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Diabetologia

, Volume 31, Issue 3, pp 134–141 | Cite as

The influence of maternal glucose metabolism on fetal growth, development and morbidity in 917 singleton pregnancies in nondiabetic women

  • G. Farmer
  • G. Russell
  • D. R. Hamilton-Nicol
  • H. O. Ogenbede
  • I. S. Ross
  • D. W. M. Pearson
  • H. Thom
  • D. F. Kerridge
  • H. W. Sutherland
Originals

Summary

To study the effects on the fetus of variations in maternal glucose tolerance, a 25 g rapid intravenous glucose tolerance test was performed at or about 32 weeks gestation in 917 randomly selected nondiabetic women with singleton pregnancies. The results were withheld from the patients and their obstetricians and paediatricians, and no treatment or advice was offered. Fasting plasma glucose and indices of glucose disposal (including a new index which we have termed “summed glucose”) were distributed unimodally, with no evidence of a separate pathological group towards the diabetic end of the distributions. Significant associations were found between maternal glucose metabolism and var ious measures of neonatal nutrition and morbidity, including the incidence of congenital malformations and morbidity related to asphyxia, suggesting that variations within the normal range in maternal glucose metabolism can influence growth and development in the fetus. These relationships were continuous throughout the range of maternal glucose tolerance and were not of predictive value in individual cases.

Key words

Pregnancy glucose tolerance test blood glucose infant newborn birth weight asphyxia neonatorum abnormalities 

References

  1. 1.
    Widness JA, Cowett RM, Coustan DR, Carpenter MW, Oh W (1985) Neonatal morbidities in infants of mothers with glucose intolerance in pregnancy. Diabetes 34 [Suppl 2]: 61–65Google Scholar
  2. 2.
    Tallarigo L, Giampietro O, Penno G, Miccoli R, Gregori G, Navalesi R (1986) Relation of glucose tolerance to complications of pregnancy in nondiabetic women. N Engl J Med 315: 989–992Google Scholar
  3. 3.
    Billis A, Rastogi GK (1966) Studies in methods of investigating carbohydrate. Diabetologia 2: 169–177Google Scholar
  4. 4.
    Butterfield WJH, Abrams ME, Whichelow MJ (1971) The 25-g intravenous glucose tolerance test: a critical appraisal. Metabolism 20: 255–265Google Scholar
  5. 5.
    Solomons E, Silverstone FA, Posner NA (1963) Obstetric factors suggesting diabetes evaluated by the rapid intravenous glucose tolerance test. Obstet Gynecol 22: 50–55Google Scholar
  6. 6.
    Lunell N-O (1966) Intravenous glucose tolerance in women with previously complicated pregnancies. Acta Obstet Gynecol Scand 45 [Suppl 4]: 1–89Google Scholar
  7. 7.
    O'Sullivan JB, Snyder PJ, Sporer AC, Dandrow RV, Charles D (1970) Intravenous glucose tolerance test and its modification by pregnancy. J Clin Endocrinol Metab 31: 33–37Google Scholar
  8. 8.
    Hadden DR, Harley JMG, Kajtar TJ, Montgomery DAD (1971) A prospective study of three tests of glucose tolerance in pregnant women selected for potential diabetes with reference to foetal outcome. Diabetologia 7: 87–93Google Scholar
  9. 9.
    Silcock DH, Hadden DR, Neill DW (1972) Computer analysis of intravenous glucose tolerance tests. Diabetologia 8: 301–304Google Scholar
  10. 10.
    Fisher PM, Hamilton PM, Sutherland HW, Stowers JM (1974) The effect of pregnancy on intravenous glucose tolerance. J Obstet Gynaecol Br Commonw 81: 285–290Google Scholar
  11. 11.
    Feige A, Mitzkat H-J, Zick R, Jakobitz K (1984) Untersuchungen zum Einfluß der Schwangerschaft auf den Kohlenhydrat- und Fettstoffwechsel der Mutter. Z Geburtshilfe Perinatol 188: 167–173Google Scholar
  12. 12.
    Hinckers HJ (1977) Glukose-Stoffwechsel in der Schwangerschaft. Urban & Schwarzenberg, München Wien BaltimoreGoogle Scholar
  13. 13.
    Office of Population Censuses and Surveys (1970) Classification. of Occupations. Her Majesty's Stationen Office, LondonGoogle Scholar
  14. 14.
    Duncan LJP (1956) The intravenous glucose tolerance test. Q J Exp Physiol 41: 85–96Google Scholar
  15. 15.
    Srikanta S, Ganda OP, Gleason RE, et al. (1984) Pre-type 1 diabetes. Linear loss of beta cell response to intravenous glucose. Diabetes 33: 717–720Google Scholar
  16. 16.
    Altman DG, Coles EC (1980) Assessing birth weight-for-dates on a continuous scale. Ann Hum Biol 7: 35–44Google Scholar
  17. 17.
    Farmer G (1985) Neonatal skinfold thickness. Measurement and interpretation at or near term. Arch Dis Child 60: 840–842Google Scholar
  18. 18.
    SPSS Inc, Illinois (1986) SPSSx User's Guide, 2nd edn. McGraw Hill, New YorkGoogle Scholar
  19. 19.
    Gardner MJ, Altman DG (1986) Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J 292: 746–750Google Scholar
  20. 20.
    Wilkerson HLC, O'Sullivan JB (1963) A study of glucose tolerance and screening criteria in 752 unselected pregnancied. Diabetes 12: 313–318Google Scholar
  21. 21.
    O'Sullivan JB, Mahan CM (1964) Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13: 278–285Google Scholar
  22. 22.
    Macfarlane CM, Tsakalakos N (1985) Evidence of hyperinsulinaemia and hypoxaemia in cord blood of neonates born to mothers with gestational diabetes. S Afr Med J 19: 81–84Google Scholar
  23. 23.
    Philipps AF, Rosenkrantz TS, Raye J (1985) Consequences of perturbations of fetal fuels in ovine pregnancy. Diabetes 34 [Suppl 2]: 32–35Google Scholar
  24. 24.
    Navarrette VN, Torres IH, Rivera IR, Shor VP, Gracia PM (1967) Maternal carbohydrate disorder and congenital malformations. Diabetes 16: 127–130Google Scholar
  25. 25.
    Milunsky A (1970) glucose intolerance in the parents of children with Down's syndrome. Am J Ment Defic 74: 475–478Google Scholar
  26. 26.
    Forbes AP, Engel E (1963) The high incidence of diabetes mellitus in 41 patients with gonadal dysgenesis, and their close relatives. Metabolism 12: 428–439Google Scholar
  27. 27.
    Endo A, Ingalls TH (1968) Chromosomal abnormalities in embryos of diabetic mice. Arch Environ Health 16: 316–325Google Scholar
  28. 28.
    Aynsley-Green A, Weindling AM, Soltesz G, Jenkins PA (1983) Transient lactic acidosis and hyperalaninaemia associated with neonatal hyperinsulinaemic hypoglycaemia: the effects of dichloroacetate (DCA). Eur J Pediatr 141: 114–117Google Scholar
  29. 29.
    Weiss PAM, Hofman H, Winter R, Purstner P, Lichtenegger W (1984) Gestational diabetes and screening during pregnancy. Obstet Gynecol 63: 776–780Google Scholar
  30. 30.
    Fuhrmann K, Reiher H, Semmler K, Fischer F, Fischer M, Glockner E (1983) Prevention of congenital malformations in infants of insulin-dependent diabetic mothers. Diabetes Care 6: 219–223Google Scholar
  31. 31.
    Sartor G, Schersten B, Carlstrom S, Melander A, Norden A, Persson G (1980) Ten-year follow-up of subjects with impaired glucose tolerance. Prevention of diabetes by tolbutamide and diet regulation. Diabetes 29: 41–49Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • G. Farmer
    • 1
  • G. Russell
    • 1
  • D. R. Hamilton-Nicol
    • 2
  • H. O. Ogenbede
    • 1
  • I. S. Ross
    • 3
  • D. W. M. Pearson
    • 4
  • H. Thom
    • 1
  • D. F. Kerridge
    • 5
  • H. W. Sutherland
    • 2
  1. 1.Department of Child HealthUniversity of AberdeenAberdeenScotland, UK
  2. 2.Department of Obstetrics and GynaecologyUniversity of AberdeenAberdeenScotland, UK
  3. 3.Department of Chemical PathologyUniversity of AberdeenAberdeenScotland, UK
  4. 4.Department of MedicineUniversity of AberdeenAberdeenScotland, UK
  5. 5.Department of StatisticsUniversity of AberdeenAberdeenScotland, UK

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