify the hormonal milieu and produce alterations in oestrogen receptor kinetics in the uterine tissue. In the present work, oestrogen and progestogen receptor levels were measured on the morning of day 6 of pregnancy in normal and in streptozotocin-induced diabetic rats, both in implantation sites and in interembryonic segments of endometrium and myometrium. Receptor levels were different in the implantation sites compared to the interembryonic segments of endometrium, both in the control and in the diabetic animals. Indeed, implantation sites were characterized by lower oestrogen receptor levels in cytosol and higher progestogen receptor levels in cytosol and nuclei. However, compared to the control rats, the diabetic rats had lower oestrogen receptor levels in implantation sites, both in cytosol and nuclei. In the myometrium, the differences between sites or between types of rats were minimal. Plasma levels of oestradiol were lower in diabetic rats than in control animals, whereas progesterone levels were similar. A 20% lower implantation rate was found in diabetic rats, compared to normal rats. These results show that the specific distribution of oestrogen and progestogen receptors between implantation sites and interembryonic segments was preserved in the diabetic rats; however the absolute level of oestrogen receptor was lower. This abnormal endocrine milieu might arise from a lower oestradiol level and a decreased oestradiol/progesterone ratio in the circulating blood. Whether the lower implantation rate in diabetic rats might be a consequence of the overall disturbed hormonal status remains to be elucidated.

Placental vanadium in gestational diabetes mellitus

Although many studies in animal models and in cell cultures have shown that vanadate has insulin-like effects, it has not been studied in human diabetes mellitus. In this study the levels of vanadium in human placentae from 23 pregnancies complicated by gestational diabetes mellitus were compared with 18 uncomplicated non-diabetic pregnancies closely matched for maternal age, gravidity, and gestational age. Using the unpaired Student's t-test, the mid-disc placental levels in gestational diabetes (7.62 +/- 1.29 micrograms/g dry weight) were significantly lower (p less than 0.05) than controls (8.73 +/- 1.85 micrograms/g dry weight). These findings appear to be independent of placental size and birthweight. When these data were analyzed according to treatment, the vanadium levels in insulin-treated cases (8.07 +/- 1.32 micrograms/g dry weight) were not significantly different from the matched controls (8.84 +/- 1.69 micrograms/dry weight); the levels in noninsulin treated cases (7.08 +/- 1.25 micrograms/g dry weight), however, were significantly (p less than 0.005) lower than controls (8.99 +/- 1.96 micrograms/g dry weight). It is interesting to speculate that there may be increased binding of vanadium to maternal tissues in human diabetes mellitus when insulin is deficient.

Increase in uterine prostaglandin E2, F2 alpha, prostacyclin and stability in thromboxane A2 production during late pregnancy in streptozotocin-induced diabetic rats

This experiment was conducted to determine the effect of diabetes on uterine prostanoids production in near-term rats. The incidence of an insulin therapy was also studied. On the 21st day of pregnancy, uterine PGE2, PGF2 alpha and PGI2 levels showed a significant increase (respectively p less than 0.05, p less than 0.01 and p less than 0.05) in diabetic rats compared to controls whereas TxA2 production remained unchanged. The insulin therapy restored PGE2 levels, the most potent stimulatory factor of the myometrial fiber at control values, whereas it enhanced significantly PGI2 concentrations (p less than 0.05) and had no effect on PGF2 alpha production; TxA2 levels remaining always unchanged. It is suggested that the increase in uterine protanolds production during diabetes could induce a myometrial hypertonicity and play a role in the disturbances of the fetal development. The maintenance of PGE2 levels to control values by the insulin therapy might contribute to a normal delivery.

Pulmonary phospholipids in amniotic fluid of pathologic pregnancies: relationship with clinical status of the newborn

We evaluated phospholipids, C-peptide and cortisol levels in amniotic fluid of 203 pathologic pregnancies (63, class A, B and C diabetics; 11 class D, F and H diabetics; 44 preclampsia and 85 Rh-isoimmunization); the control group was 82 normal pregnant women. There was an acceleration of fetal pulmonary maturation in women with preclampsia and severe Rh-isoimmunization in class D, F and H diabetics (at 34 weeks gestation the incidence of mature surfactant (lecithin/sphingomyelin greater than or equal to 2.7 and presence of phosphatidyl-glycerol) in these groups was 30%, 50% and 100%, respectively, while it was zero in the control group). At 37 and 38 weeks only 44.4% of the class A, B and C diabetics had mature surfactant and there was a significant difference with respect to the control group (x2 = 4.9; p less than 0.05); C-peptide levels in these diabetics (class A, B and C) were higher than in controls (p less than 0.001); in pregnant women with accelerated fetal lung maturation they were lower. We demonstrated a close relationship between fetal pulmonary maturity and the type of surfactant in amniotic fluid, which was independent of gestational age.

Functional enteroinsular axis in full-term newborn infants

The term "enteroinsular axis" refers to the enhancement of insulin release by hormones secreted from the gut. Gastric inhibitory polypeptide (GIP) is one of the major hormones that mediates this function. The purpose of the present study was to examine whether the enteroinsular axis is functional in newborn infants born at term gestation. Between d 2 and d 4 of life, glucose was infused for 2 h intravenously or orogastrically to 44 fullterm newborn infants, of whom 18 were appropriate for gestational age, nine large for gestational age, eight small for gestational age; nine infants were born to diabetic mothers. Glucose was infused at either 8 mg/kg/min intravenously or 16 mg/kg/min orogastrically to achieve similar plasma glucose concentrations. Plasma insulin and GIP concentrations were compared. Plasma GIP concentration increased significantly with enteral glucose administration in all infants but remained unchanged with parenteral glucose infusion. The responses of plasma insulin and the insulin/glucose ratio were significantly greater in infants receiving enterally than parenterally infused glucose. However, when glucose was infused orogastrically at a lower rate (8 mg/kg/min), plasma GIP concentrations rose, but no enhancement of insulin response was detected, suggesting the importance of the role of circulating glucose in the "enteroinsular axis". The infants of diabetic mothers and the large-for-gestational-age infants had more rapid insulin response to orogastrically administered glucose, but their GIP responses were similar to that of normal infants. These findings suggest that, at term gestation, the newborn infants have a "functional" enteroinsular axis in response to glucose, i.e. the rising plasma GIP contributed in part to the enhanced insulin response to enterally infused glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased insulin binding in Asian Indian women with gestational diabetes mellitus

Insulin binding to erythrocyte insulin receptors was studied in 10 women with gestational diabetes and compared with 10 matched, normal, pregnant women and 10 normal, non-pregnant controls, with no family history of diabetes. Pregnant women had higher mean fasting and post-glucose plasma immunoreactive insulin (IRI) compared to non-pregnant controls (p less than 0.001). Women with gestational diabetes had higher mean fasting and post-glucose plasma glucose levels and a lower mean specific binding of insulin when compared with the other two groups (p less than 0.001). The decreased insulin binding was significant only at lower insulin concentrations (0.2-2 ng/ml) when compared with those of normal pregnant women (p less than 0.01), suggesting decreased receptor affinity with no change in receptor number. In addition, an increased mean ED50 value for 50% inhibition of maximal binding and a lower mean average affinity constant Ke (empty site) obtained in gestational diabetes in comparison to the other two groups also suggested de decreased affinity of the receptor. The finding that pregnancy with normal glucose tolerance was not accompanied by changes in insulin binding against decreased insulin binding and affinity observed in gestational diabetes suggested a pathogenetic role for impaired insulin binding as one of the factors responsible for insulin resistance and hyperglycemia in gestational diabetes.

Osteocalcin during the reproductive cycle in normal and diabetic rats

Concentrations of osteocalcin were measured in plasma and bone of normal and diabetic rats during the reproductive cycle and compared with plasma 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) concentrations. The age-dependence of osteocalcin was also examined. Plasma concentrations of osteocalcin levels were low but detectable in 21-day-old fetuses (3.7 +/- 0.3 nmol/l); osteocalcin concentrations were highest in weaning rats (104 +/- 9 nmol/l) and decreased thereafter. In adult rats, plasma concentrations of both osteocalcin and 1,25-(OH)2D3 increased during the last days of normal pregnancy, and even more so in rats fed a diet low in calcium and phosphate. After an early post-partum decline, osteocalcin concentrations in plasma remained at non-pregnant levels in lactating rats fed a high calcium/phosphate diet while their 1,25-(OH)2D3 concentrations were higher than in non-pregnant rats; however, lactating rats fed a low calcium/phosphate diet showed increasing osteocalcin concentrations. In spontaneously diabetic BB rats, plasma osteocalcin concentrations were severely decreased compared with those in non-diabetic rats, more than would have been expected from their decreased 1,25-(OH)2D3 concentrations. Moreover, plasma osteocalcin did not increase during pregnancy or lactation in diabetic rats, even when fed a low calcium/phosphate diet. Fetuses of diabetic rats also had lower plasma osteocalcin levels than fetuses from non-diabetic rats or than weight-matched fetuses from semistarved rats. In contrast to plasma osteocalcin concentrations, bone osteocalcin concentrations and content were not altered by pregnancy, lactation, low calcium/phosphate diet or diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of immunoreactive gonadotropin-releasing hormone and human chorionic gonadotropin in term placentas from normal women and those with insulin-dependent and gestational diabetes

We measured prohormone gonadotropin-releasing hormone (high-molecular-weight gonadotropin-releasing hormone), gonadotropin-releasing hormone and human chorionic gonadotropin concentrations in term placentas from normal women and those with insulin-dependent and gestational diabetes. The placental immunoreactive gonadotropin-releasing hormone levels were significantly higher in normal tissues than in tissues from insulin-dependent and gestational diabetes (p less than 0.01). When compared with diabetic placental extracts, normal tissue also had more stored prohormone immunoreactive gonadotropin-releasing hormone. Whereas there were no consistent differences in placental human chorionic gonadotropin concentrations in normal tissues and tissues from insulin-dependent and gestational diabetes, there was a significant correlation between gonadotropin-releasing hormone and human chorionic gonadotropin concentrations in normal samples (r = 0.57, p less than 0.05), which was abolished when the diabetic tissue was included in the analysis. These data suggest that differences in high-molecular-weight gonadotropin-releasing hormone and gonadotropin-releasing hormone concentrations in term placentas from normal versus diabetic mothers may be due to enhanced processing of the prohormone and increased release of the decapeptide in diabetic pregnancy.

Placental protein distribution in maternal diabetes mellitus: an immunocytochemical study

Placentas associated with maternal diabetes are generally characterized by features of villous immaturity. We correlated the villous histology with the immunocytochemical distribution of four trophoblastic proteins: beta human chorionic gonadotropin (beta HCG), placental alkaline phosphatase (PLAP), pregnancy specific beta-1-glycoprotein (SP1), and human placental lactogen (HPL) in 14 third-trimester placentas associated with diabetes mellitus. Staining was increased for beta HCG and decreased for PLAP, SP1, and HPL in the diabetic placentas compared to control placentas of similar gestational age. This pattern was most prominent in areas of marked architectural villous immaturity within individual placentas and suggests concomitant functional immaturity.

Insulin-like growth factors in fetal macrosomia with and without maternal diabetes

Insulin-like growth factors (IGFs/somatomedins) have been implicated as regulators of fetal growth. This study investigates whether IGFs are related to macrosomia in infants of normal or insulin-dependent diabetic mothers. Cord concentrations of IGF-I (radioimmunoassay), total IGF (radioreceptor assay) and IGF binding protein (radiobinding assay) were measured in 15 term infants of diabetic mothers (IDM) and 29 term infants of nondiabetic mothers. In infants of control mothers cord IGF and total IGF levels were significantly higher in large-for-gestational-age than appropriate-for-gestational-age infants; but this relationship was lost in IDM, in whom IGF-I concentrations were similar to control infants. IGF binding protein levels were not significantly different in any of these groups. The absence of elevated IGF levels in macrosomic IDM indicates that the pathologic process does not involve a simple increase in these growth factors.

The concentration of the 35-kDa surfactant apoprotein in amniotic fluid from normal and diabetic pregnancies

A specific, enzyme-linked immunoabsorbent assay was used to determine the concentration of the 35,000 mol wt surfactant apoprotein (SP-A) in samples of amniotic fluid obtained from nondiabetic (n = 358) and diabetic (n = 29) women. The enzyme-linked immunoabsorbent assay was performed with rabbit antibodies directed against SP-A present in lavage fluid from a patient with alveolar proteinosis. Amniotic fluid SP-A concentrations increased as a function of gestational age, from less than 3 micrograms/ml at 30-31 wk to 24 micrograms/ml at 40-41 wk, and were positively correlated with the lecithin to sphingomyelin ratio (p less than 0.01). SP-A concentrations also increased as a function of gestational age in shake test positive samples (p less than 0.05), but were unchanged in shake test-negative samples. There was no difference in the surfactant apoprotein concentration of male compared with female fetuses at any gestational age. In amniotic fluid obtained from 20 diabetic women, SP-A levels were significantly less than in nondiabetic pregnancies that were matched for gestational age and sex of the fetus (p less than 0.05). The SP-A concentrations in amniotic fluids obtained from nine women who were diabetic and hypertensive and from 10 hypertensive women were not different from matched controls. The relationships described above were valid whether the SP-A concentration was expressed per mg protein or per ml amniotic fluid. These data are suggestive that the concentration of amniotic fluid SP-A is decreased in diabetic pregnancies.

Maternal diabetes in rats. II. Effects on fetal growth and protein turnover

The developmental growth of the rat fetus was studied between days 14 and 21 of pregnancy in normal control, established-diabetic, gestational-diabetic, and insulin-maintained-diabetic mothers. Measurements of fetal body weights and protein mass revealed a suppression of growth in the diabetic pregnancies, probably arising from reduced hyperplasia. Growth of the liver and skin appeared to be suppressed in proportion to the whole fetus, whereas the lung, brain, and particularly the heart were relatively well protected from growth retardation. Fetal growth during development, and its retardation in association with the hyperglycemic state, was explained by measuring the rates of fetal protein turnover in vivo. Both the protein synthetic and degradative rates gradually declined during normal development. However, in the diabetic pregnancies, fetal protein synthesis was consistently lower than control rates, whereas protein degradation increased sharply toward the end of gestation. These changes in protein synthesis and breakdown probably combine to yield a smaller fetus in the absence of normoglycemia.

Review of fetal cardiovascular and metabolic responses to diabetic insults in the pregnant ewe

Studies with pregnant sheep are reviewed, which were designed to investigate whether short-term episodes of maternal hyperglycemia or hyperketonemia were detrimental to the fetus, whether ketones can cross the ovine placenta, and whether the combination of maternal hyperglycemia and hyperketonemia would contribute to an increased risk of fetal morbidity. It is concluded that acute increases in maternal ketones appear to be more detrimental to the fetus than acute increases in maternal glucose, as assessed by fetal cardiovascular, metabolic, and blood gas changes.

Effect of varying degrees of "normal" glucose metabolism on maternal and perinatal outcome

Prior studies concerning effects of varying degrees of normal glucose metabolism on pregnancy have reported an increase in the incidence of a variety of pregnancy complications in women with normal oral glucose tolerance test results as the glucose concentration after a standardized meal rose. However, these investigations have neglected to include a control group of women with gestational diabetes for comparison. We theorized that if the adverse outcomes noted were indeed a reflection of glucose concentration, women with gestational diabetes should have an even higher incidence of these complications. Mother and infant charts of 312 consecutive women undergoing an oral glucose tolerance test were reviewed. A glucose challenge test preceded the oral glucose tolerance test in 310. The glucose challenge test value was less than 140 mg/dl in 64 and greater than or equal to 140 mg/dl in 246. There were 63 abnormal oral glucose tolerance test results (2.7% of the population studied). Among all patients, the relationship between glucose challenge test and oral glucose tolerance test values followed a gradient with a progressive rise in mean oral glucose tolerance test values when the glucose challenge test result was greater than or equal to 160 mg/dl. However, the incidence of an abnormal oral glucose tolerance test result did not rise significantly until the glucose challenge test result exceeded 180 mg/dl. A wide variety of outcome parameters were studied; none were related to the glucose challenge test value. Similar analysis of the 2-hour oral glucose tolerance test value revealed an increase in the incidence of nonelective operative deliveries and a decrease in the percentage of infants discharged home with their mother where values were greater than 180 mg/dl. However, when women with gestational diabetes were excluded from analysis, neither the glucose challenge test nor the 2-hour glucose tolerance test measurements were related to adverse outcome. When analysis was limited to women with gestational diabetes, there was no clinically significant relationship between either glucose challenge test or 2-hour glucose tolerance test and the outcome parameters. Finally, when analysis was repeated according to diagnosis, women with gestational diabetes had a significantly higher risk of having nonelective operative delivery, premature delivery, growth-retarded neonate, 1-minute Apgar score less than 7, and neonatal hypoglycemia than women with normal oral glucose tolerance test results.(ABSTRACT TRUNCATED AT 400 WORDS)

Decreased bone mineral content in infants of diabetic mothers

The present study was conducted to test the hypothesis that infants of diabetic mothers (IDMs) have decreased bone mineral content at birth, and whether or not decreased infant bone mineral content in IDMs correlates with poor control of diabetes during pregnancy, maternal bone mineral content, and the development of neonatal hypocalcemia. Forty-five pregnant diabetic women and their infants were enrolled in a prospective trial. In addition, 55 normal newborn infants of nondiabetic mothers were used as controls. Bone mineral content was measured before delivery in all diabetic pregnant patients and at birth in all infants by photon absorptiometry. Bone mineral content was significantly decreased in infants of diabetic mothers compared with control infants and correlated inversely with mean first trimester maternal capillary blood glucose; it did not correlate with cord serum 1,25-dihydroxyvitamin D concentrations. By stepwise multiple regression analysis, in infants of diabetic mothers, bone mineral content correlated inversely with mean first trimester capillary blood glucose and maternal bone mineral content, but did not correlate with maternal blood glycosylated hemoglobin, infant gestational age, infant birthweight or weight percentile, or development of neonatal hypocalcemia.