Of Diabetic Mothers and Their Babies. An Examination of the Impact of Maternal Diabetes on Offspring Prenatal Development and Survival

Intrauterine fetal conditions can have lifelong cardiovascular effects. The impact of maternal diabetes mellitus on children’s cardiovascular profile is not well established. The goal of this study was to explore the association between maternal diabetes mellitus and offspring’s blood pressure (BP) ≤10 years of age. Generation XXI is a prospective birth cohort, which enrolled 8301 mother-offspring pairs, including 586 (7.1%) children of diabetic mothers. The associations between maternal diabetes mellitus and BP at 4, 7, and 10 years of age was modeled using linear regression. A mixed-effects model was built to assess differences in BP variation over time. Path analysis was used to quantify effects of potential mediators. Maternal diabetes mellitus was associated with higher BP in offspring at the age of 10 (systolic: β, 1.48; 95% CI, 0.36–2.59; and diastolic: β, 0.86; 95% CI, 0.05–1.71). This association was independent of maternal perinatal characteristics, and it was mediated by child’s body mass index and, to a lesser extent, by gestational age, type of birth, and birth weight (indirect effect proportion, 73%). No significant differences in BP were found at 4 and 7 years of age. Longitudinal analysis showed an accelerated systolic BP increase on maternal diabetes mellitus group (β, 1.16; 95% CI, 0.03–2.28). These finding were especially relevant in males, suggesting sex differences in the mechanisms of BP prenatal programing. Our results provide further evidence that maternal diabetes mellitus is associated with high BP late in childhood, demonstrating a significant role of child’s body mass in the pathway of this association.

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The Impact of Diabetes on Hippocampus

10.5772/intechopen.99895 ◽

2021 ◽

Author(s):

Saeed Vafaei-Nezhad ◽

Masood Vafaei-Nezhad ◽

Mehri Shadi ◽

Samira Ezi

Keyword(s):

Central Nervous System ◽

Developing Countries ◽

Nervous System ◽

Child Mortality ◽

Maternal Diabetes ◽

Mortality And Morbidity ◽

Increased Risk ◽

The Impact ◽

Diabetic Mothers ◽

Lines Of Evidence

Maternal Diabetes is one of the most common metabolic disorders resulting an increased risk of abnormalities in the developing fetus and offspring. It is estimated that the prevalence of diabetes during pregnancy among women in developing countries is approximately 4.5 percent and this range varies between 1 to 14 percent in different societies. According to earlier studies, diabetes during pregnancy is associated with an increased risk of maternal and child mortality and morbidity as well as major congenital anomalies including central nervous system (CNS) in their offspring. Multiple lines of evidence have suggested that infants of diabetic women are at risk of having neurodevelopmental sequelae. Previous studies reveal that the offspring of diabetic mothers exhibit disturbances in behavioral and intellectual functioning. In the examination of cognitive functioning, a poorer performance was observed in the children born to diabetic mothers when compared with the children of non-diabetic mothers. Therefore, it is important to study the possible effects of maternal diabetes on the hippocampus of these infants.

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The impact of maternal diabetes on fetal left atrial size and function

European Heart Journal ◽

10.1093/ehjci/ehaa946.0125 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Pathan ◽

P Lam ◽

S Sivapathan ◽

S Orde ◽

R Nanan ◽

...

Keyword(s):

Gestational Age ◽

Left Atrial ◽

Smoking Status ◽

Region Of Interest ◽

Maternal Diabetes ◽

Left Atrial Strain ◽

Endocardial Border ◽

And Function ◽

The Impact ◽

Diabetic Mothers

Abstract Introduction The developmental impact of maternal diabetes on the fetal left atrium (LA) is unclear. Purpose To determine if maternal diabetes mellitus (DM) impacts fetal LA size and function (fetal LA strain (LAS)). Methods We evaluated LA area (LAA) and LAS on fetuses of diabetic and control mothers who attended a mandated 24 week fetal morphology scan. Participants were excluded from the study if: there was a history of pre-eclampsia or if the fetus did not have adequate images for LAS analysis We used fetal cardiac 4-chamber view for analysis. A region of interest was drawn along the LA endocardial border for tracking and was used for assessment of maximum LAA. Baseline variables were compared using Student t test or Mann-Whitney U test and are presented as Mean ± Standard Deviation or Median (Interquartile range (IQR)). Body mass index (BMI), maternal age, gestational age, fetal heart rate (FHR), smoking status, estimated fetal weight (EFW) and Maternal DM were analysed in univariate and multivariate models with respect to LAA and LAS. Results 160 pregnant women (50 controls, 110 diabetics) were scanned. 9 were excluded due to poor image quality, resulting in 104 mothers with diabetes (T1DM 9, T2DM 8, and gestational DM 87) and 47 controls without diabetes. The mothers were well matched for age, blood pressure, smoking prevalence and gestational age. The diabetic mothers had a significantly higher BMI: Median (IQR) ((30.4 kg/m2 (25.1–34.8) vs 20.8 kg/m2 (21.4–27.4), p<0.001) and had higher weight (77 kg (65–93) vs 64 kg (62–68), p<0.001). FHR was higher in fetuses of diabetic mothers (147±10 vs 144±8, p 0.04). Maternal DM resulted in larger LAA 1.68 cm2±0.39 cm2 vs 1.56 cm2±0.36 cm2; p=0. 08, however the result was not significant. The LAS was significantly lower in fetuses with maternal DM compared to fetuses of controls: 28.8% ± 8.8% vs 32.3% ± 9.2%; p 0.033. On multivariate analysis (Table 1), the predictors of LAS were Maternal DM and FHR and predictors of LAA were EFW and Maternal DM. Conclusions Maternal diabetes modulates both LA size and LA function. The association between LA function and FHR may provide an explanation for fetal tachycardia in Maternal DM. Fetal left atrial strain Funding Acknowledgement Type of funding source: None

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Advanced echocardiography in neonates of diabetic mothers: a large population study of newborns

European Heart Journal ◽

10.1093/ehjci/ehaa946.3197 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Paerregaard ◽

R.O.B Voegg ◽

C.A Pihl ◽

H Bundgaard ◽

K.K Iversen

Keyword(s):

Gestational Diabetes ◽

Cardiac Function ◽

Large Population ◽

Maternal Diabetes ◽

Doppler Imaging ◽

Funding Source ◽

Private Company ◽

Increased Risk ◽

The Impact ◽

Diabetic Mothers

Abstract Background Maternal diabetes is associated with increased risk of congenital heart defects in the newborn, but the impact on systolic and diastolic function is less well described and findings are conflicting. Purpose To assess subclinical cardiac abnormalities in newborns of diabetic mothers using advanced echocardiography. Methods Transthoracic echocardiography (TTE) was performed within 30 days after birth in unselected neonates consecutively included in a prospective, multicenter, population-based study (2016–2018 (n=25,750)). Cardiac function in newborns of mothers with pre-gestational (pre-GDM) or gestational diabetes (GDM) and a group of matched controls of newborns of non-diabetic mothers was assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE) to detect myocardial abnormalities. Controls were matched 1:1 by the following criteria; multiple pregnancy, sex, gestational age (± five days), age at TTE (± three days) and weight (± 200 g). Results TDI and STE was performed in 317 newborns exposed to maternal diabetes during pregnancy (98 newborns of mothers with pre-GDM (females; 45.7%) and 219 newborns of mothers with GDM (females; 50%)). The mean age at time of TTE in newborns of diabetic mothers was 12 days (± 7 days). Cardiac function assessed with TDI showed significantly lower mitral valve (MV) systolic annular velocity (MV S') (3.15 cm/sec ± 0.67 vs 3.41 cm/sec ± 0.68, p=0.001), MV early diastolic annular velocity (MV E') (−4.71 cm/sec ± 1.26 vs −5.07 cm/sec ± 1.10, p=0.009), MV late diastolic annular velocity (MV A') (−4.24 cm/sec ± 1.25 vs −4.67 cm/sec ± 1.34, p=0.007) and interventricular septum late diastolic velocity (IVS A') (−4.49 cm/sec ± 0.89 vs −4.84 cm/sec ± 1.01, p=0.005) in newborns of mothers with pre-GDM compared to newborns of non-diabetic mothers. Newborns of mothers with GDM showed significantly lower MV A' (−4.35 cm/sec ± 1.35 vs −4.67 cm/sec ± 1.34, p=0.008) compared to newborns of non-diabetic mothers. When comparing subtypes of diabetes, newborns of mothers with pre-GDM had significantly lower MV E' (−4.71 cm/sec ± 1.26 vs −5.02 cm/sec ± 1.22, p=0.046) and IVS A' (−4.49 cm/sec ± 0.89 vs −4.75 cm/sec ± 0.93, p=0.033) compared to newborns of mothers with GDM. STE analysis showed that end-systolic and peak longitudinal strain (LS) were significantly lower in both subtypes of diabetes when compared to newborns of non-diabetic mothers; pre-GDM: end-systolic LS −17.93% and peak LS −19.18%, GDM: end-systolic LS −18.39% and peak LS −19.56% vs −19.56% and −20.29% in children of non-diabetic mothers, p<0.001 for all. Standard echocardiographic parameters were similar when comparing each subtype of diabetes with the newborns of non-diabetic mothers. Conclusion Advanced echocardiography showed impaired systolic and diastolic cardiac function in newborns of diabetic mothers. The most severe impairment was seen in newborns of mothers with pre-gestational diabetes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): PRIVATE COMPANY, Novo Nordisk Foundation: Pre-graduate Scholarhips 2019 - 6 months scholarship. Public Hospital, Herlev-Gentofte Internal Research Foundation 2019 - 6 months scholarship

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Understanding the impact of metformin on maternal health and fetal growth in pregnancies complicated by maternal diabetes

http://isrctn.com/ ◽

10.1186/isrctn13866189 ◽

2021 ◽

Author(s):

Jenny Myers

Keyword(s):

Maternal Health ◽

Fetal Growth ◽

Maternal Diabetes ◽

The Impact

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Neonatal Morbidity Pattern among Infants Born to Diabetic Mothers at Jamhouria Hospital, Benghazi- Libya

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2021/v7i430222 ◽

2021 ◽

pp. 38-55

Author(s):

Munera Awad Radwan ◽

Najia Abdelati El Mansori ◽

Mufeda Ali Elfergani ◽

Faiaz Ragab Halies ◽

Mohanad Abdulhadi Lawgali

Keyword(s):

Diabetes Mellitus ◽

Birth Weight ◽

Glycemic Control ◽

Gestational Diabetes ◽

Congenital Anomalies ◽

Maternal Diabetes ◽

Birth Trauma ◽

Metabolic Disturbance ◽

Cardiac Lesion ◽

Diabetic Mothers

Introduction: Diabetes has long been associated with maternal and perinatal morbidity and mortality. The infant of a diabetic mother have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risks of abortions and stillbirths. Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequallae, including abnormalities of growth, glucose and calcium metabolism, hematologic status, cardio- respiratory function, bilirubin metabolism, and congenital anomalies. The causes of the fetal and neonatal sequallae of maternal diabetes are Multifactorial. However, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus & can be prevented by appropriate periconceptional & prenatal care. Objective: to describe the morbidity pattern among infants of diabetic mothers (IDMs) either gestational or preconception diabetes mellitus. Methods: A cross sectional study was conducted in Jamhouria hospital/ neonatal ward & enrolled 120 consecutive infants born to diabetics mother either gestational or preconception diabetes mellitus over one year period. Results: 120 babies were diagnosed as IDMs and were admitted to Neonatal intensive care unit, male, female, 74(60.8%) were gestational diabetes, and 46 (38.3%) with preconception diabetes, full term comprise 98 cases (81.6%) while premature were 22 cases (18.3%). For birth weight 20 case [16.7%} were low birth weight, macrosomia represent 16 case (13.3%). Most common congenital anomalies was cardiac lesion 36 cases, for GDM 18 case =24.3% were PCDM 18 case around 40.0%. Central nervous system 11 case (9.1%) all of them dilated ventricular system& only 2 of them need surgical intervention with shunt. Gastrointestinal anomalies 4 cases {3.4%} 2 of them ectopic anus & 2 short bowel syndrome. Most common metabolic disturbance was Hypocalcemia 17 case (14.1%), followed by hypoglycemia 11 case (9.1%), followed with hyper bilirubinemia 3 cases (2.5%) Followed by Respiratory distress syndrome 26 case (21.6%), 17 case hyaline membrane disease (14.1%) ,transient tachypnea of neo born 9 cases (7.5%) , Birth trauma 3 cases Erb,s palsy one of them birth asphyxia. Conclusion: Most common type of diabetes in pregnancy is gestational diabetes, and most common congenital anomalies is the cardiac lesion & the most common metabolic disturbance is the hypocalcemia. Macrosomia associated with large birth weight as well as birth trauma. Large for gestational age and hypoglycemia associated mainly with poor maternal glycemic control.

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Prenatal Development

Advances in Medical Diagnosis, Treatment, and Care - Handbook of Research on Prenatal, Postnatal, and Early Childhood Development ◽

10.4018/978-1-7998-2952-2.ch008 ◽

2020 ◽

pp. 140-158

Author(s):

Nezahat Hamiden Karaca

Keyword(s):

Prenatal Development ◽

Point Of View ◽

Prenatal Period ◽

Severe Injuries ◽

Factors Affecting ◽

Development Section ◽

Basic Concepts ◽

Developmental Principles ◽

Physical Changes ◽

The Impact

The prenatal period is a vital process for the mother and father to become conscious about the development of the baby. Particularly in this process, in which mental and physical changes are observed in the mother, both the mother and father should be supported in order for the baby in the mother's womb to have a healthy gestation and to prevent a risky pregnancy. In this regard, particularly with the impact of recent technological innovations and with the increasing awareness of parents through increasing literacy, it is reported that the mortality rate is decreased; however, it is also reported that severe injuries during pregnancy and disabled babies still exist. From this point of view, the basic concepts related to development, developmental areas, developmental principles, factors affecting development and prenatal development will be explained in detail in the antenatal development section.

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Maternal or Paternal Diabetes and Its Crucial Role in Offspring Birth Weight and MODY Diagnosis

Metabolites ◽

10.3390/metabo10100387 ◽

2020 ◽

Vol 10 (10) ◽

pp. 387

Author(s):

Valeria Calcaterra ◽

Angela Zanfardino ◽

Gian Vincenzo Zuccotti ◽

Dario Iafusco

Keyword(s):

Birth Weight ◽

Crucial Role ◽

Autosomal Dominant ◽

Maternal Diabetes ◽

Fetal Weight ◽

Maturity Onset Diabetes ◽

Heterogenous Group ◽

History Of ◽

The Impact

Maturity-onset diabetes of the young (MODY) represents a heterogenous group of monogenic autosomal dominant diseases, which accounts for 1–2% of all diabetes cases. Pregnancy represents a crucial time to diagnose MODY forms due to the 50% risk of inheritance in offspring of affected subjects and the potential implications on adequate fetal weight. Not only a history of maternal diabetes may affect the birth weight of offspring, paternal diabetes should also be taken into consideration for a correct pathogenetic diagnosis. The crucial role of maternal and paternal diabetes inheritance patterns and the impact of this inherited mutation on birthweight and the MODY diagnosis was discussed.

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THE IMPACT OF MATERNAL DIABETES ON HEART AND VASSCULAR DEVELOPMENT; A POSSIBLE ROLE FOR GLYCATION

Cardiovascular Pathology ◽

10.1016/j.carpath.2004.03.264 ◽

2004 ◽

Vol 13 (3) ◽

pp. 89

Author(s):

P.A.M Roest ◽

D.G.M Molin ◽

K.S de Haseth-Weber ◽

C.G Schalkwijk ◽

U.J Eriksson ◽

...

Keyword(s):

Maternal Diabetes ◽

The Impact

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Effect of maternal diabetes on female offspring

Einstein (São Paulo) ◽

10.1590/s1679-45082014ao3200 ◽

2014 ◽

Vol 12 (4) ◽

pp. 413-419 ◽

Cited By ~ 2

Author(s):

Juliana de Oliveira Martins ◽

Maurício Isaac Panício ◽

Marcos Paulo Suehiro Dantas ◽

Guiomar Nascimento Gomes

Keyword(s):

Blood Pressure ◽

Kidney Function ◽

Maternal Diabetes ◽

Female Offspring ◽

Female Rats ◽

Urinary Flow ◽

Plasma Urea ◽

Creatinine Excretion ◽

Diabetic Mothers ◽

Creatinine Excretion Rate

Objective To evaluate the effect of maternal diabetes on the blood pressure and kidney function of female offspring, as well as if such changes exacerbate during pregnancy.MethodsDiabetes mellitus was induced in female rats with the administration of streptozotocin in a single dose, one week before mating. During pregnancy, blood pressure was measured through plethysmography. On the 20th day of pregnancy, the animals were placed for 24 hours in metabolic cages to obtain urine samples. After the animals were removed from the cages, blood samples were withdrawn. One month after pregnancy, new blood and urine sample were collected. Kidney function was evaluated through proteinuria, plasma urea, plasma creatinine, creatinine excretion rate, urinary flow, and creatinine clearance.Results The female offspring from diabetic mothers showed an increase in blood pressure, and a decrease in glomerular filtration rate in relation to the control group.Conclusion Hyperglycemia during pregnancy was capable of causing an increase in blood pressure and kidney dysfunction in the female offspring.

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