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Metabolic parameters and fetal development in offspring of mother with gestational diabetes

In normal pregnancy, physiological insulin resistance (IR) is present as the result from placental hormones. In women with gestational diabetes (GDM), IR is more severe and leads to elevated concentration of glucose and other nutrients such as lipids and amino acids with increased transfer to the fetus. We aimed to determine the concentration of adiponectin, leptin and C-peptide in maternal vein serum (MVS) and umbilical vein serum (UVS) of newborns born from mother with GDM and healthy mothers at term and to investigate their associations with offspring outcome. Further, the aim was also to assess the associations between adiponectin, leptin and C-peptide in MVS /UVS at delivery and to examine whether or not there are correlations between those hormonal levels and birth weight, maternal body weights and body mass indexes. To examine the influence of GDM on cord blood lipids at birth and relationship to body composition, cord blood iC-peptide, leptin and adiponectin. Evaluate metabolic profile GDM and healthy pregnancies. Material and Methods: Pregnant women included in this prospective study underwent routine physical examination and performed 2-h 75- g oral glucose tolerance test (OGTT). Diagnosis of GDM was defined according WHO criteria. The serum sample was taken from 37 GDM and 46 healthy pregnant women. Maternal characteristics were analyzed: age, weight, height, BMI, parity, mode of delivery, and gestational age at delivery. Newborn characteristics were gender, cranial perimeter, weight, and length and ponderal index. All were delivered by cesarean section. We measured in maternal and in umbilical vein serum: glucose, HbA1c, triglycerides (TG), cholesterol, HDL and LDL cholesterol, C-peptide, adiponectine, leptine, HOMA-IR. RESULTS: Mothers with GDM and healthy ones were primiparous and there was no significant difference in age. Women with GDM had a significantly higher mean BMI than mothers in control group (29.6±3.2:23.3±2.3 ; p<0.001). The study group with GDM had a significantly higher values of most measured parameters: HbA1c 5.9±0.4%:4.0±0.2%, glucose (5.3±3.3 mmol/L:4.7±0.6 mmol/L ; p<0.001), TG (3.8±0.7:2.9±0.6 ; p<0.001), cholesterol (6.1±1.2:5.0±0.5 ; p<0.001), LDL (3.98±0.66:2.93±0.6 ; p<0.001), C- peptide (1038.8±628.1pg/L±926.9±434.2 pg/L ; p<0.001) IR (5.2±2.3:3.8±1.7 ; p<0.001). Leptin and adiponectin values were not significantly different between the groups. The mean birth weight of offspring of GDM mothers was significantly higher compared to the controls (3644.1±538g:3313.2±397.4g ; p<0.01). Infants of GDM mothers had higher levels of glucose, Cpeptide, leptin, IR and LDL cholesterol. The strong correlation was established between mother’s BMI and C-peptide, adiponectin, HbA1c and infants birth weight. Conclusion: Carbohydrate and lipid metabolism disturbance in GDM pregnant women explains enhanced fetal growth.

gestational diabetes; insulin resistance; fetal development

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