Emergence of behavioural states in fetuses of type-1-diabetic women |
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| Authors: | E J Mulder G H Visser D J Bekedam H F Prechtl |
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| Affiliation: | 1. Department of Obstetrics, University Hospital Groningen, The Netherlands;2. Department of Developmental Neurology, University Hospital Groningen, The Netherlands;1. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States;2. Esophageal and Airway Treatment Center, Department of Surgery, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA, United States;3. Harvard Medical School, 25 Shattuck St., Boston, MA, United States;1. Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain;2. Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain;3. Network of Centres of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain;4. Unit of Research. Fundació Docència i Recerca Mútua Terrassa, University of Barcelona, Terrassa, Spain;5. Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;6. Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain;1. Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children''s Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands;2. Department of Neonatology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium;3. Department of Radiology, Erasmus MC-Sophia Children''s Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands;4. Department of Neurology, Erasmus MC-Sophia Children''s Hospital, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands;5. Department of Neonatology, VU University Medical Center, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands;6. Department of Radiology, Wilhelmina Children''s Hospital, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;7. Department of Pediatrics, Division of Neonatology, Wilhelmina Children''s Hospital, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands;1. Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil;2. Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil;1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;2. Deparmernt of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;3. Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;1. Department of Neurology, University of Washington, Seattle Children׳s Hospital, Seattle, WA;2. Division of Neurology, Ann & Robert H. Lurie Children׳s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Box #51, Chicago, IL 60611 |
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| Abstract: | ![]()
The aim of this study was to investigate the effects of tightly controlled maternal (type-1-)diabetes mellitus on the development of fetal behavioural states. Seventeen diabetic women, who required insulin (White's class C predominantly) and were treated with continuous subcutaneous insulin infusion (CSII) therapy, participated in the study. Adjustment to an insulin-pump occurred before conception or during early pregnancy. In all diabetic women (near-)normoglycemia was achieved during pregnancy, with glycosylated hemoglobin-values within the normal range (6-8.5%). Fifty-three 2-h recordings of fetal heart rate, uterine contractions and of real-time ultrasound scanning for fetal body movements, breathing and eye movements were obtained from the 17 fetuses. The fetuses were longitudinally studied between 32 and 40 weeks post menstrual age, at intervals of 2 weeks. The 3 state variables, fetal heart rate, body movements and eye movements, were analyzed for the presence of combinations meeting the definitions of the four fetal behavioural states. Findings in the fetuses of diabetic women were compared with those obtained from 28 low risk fetuses. The criteria of states were met in only 3 of 8 fetuses studied at 38 weeks and in one of two studied at 40 weeks. For comparison: in low risk fetuses studied at 38 and 40 weeks, states were present in 70% and 90% of the cases, respectively. This poorly developed state organization exhibited by the near term fetuses of the diabetic group, was related to maternal parity, but not to pre- or postconceptional onset of CSII-treatment. Fetuses of nulliparous diabetic women showed more often asynchrony of transitions (greater than 3 min) and interruption of periods of concordant association. This resulted in significantly higher percentages of 'no-coincidence' and in low incidence of behavioural states as compared with control fetuses of nulliparous women. In the few multiparous diabetic cases studied near term the development of fetal behavioural states was normal. We conclude therefore that, despite tight control of maternal diabetes, the development of behavioural states is disturbed in fetuses of nulliparous diabetic women. |
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