General Obstetrics and Gynecology: Obstetrics
What proportion of birth weight is attributable to maternal glucose among infants of diabetic women?

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Objective

This study was undertaken to determine the proportion of birth weight attributable to glucose concentrations of diabetic mothers.

Study design

Data of diabetic women who used insulin were eligible for analysis if the women had been treated during pregnancy for at least 12 weeks, and had recorded at least 50% of 4 daily glucose checks (fasting and 1-hour postprandial) until the last office visit before delivery. The independent association between maternal glucose values and demographics and birth weight percentiles for gestational age and gender were analyzed by multiple regression methods.

Results

Data of 90 diabetic women were analyzed. Only third-trimester glucose concentrations were associated with birth weight. Prepregnancy body mass index was also selected in the models, including second- and/or third-trimester glucose. Together, these variables explained 18% of the variance in birth weight percentiles.

Conclusion

Maternal glycemia during third-trimester and prepregnancy body mass index are independent predictors of birth weight in pregnancies complicated by insulin-requiring gestational or type 2 diabetes.

Section snippets

Material and methods

All patients were treated at Kaiser Foundation Hospital, Bellflower, Calif. Women requiring insulin treatment of their diabetes during pregnancy were eligible for inclusion in the study. Their memory-based meters were calibrated to whole blood glucose values and recorded the date and time of each glucose measurement (One Touch 2 and One Touch Profile, Lifescan, Johnson & Johnson, Milpitas, CA). Patients were requested to return for office visits every 1 to 2 weeks at which time their glucose

Results

The data of 198 diabetic women who had been treated from January 1, 1997, to December 31, 2002, were available for review. Of these, 97 (46 GDM, 44 type 2, and 7 type 1 diabetic women) met inclusion criteria. The data of the remaining 101 subjects were excluded because they had been treated for fewer than 12 weeks. Because of their small numbers, the data of the type 1 diabetic women were also excluded from analysis. For the women found to have GDM, the mean gestational age at glucose tolerance

Comment

The results of this study suggest that in pregnancies of women who have GDM and type 2 diabetes requiring insulin both maternal glucose in third trimester and maternal prepregnancy BMI are independent predictors of infants' birth weights. Together these 2 variables explained 18% of the variance in birth weight for gestational age and gender. There did not appear to be much variation in the strength of the relationship between maternal glucose and birth weight percentile at different times of

References (37)

  • E. Rey et al.

    The effects of first-trimester diabetes control on the incidence of macrosomia

    Am J Obstet Gynecol

    (1999)
  • O. Langer et al.

    Pregestational diabetes: insulin requirements throughout pregnancy

    Am J Obstet Gynecol

    (1988)
  • L. Jovanovic

    What is so bad about a big baby?

    Diabetes Care

    (2001)
  • D.M. Thompson et al.

    Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes

    Obstet Gynecol

    (1994)
  • H.C. Jang et al.

    Increased macrosomia and perinatal morbidity independent of maternal obesity and advanced age in Korean women with GDM

    Diabetes Care

    (1997)
  • F.F. Lauszus et al.

    Birthweight in women with potential gestational diabetes mellitus—an effect of obesity rather than glucose intolerance?

    Acta Obstet Gynecol Scand

    (1999)
  • A. Gokcel et al.

    Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy

    J Endocrinol Invest

    (2002)
  • U.M. Schaefer-Graf et al.

    Determinants of fetal growth at different periods of pregnancies complicated by gestational diabetes mellitus or impaired glucose tolerance

    Diabetes Care

    (2003)
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