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The effect of diabetes during pregnancy on fetal renal parenchymal growth

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Journal of Nephrology Aims and scope Submit manuscript

Abstract

Aims/hypothesis

Diabetes in pregnancy is thought to adversely affect the developing fetal kidneys. The rate of gestational diabetes is increasing globally with major consequences for future renal function. Very little is known about the impact of hyperglycaemia on the fetal renal parenchyma which contains the developing nephrons. The aim of this study was to measure the fetal renal parenchymal thickness and evaluate whether diabetes during pregnancy affects the growth of the fetal kidneys.

Methods

This prospective, observational study used serial ultrasound measurements to evaluate the fetal renal parenchymal growth of 55 pregnancies with diabetes compared to 72 control pregnancies. Mixed effects modelling was used to analyse the data.

Results

The renal parenchyma of fetuses from mothers with gestational diabetes was significantly thicker than those from the control group (LR Chisq = 4.8, df = 1, p = 0.029), however, the difference was proportional to the larger size of these fetuses. Fetuses of pregestational diabetics demonstrated no significant difference in renal parenchymal thickness compared to the control group even though they were also larger fetuses. Parenchymal growth slowed with increasing abdominal circumference in the pregestational diabetic group, suggesting an adverse effect on nephrogenesis, however this did not reach statistical significance.

Conclusions/interpretation

Our study provides unique data on how diabetes during pregnancy influences fetal kidney growth. Appropriate management of diabetic pregnancies may mitigate some of the adverse effects on the fetal kidneys. Increasing degrees of hyperglycaemia, as seen sometimes in pregestational diabetes, may affect nephrogenesis; however larger studies are needed.

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Acknowledgements

We would like to thank all the women who participated in the study and acknowledge their significant contribution. The authors also thank sonographers Ms Sue Bloomfield and Ms Kate Gerard for helping to perform the ultrasound examinations and Ms Nicole Clapham for organising participants, data management and collection. Author SB is supported by a Queensland Advancing Clinical Research Fellowship.

Funding

This work was supported by the Australasian Society for Ultrasound in Medicine (ASUM research grant 2018) and Townsville Hospital Study, Education and Research Trust Account (SERTA Grant: 27_2016). This observational study adheres to the STROBE reporting guideline and the STROBE checklist is included with the submission of this manuscript.

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Authors and Affiliations

  1. Ultrasound Department, Townsville University Hospital, IMB 47, P.O. Box 670, Douglas, Townsville, QLD, 4810, Australia

    Sonja Brennan

  2. Division of Tropical Health and Medicine, James Cook University, Townsville, Australia

    Sonja Brennan, Yogavijayan Kandasamy, Donna M. Rudd, Rhondda E. Jones & David L. Watson

  3. Department of Neonatology, Townsville University Hospital, Townsville, Australia

    Yogavijayan Kandasamy

  4. Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia

    Yogavijayan Kandasamy

  5. Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia

    Michal E. Schneider

  6. Maternal Fetal Medicine Unit and Department of Obstetrics and Gynaecology, Townsville University Hospital, Townsville, Australia

    David L. Watson

Authors
  1. Sonja Brennan
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  2. Yogavijayan Kandasamy
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  3. Donna M. Rudd
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  4. Michal E. Schneider
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  5. Rhondda E. Jones
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  6. David L. Watson
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Contributions

SB designed the study, was involved in the acquisition of the data and analysed the data under the guidance of REJ. SB also wrote the manuscript, reviewed and edited the manuscript. YK, DLW, DMR and MES helped design the study and critically reviewed and edited the manuscript. REJ was involved in the data analysis and reviewed and edited the manuscript. All authors read and approved the final version. DLW and SB are the guarantors of this work and as such accept official responsibility for the overall integrity of the data and the manuscript.

Corresponding author

Correspondence to Sonja Brennan.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. The Townsville Hospital and Health Service Human Research Ethics Committee approved the study (HREC/16/QTHS/216).

Informed consent

Written informed consent was obtained from all participants.

Availability of data and code

The full data that supports the findings of this study are available from the corresponding author upon reasonable request. The full code of the models fitted, with their outputs, are provided in Online Resource 1.

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Brennan, S., Kandasamy, Y., Rudd, D.M. et al. The effect of diabetes during pregnancy on fetal renal parenchymal growth. J Nephrol 33, 1079–1089 (2020). https://doi.org/10.1007/s40620-020-00815-z

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  • DOI: https://doi.org/10.1007/s40620-020-00815-z

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