Abstract
Introduction: Undiagnosed gestational diabetes mellitus (GDM) is associated with severe perinatal complications.
Patients and Methods:Out of 970 women, infant and maternal morbidity was assessed in 114 mother-children-pairs with an infant birth weight over the 90th percentile ([Voigt et al., 1996]). It was the aim of this retrospective study to assess the number of mothers with undiagnosed GDM, who have born a macrosomic child.
Results: The macrosomia rate in newborns was 12 % in this study excluding macrosomic infants of mothers with preexisting diabetes mellitus. Maternal data: Age 28.3 ± 5.3 years, adipositas (body-mass-index > 30 kg/m2) in 42.1 % vs. 30.4 % in the peer group (p < 0.02), increase in weight > 15 kg during pregnancy in 57.9 % of the mothers who have given birth to a macrosomic child vs. 30.9 % in the peer group (p < 0.0001), family history of diabetes mellitus (28.0 % vs. 11.3 % in the peer group, p = 0.006), preeclampsia in 8.8 % vs. 2.7 % in the peer group (p = 0.002), cervical insufficiency in 2.6 % vs. 0.4 % in the peer group (p = 0.02). After delivery HbA1c was elevated in 38.6 % of the women having born macrosomic infant (mean HbA1c: 5.0 % ± 0.5). Infant data: neonatal jaundice 16.7 % vs. 4.5 % in the peer group, p < 0.0001. There were no statistically significant differences concerning perinatal condition and malformations. Neonatal hypoglycaemia occurred in 9.6 % of the macrosomic infants. Cord blood insulin levels were significantly elevated in comparison to the peer group of mothers without metabolic disorders and having born eutroph infants (8.4 mU/l [3.0 - 100.0] vs. 5.3 mU/l [3.0 - 30.7], p = 0.01). 11.4 % of all macrosomic infants had cord blood insulin levels above the normal range.
Conclusion: More than one third of the mothers having born one or more macrosomic infants had an impairment of glucose metabolism immediately after birth. The elevated prevalence of preeclampsia in this group confirms the relationship of hypertension and impaired glucose metabolism during pregnancy. The detection of hyperinsulinaemia, postnatal hypoglycaemia, elevated prevalence of neonatal jaundice with need of further therapy and diabetic fetopathy in macrosomic infants of mothers, whose metabolism was not monitored during pregnancy, pinpoint the need for a diagnostic screening for GDM.
Key words
Undiagnosed gestational diabetes mellitus - maternal and infant morbidity - fetal macrosomia - infant hyperinsulinaemia - diabetes screening
References
-
1
Aberg A, Rydhström H, Kallen B, Kallen K.
Impaired glucose tolerance during pregnancy is associated with increased fetal mortality in preciding sibs.
Acta Obstet Gynecol Scand.
1997;
76
212-217
-
2
Aberg A, Westbom L.
Association between maternal pre-existing or gestational diabetes and health problems in children.
Acta Paediatr.
2001;
90
746-750
-
3
Adams K M, Li H, Nelson R L, Ogburn P L, Danilenko-Dixon D R.
Sequelae of unrecognized gestational diabetes.
Am J Obstet Gynecol.
1998;
178
1321-1332
-
4
American Academy of Pediatrics .
Practice parameter: Management of hyperbilirubinemia in the healthy term newborn.
Pediatrics.
1994;
94
558-565
-
28
Arbeitsgruppe Perinatologie/Neonatologie der Landesärztekammer Sachsens .
Qualitätssicherung in der Perinatologie und Neonatologie im Freistaat Sachsen.
Ärzteblatt Sachsen.
2002;
12
1-16
-
5
Briese V, Kerler B.
Gestationsdiabetes - Diagnostik unter Berücksichtigung anamnestischer Risikofaktoren.
Gynecol Obstet Invest.
1997;
2
165-169
-
6
Bühling K J, Stein U, Dudenhausen J W.
Evaluation des 50 g-Glukose-Screeningtests an 1416 Schwangeren.
Geburtsh Frauenheilk.
1998;
58
100-109
-
7
Catalano P M, Drago N M, Amini S B.
Maternal carbohydrate metabolism and its relationship to fetal growth and body composition.
Am J Obstet Gynecol.
1995;
172
1464-1470
-
8
Deutsche Diabetesgesellschaft, AGMFM der DDG, Deutsche Gesellschaft für Perinatale Medizin .
Empfehlung zur Diagnostik und Therapie des Gestationsdiabetes.
Frauenarzt.
2001;
42
891-899
-
9
Djelmis J, Blajic J, Pfeifer D, Ivanisevic M, Kendic S, Votava-Raic A.
Glycosylated hemoglobin and fetal growth in normal, gestational and insulin dependent diabetes mellitus pregnancies.
Coll Antropol.
1997;
21
621-629
-
10 Düring P. Hypertensive Schwangerschaftserkrankungen. Schneider H, Husslein P, Schneider KTM Geburtshilfe. Berlin, Heidelberg; Springer 2000: 343-370
-
11
Festa A, Schwarzmaier A, Bechter B, Grünberger W, Schernthaner G.
Anwendung eines sensitiven Verfahrens zur Diagnostik des Gestationsdiabetes. Metabolische und klinische Ergebnisse.
Geburtsh Frauenheilk.
2001;
61
79-84
-
12
Fraser R B, Bruce C.
Amniotic fluid insulin levels identify the fetus at risk of neonatal hypoglycemia.
Diabet Med.
1999;
16
568-572
-
13
Griffin M E, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J. et al .
Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestational at diagnosis and outcome.
Diabet Med.
2000;
17
26-32
-
14 Harms V. Biomathematik, Statistik und Dokumentation. 7. überarb. Aufl. Kiel-Mönkeberg; Harms 1998
-
15 Hauner H. Körpergewicht. Nawroth PP, Ziegler R Klinische Endokrinologie und Stoffwechsel. Berlin, Heidelberg; Springer 2001: 575-602
-
16
Heyl W, Rath W.
Die Überwachung der schwangeren Diabetikerin.
Z Geburtsh Neonatol.
1995;
199
132-137
-
17
Hiramatsu Y, Masuyama H, Mizutani Y, Kudo T, Oguni N, Oguni Y.
Heavy-for-date infants: their backgrounds and relationship with gestational diabetes.
J Obstet Gynaecol Res.
2000;
26
193-198
-
18
Hoegsberg B, Gruppuso P A, Coustan D R.
Hyperinsulinemia in macrosomic infants of nondiabetic mothers.
Diabetes Care.
1993;
16
32-36
-
19
Hopp H, Vollert W, Ragosch V, Pritze W, Ebert A, Entezami M. et al .
Vermeidung kindlicher Risiken durch ein generelles Gestationsdiabetes-Screening, intensivierte Diagnostik und konsequente Therapie.
Geburtsh Frauenheilk.
1995;
55
28-31
-
20
Jang H C, Min K H, Lee H K, Cho N H, Metzger B E.
Short stature in Korean women: a contribution to the multifactorial predisposition to gestational diabetes mellitus.
Diabetologia.
1998;
41
778-783
-
21
Kleinwechter H.
75 g Glukose für jede Schwangere.
ÄP Gynäkologie.
1999;
9
17
-
22
Köhler B.
Statistische Ergebnisse der Perinatal- und Neonatalerhebung 1997.
Brandenburgisches Ärzteblatt.
1999;
8
296-298
-
23
Kousseff B G.
Gestational diabetes mellitus (class A): a human teratogen?.
Am J Med Genet.
1999;
83
402-408
-
24
Kunkel S, Briese V, Kluge K, Friese K, Koepcke E.
Die Ermittlung von Referenzbereichen und der Einfluss von mütterlichen und kindlichen Faktoren auf Insulin- und C-Peptidspiegel im Nabelschnurblut.
Zentralbl Gynäkol.
1999;
121
488-494
-
25
Kurishita M, Nakashima K, Kozu H.
A retrospective study of glucose metabolism in mothers of large babies.
Diabetes Care.
1994;
17
649-652
-
26
Metzger B E, Coustan D R.
Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus.
Diabetes Care.
1998;
21
161-167
-
27
Metzger B E, Freinkel N.
Accelerated starvation in pregnancy: implications for dietary treatment of obesity and gestational diabetes mellitus.
Biol Neonate.
1987;
51
78-85
-
29
Niesen M, Jährig D.
Das Neugeborene der diabetischen Mutter.
Gynäkologe.
1998;
31
76-84
-
30
Okun N, Verma A, Mitchell B F, Flowerdew G.
Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia.
J Matern Fetal Med.
1997;
6
285-290
-
31
Roach V J, Hin L Y, Tam W H, Ng K B, Rogers M S.
The incidence of pregnancy induced hypertension among patients with carbohydrate intolerance.
Hypertens Pregnancy.
2000;
19
183-189
-
32
Roberts R N, Traub A I, Kennedy A L, Hadden D R.
Glycosylated hemoglobin and hypertension arising in pregnancy.
Br J Obstet Gynecol.
1998;
105
1122-1124
-
33
Robson S, Chan A, Keane R J, Luke C G.
Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study.
Aust N Z J Obstet Gynecol.
2001;
29-35
-
34 Salvesen D R, Nicolaides K H. Findings from cordocentesis in diabetic pregnancies. Dornhorst A, Hadden DR Diabetes and Pregnancy: An International Approach to Diagnosis and Management. Chichester; Wiley & Son 1996: 207-220
-
35
Sameshima H, Kamitomo M, Ibara S, Kajiya S, Kai M, Ikenoue T.
Neonatal 24-hour urinary C-peptide and birth weight in infants of diabetic mothers.
J Matern Fetal Med.
1999;
8
57-60
-
36
Schäfer U, Dupak J, Dudenhausen J, Vetter K.
Postpartale Diagnose des Gestationsdiabetes bei makrosomen Neugeborenen - Vergleich zweier Untersuchungsmethoden.
Z Geburtsh Perinat.
1993;
197
257-261
-
37
Schmitt S, Burger D, Kühl P G, Kiess W.
Diabetische Fetopathie.
Monatsschr Kinderheilkd.
1996;
144
79-86
-
38
Schrader H M, Jovanovic-Peterson L, Brevier W C, Peterson C M.
Fasting plasma glucose and glycosylated plasma protein at 24 to 28 weeks of gestation predict macrosomia in the general obstetric population.
Am J Perinatol.
1995;
12
247-251
-
39
Schwartz R, Gruppuso P A, Petzold K, Brambilla D, Hiilesmaa V, Teramo K A.
Hyperinsulinemia and macrosomia in the fetus of the diabetic mother.
Diabetes Care.
1994;
17
640-648
-
40
Soares J AD, Dornhorstt A, Beard R W.
Should we screen for gestational diabetes? The case for screening for gestational diabetes.
BMJ.
1997;
315
737-739
-
41
Solomon C G, Willett W C, Carey V J, Rich-Edwards J, Hunter D J, Colditz G A. et al .
A prospective study of pregravid determinants of gestational diabetes mellitus.
JAMA.
1997;
278
1078-1083
-
42
Stiete H, Stiete S, Jährig D, Briese V, Willich S N.
Risikogruppen Neugeborener diabetischer Mütter in Abhängigkeit von ihrem somatischen Outcome und der mütterlichen diabetischen Stoffwechsellage in der Schwangerschaft.
Z Geburtsh Neonatol.
1995;
199
156-162
-
43
Stiete S, Stiete H, Jährig D.
Diabetes und Schwangerschaft: Babies auch postpartal überwachen.
Therapiewoche.
1993;
43
2260-2271
-
44
Stoz F, Paulus W, Flock F, Kreienberg R.
Diabetes-Screening bei Schwangeren mit unterschiedlichem Risiko.
Z Geburtsh Neonatol.
1995;
199
138-141
-
45
Tyrala E E.
The infant of the diabetic mother.
Obstet Gynecol Clin North Am.
1996;
23
221-241
-
46
van Assche F A, Spitz B.
Beziehung zwischen Präeklampsie und Diabetes in der Schwangerschaft.
Gynäkologe.
1998;
31
162-164
-
47
Voigt M, Schneider K TM, Jährig K.
Analyse des Geburtengutes des Jahrganges 1992 der Bundesrepublik Deutschland.
Geburtsh Frauenheilk.
1996;
56
550-558
-
48
Weiss P AM.
Klinische Bedeutung des Geburtsgewichts bei Diabetes mellitus.
Gynäkologe.
1998;
31
58-67
-
49
Weiss P AM, Kainer F, Haas J.
Cord blood insulin to assess the quality of treatment in diabetic pregnancies.
Early Hum Dev.
1998;
51
187-195
-
50
Weiss P AM, Kainer F, Haeusler M CH, Pürstner P, Urasch R.
Schnellmethode zum Diabetesscreening in der Schwangerschaft.
Geburtsh Frauenheilk.
1994;
54
697-701
-
51
Weiss P AM, Walcher W, Scholz H S.
Der vernachlässigte Gestationsdiabetes: Risiken und Folgen.
Geburtsh Frauenheilk.
1999;
59
535-544
-
52
Wollschlaeger K, Nieder J, Koppe I, Hartlein K.
A study of fetal macrosomia.
Arch Gynecol Obstet.
1999;
263
51-55
Dr. med. W. Hunger-Dathe
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