Amniotic fluid C-peptide and cortisol in normal and diabetic pregnancies and pregnancies accompanied by fetal growth retardation

The interrelationship between amniotic fluid (AF) concentration and content (AF X conc) of C-peptide and cortisol was studied in four groups of women comprising 10 gestational and 16 type-I diabetics, 11 women with intrauterine growth retarded fetuses (IUGR), and 17 healthy control women. Mean AF volume was significantly greater (P less than 0.05) in the type-I diabetic group than in the control group. Both concentration and content of AF C-peptide was significantly higher in the type-I diabetic group than in the control group (P less than 0.05 and P less than 0.01, respectively). The corresponding values were significantly lower in mothers with IUGR fetuses compared to controls (P less than 0.05). AF cortisol content was significantly higher (P less than 0.05) in the gestational diabetic group compared to the control group; there were no other significant differences between the groups regarding the cortisol concentration or content. Both cortisol and C-peptide contents were significantly interrelated in both control women (r = 0.68, P less than 0.01) and women with gestational (r = 0.68, P less than 0.05) and type-I diabetes (r = 0.63, P less than 0.01). The C-peptide/cortisol ratio was lowest in the IUGR group and highest in the type-I diabetic group. The same ratio was intermediate and almost equal in the control and gestational diabetic group. Both C-peptide and cortisol concentrations were unrelated to AF volume as well as infant birthweight. C-peptide content was significantly correlated to birthweight percentile in type-I diabetic women (r = 0.61, P less than 0.05). No such correlation was found in the three other groups.     

Interrelationship between amniotic fluid C-peptide and catecholamines in the last trimester of diabetic pregnancy

Amniotic fluid concentration and content (amniotic fluid volume X concentration) of C-peptide and catecholamines (epinephrine, norepinephrine) and their interrelationship was studied in nine women with gestational diabetes, in 14 women with type I diabetes, and in 20 healthy control women between the thirty-sixth and thirty-ninth week of gestation. Mean amniotic fluid volume was significantly larger (p less than 0.05) in the type I diabetic group than in the control group. Mean concentration and content of amniotic fluid C-peptide were elevated in women with gestational diabetes, significantly so in women with type I diabetes (p less than 0.05) as compared with nondiabetic control women. Mean amniotic fluid catecholamine concentrations were lower, although not statistically so, in both insulin-dependent and gestational diabetic women than in control women. Mean amniotic fluid catecholamine content was higher, although not statistically so, in women with gestational diabetes than in control women. In the type I diabetic group, epinephrine content was significantly lower (p less than 0.05) and norepinephrine content significantly higher (p less than 0.05) than in the control group. A significant positive correlation between the content of norepinephrine and C-peptide was found in control women (r = 0.57; p less than 0.05) and in women with gestational diabetes (r = 0.75; p less than 0.05). The close interrelationship could indicate a parallel maturation of these two hormonal systems.     

Amniotic fluid volumes and concentrations of C-peptide in diabetic pregnancies

Summary. Amniotic fluid (AF) volumes were determined by sodium paminohippurate (PAH) diloution in a consecutive series of 24 diabetic women at 34–35 weeks gestation. AF and maternal venous blood samples were analysed for C-peptide immunoreactivity (CPR). When the patients were subgrouped according to the presence ( n =17) or absence ( n =8) of neonatal morbidity, AF volumes (1340±236 ml vs 807±130 ml; mean ±SEM), AF concentrations of CPR (l.38±0.54 nmol/1 vs 0.61±0.14 nmol/1) and maternal blood glucose levels (5.3±0.2 mmol/1 vs 4.8±0.3 mmol/1) during the last trimester of pregnancy were not different. The total content of CPR was significantly (P<0.05) greater in pregnancies with neonatal complications (1.25±0.31 nmol) compared with that in pregnancies without neonatal complications (0.54±0.18 nmol). AF volumes were significantly (P<0.02) larger in pregnancies where feeding problems occurred (1546±307 ml, n =9) compared with that in pregnancies without such problems (957±188 ml, n =16). These findings indicate an impact of fetal hyperinsulinism on the functional maturation of the fetus. When the patients were subgrouped according to the presence or absence of detectable maternal plasma CPR, i.e. >0.05 nmol/1, and to insulin dependent and gestational diabetes no differences of AF volumes, AF concentrations of CPR or total AF contents of CPR were found.     

Fetal pancreatic function in infants of diabetic and rhesus-isoimmunized women

OBJECTIVE: To measure insulin and glucagon concentrations in amniotic fluid (AF) collected near term in basal conditions and after an arginine test in diabetic, rhesus-isoimmunized, and control pregnant women. METHODS: At baseline, AF was collected from 44 diabetic, 32 rhesus-isoimmunized, and 27 control pregnant women in late pregnancy. Fifty-two diabetic, six rhesus-isoimmunized, and nine control pregnant women had amniocentesis 2 hours after arginine infusion (30 g intravenous/30 minutes) at 33-36 weeks. RESULTS: Baseline AF glucose concentrations were significantly greater in diabetic women than the other conditions, and they related to the gestational age in the women with hemolytic disease of the newborn. Insulin and glucagon AF content of isoimmunized pregnancies overlapped controls, whereas insulin and insulin/glucagon molar ratios were significantly higher, and glucagon values lower, in diabetic pregnancies compared with isoimmunized and control pregnancies. In isoimmunized pregnancies, the AF concentrations of glucose, insulin, and glucagon were correlated with gestational age (less than 34, 34 weeks or more). The samples collected after arginine infusion, compared with those collected at baseline, showed significantly greater insulin and insulin/glucagon molar ratio values in diabetic (28 +/- 5 versus 11 +/- 1 microU/mL, P = .001; 29.4 +/- 1.7 versus 12.0 +/- 2.8, P = .001) and in Rh pregnant women (18 +/- 6 versus 7.7 +/- 0.7 microU/mL, P = .001; 30 +/- 9 versus 3.4 +/- 0.4 I/G, P = .001), whereas no significant difference was observed in the controls. CONCLUSION: Basal islet hormone concentrations in AF are modified by maternal diabetes and further influenced by arginine administration. Arginine produces an AF response that is similar in pregnancies complicated by diabetes mellitus and rhesus-isoimmunization, despite different (hyperglycemia and euglycemia) maternal blood glucose levels.     

Patterns of maternal weight gain in pregnancy

Summary. A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (   P < 0.05  ). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (>68 kg) and light (<55.4 kg) women was less than that in women whose weight was in the third quartile (60–68 kg,   P <0.05  ). The mean maternal weight gain was less in young (<20 years) women than in older women (>25 years;   P <0.05  ), less in parous than in primigravid women from week 37 onwards (   P <0.05  ), less in smokers than in non-smokers from 20 weeks onwards (   P <0.05  ), and greater in hypertensive women (BP> 140/90) than in normotensive women (   P <0.05  ) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure. Only 9.6% of the variation in average weekly weight gain could be predicted using these variables. It is unlikely that the measurement of maternal weight gain would be useful in detecting women who will have SGA infants or will develop hypertension.     

Patterns of maternal weight gain in pregnancy

A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (P less than 0.05). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (greater than 68 kg) and light (less than 55.4 kg) women was less than that in women whose weight was in the third quartile (60-68 kg, P less than 0.05). The mean maternal weight gain was less in young (less than 20 years) women than in older women (greater than 25 years; P less than 0.05), less in parous than in primigravid women from week 37 onwards (P less than 0.05), less in smokers than in non-smokers from 20 weeks onwards (P less than 0.05), and greater in hypertensive women (BP less than 140/90) than in normotensive women (P less than 0.05) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Umbilical amino acid concentrations in appropriate and small for gestational age infants: a biochemical difference present in utero

Plasma amino acid concentrations were determined in 28 pregnant women and their infants at term. Samples were obtained from 17 appropriate for gestational age and eight small for gestational age infants at cesarean section, while three small for gestational age fetuses were studied in utero by transabdominal cord sampling by means of ultrasonic guidance. Small for gestational age fetuses have significantly lower concentrations of alpha-aminonitrogen, compared with those of appropriate for gestational age fetuses, in both the umbilical artery and vein. Most of the difference is accounted for by the branched chain amino acids valine, leucine, and isoleucine. In contrast, hydroxyproline concentration is significantly higher in both the umbilical artery and vein of small for gestational age fetuses. The sum of the branched chain amino acid concentrations in the umbilical vein is directly related to maternal arterial values in both appropriate for gestational age and small for gestational age fetuses. Maternal arterial concentrations were slightly lower in small for gestational age fetuses and the regression analysis of umbilical venous versus maternal arterial branched chain amino acid concentrations was significantly different for small for gestational age and appropriate for gestational age infants. Umbilical venoarterial concentration differences in normal fetuses are significantly positive for most essential amino acids and for total alpha-aminonitrogen. In contrast, these differences were significant only for four essential amino acids in small for gestational age infants, while the total alpha-aminonitrogen venoarterial difference was not significant. The data obtained by transabdominal cord sampling from relatively undisturbed fetuses were in agreement with the data obtained at cesarean section; this information suggests that these differences between small for gestational age and appropriate for gestational age infants reflected steady-state conditions.     

Amniotic fluid C-peptide and phosphatidyl glycerol in diabetic pregnancy

The concentrations of C-peptide and phosphatidylglycerol in the amniotic fluid were determined in 36 pregnant diabetic women. Twenty-one patients who were being treated with insulin for gestational diabetes as well as 15 patients who were insulin dependent were studied. All patients were subjected to a program of strict metabolic control, and amniocentesis was performed at gestational week 36-37. Phosphatidyl glycerol was present in the amniotic fluid in 15 cases and absent in 21. The mean concentration of C-peptide did not differ whether phosphatidyl glycerol was present or absent. (C-peptide: 0.56 +/- 0.06 and 0.43 +/- 0.05 nmol/l respectively). Although the mean value for amniotic fluid C-peptide in both groups was close to that in diabetic pregnancies with an uneventful neonatal outcome, it was significantly higher than that in non-diabetic pregnancies, indicating minor fetal hyperinsulinemia. The level of C-peptide in the amniotic fluid showed a correlation to the subsequent birthweight of the infant (r = 0.50; p less than 0.01). It is concluded that with rigorous metabolic control of the pregnant diabetic patient, the presence or absence of phosphatidyl glycerol, as an index of fetal lung maturity, is apparently not related to the level of C-peptide in the amniotic fluid.     

The association of birthweight with maternal and cord serum and amniotic fluid growth hormone and insulin levels, and with neonatal and maternal factors in pregnant women who delivered at term

AIM: To investigate the influence of maternal and cord serum and amniotic fluid growth hormone (GH) and insulin and other neonatal and maternal factors on birthweight. METHODS: A total of 160 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 50), large for gestational age (LGA) (n = 50) or average for gestational age (AGA) (n = 60). GH and insulin levels were measured in maternal and cord serum and amniotic fluid at birth. RESULTS: GH levels in maternal and cord serum and amniotic fluid showed no differences among the three weight groups (P > 0.05). The cord insulin level was significantly lower in SGA (P < 0.01). The insulin level in venous cord blood correlated with birth and placental weights and neonatal height, whereas maternal serum and amniotic fluid insulin levels, and maternal and cord serum and amniotic fluid GH levels did not show any correlation with birthweight. The cord GH level at birth was correlated with GH levels after 4 postnatal weeks in the SGA group (P < 0.01). In addition, birthweight showed a correlation with prepartum maternal weight, maternal weight gain, maternal height, neonatal length and placental weight in all three weight groups. CONCLUSIONS: Cord GH, maternal serum and amniotic fluid GH and insulin levels did not correlate with birthweight in all three weight groups. The lack of correlation for GH levels in maternal and cord serum and amniotic fluid suggests that these compartments may be non-communicating separate units.     

Urinary C-peptide in the neonate correlates both to maternal glucose tolerance and to fetal size at birth

In 18 women with gestational diabetes the variables of an oral glucose tolerance test (fasting and 2-hour blood glucose values and area under the blood glucose curve) performed in the last trimester of pregnancy correlated significantly with the urinary C-peptide excretion during the first 12 hours of the life (r = 0.47, 0.71, and 0.60, respectively). In a combined group with 28 type II pregnant diabetic women there was also a significant correlation between the urinary C-peptide excretion of the infants and their skinfold. Assay of the urinary C-peptide excretion of the neonate, reflecting its insulin production, seems to be a sensitive parameter to study the influence of the maternal carbohydrate metabolism in the offspring.     

Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women

Objective To study risk factors for small for gestational age (SGA) infants by gestational age among nulliparous women and to estimate mortality rates among SGA and appropriate-for-gestational-age (AGA) infants by gestational age.
Design A population-based study from the Swedish Medical Birth Register.
Setting Sweden 1992–1993.
Population Liveborn singleton infants to nulliparous women (   n = 96,662  ).
Main outcome measures Crude and adjusted odds ratios of risk factors for SGA by gestational age. Rates of neonatal and postneonatal mortality.
Results Older maternal age (≥ 30 years) was foremost associated with increased risks of very and moderately preterm SGA (≥ 32 weeks and 33–36 weeks, respectively), but also with term SGA (≥ 37 weeks). Risks of SGA increased with decreasing maternal height at all gestational ages. Smoking increased the risks of moderately preterm and term SGA. Short maternal education increased the risk of preterm SGA and low pre-pregnancy body mass index slightly increased the risk of term SGA. Pre-eclampsia and essential hypertension foremost increased the risk of very preterm SGA (OR = 40.5 and 32.4, respectively) and moderately preterm SGA (OR = 17.4 and 10.6, respectively), but also increased the risk of term SGA. Neonatal and postneonatal mortality rates of SGA infants were substantially influenced by gestational age, and mortality rates were consistently higher among preterm SGA infants compared with AGA infants.
Conclusions Risk factors for SGA and mortality rates among SGA infants vary by gestational age. A subdivision of risk factors by gestational age adds knowledge, particularly about risks of preterm SGA, where the highest rates of mortality were observed.     

Outpatient obstetric management of women with type I diabetes

Conventional obstetric management of diabetic women has frequently incurred extensive hospitalization. Although this approach improved perinatal results for these women and their infants, it is costly and cumbersome. The 3-year experience of an outpatient diabetic obstetric clinic is compared with the results obtained at the same facility during 5 previous years when hospitalization was used more extensively. Perinatal mortality and morbidity were not different in 51 type I diabetic women managed almost entirely as outpatients when compared with 58 similarly complicated diabetic patients receiving more conventional management. Mean prenatal admissions (1 vs 2, p = less than 0.01), mean prenatal hospital days (6 vs 12, p = 0.05), and prolonged delivery admissions of greater than 7 days (31% vs 69%, p = less than 0.01) were significantly less. Outpatient obstetric management of diabetic women efficiently decreases maternal morbidity without increasing infant morbidity and mortality.     

Placental function test, clinical and biochemical parameters in diabetic pregnancy complicated by retinopathy

The pregnancy in specific-beta 1-glycoprotein (SP1) has been characterized as a beta 1 electrophoretic mobile glycoprotein with a molecular weight of 90,000 daltons. SP1 is known to be synthesized by the trophoblast. The measurement of this protein has been shown to be useful as a placental function test. At present, we have compared maternal SP1 serum levels in diabetic pregnancies between White classes A to D on the one hand and R, F on the other. A total of 37 uncomplicated pregnancies in healthy women and 32 of insulin-dependent pregnant diabetic women were examined between completed gestational weeks 8 and 41. In the diabetic group there were eleven women with diabetic retinopathy. Maternal SP1 serum levels were estimated by single radial immunodiffusion using a monospecific antiserum. In the results were integrated maternal and neonatal data such as glycemic control, glycosylated hemoglobin and insulin requirements. In each group there was a significant rise in maternal SP1 serum values in the second and the third trimester, when compared with values in the first trimester (p less than 0.01). Between the 34th and the 37th gestational week we found significantly lower SP1 values (p less than 0.05) in the retinopathic group (104.2 +/- 28.7 mg/l) in comparison with the control group (149.9 +/- 61.0 mg/l) and non-retinopathic group (139.1 +/- 41.7 mg/l).     

Nucleated red blood cells in healthy infants of women with gestational diabetes

OBJECTIVE: To evaluate whether absolute nucleated red blood cell (RBC) counts are elevated in large-for-gestational-age (LGA) infants of women with gestational diabetes compared with appropriate-for-gestational-age (AGA) infants of women with or without gestational diabetes. METHODS: We compared absolute nucleated RBC counts during the first 12 hours of life in three groups of term, vaginally delivered infants, LGA infants of women with gestational diabetes (n = 20), AGA infants of women with gestational diabetes (n = 20), and AGA infants of nondiabetic women (n = 30). We excluded infants of women with hypertension, smoking, alcohol or drug abuse, and those with fetal heart rate abnormalities in labor, low Apgar scores, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no significant differences among groups in gestational age, gravidity, parity, maternal analgesia, 1- and 5-minute Apgar scores, and lymphocyte counts. Corrected white blood cell counts and hematocrit were significantly higher in LGA infants of women with gestational diabetes than in the other groups. The median nucleated RBC count was significantly higher in LGA infants of women with gestational diabetes (0.56 x 10(9)/L, range 0-1.8 x 10(9)/L) than AGA infants of women with gestational diabetes (0.13 x 10(9)/L, range 0-0.65 x 10(9)/L) and controls (0.0005 x 10(9)/L, range 0-0.6 x 10(9)/L) (P < .001). Multiple regression analysis showed that absolute nucleated RBC count was significantly correlated with birth weight (or macrosomia) and maternal diabetic status (r2 = .25, P < .001 for the multiple regression, contribution of birth weight r2 = .19, and diabetes r2 = .06). CONCLUSION: At birth, term LGA infants born to women with gestational diabetes had higher absolute nucleated RBC counts compared with AGA infants born to women with gestational diabetes and controls.     

Placental weight in diabetic pregnancies

The placenta from 30 women with diabetes mellitus were examined and weighed at delivery. Nineteen of these were from women with overt and eleven from women with gestational diabetes. Eleven placentae from normal pregnancies served as controls. There was no difference between the mean +/- s.d. placental weight for the diabetic group and the control group (609 +/- 148 versus 591 +/- 93 g, NS). The mean placental weight ratios for the diabetic group and the control group were also similar (0.98 +/- 0.23 versus 0.89 +/- 0.15, NS). Moreover, there was no difference between the weights and weight ratios of placentae from women with overt (622 +/- 173 g, 1.02 +/- 0.27) and those with gestational diabetes (586 +/- 90 g, versus 0.90 +/- 0.13). Placental weights correlated with birthweights (r = 0.70, P less than 0.01) and with skinfold thickness measurements fo the infants (r = 0.40, P less than 0.05), but neither with gestational ages (r = 0.15, NS) nor with maternal glycosylated haemoglobin levels in the third trimester (r = 0.24, NS). Among the women with overt diabetes, placental weights were greater in those in White's class B and C than those in class D and R (689 +/- 143 versus 530 +/- 177 g; P less than 0.05). In general, placentae from well controlled diabetic patients were not heavier than those from normal pregnant women, although there was an increase in placental weight in White's class B and C, as compared with those in class D and R.     

瘦素在胎盘组织中的表达及其与新生儿体重的关系

目的探讨瘦素在胎盘组织中的表达及其与新生儿体重的关系.方法采用放射免疫法(RIA)检测100例足月孕妇静脉血及其新生儿脐血瘦素水平,根据新生儿出生体重分为大于胎龄儿(LGA)组19例,适于胎龄儿(AGA)组65例,小于胎龄儿(SGA)组16例,同时采用逆转录-聚合酶链反应(RT-PCR)技术,检测41例胎盘组织中瘦素mRNA表达水平.结果(1)胎盘组织中瘦素mRNA表达水平为0.97±0.04,与新生儿体重呈显著正相关关系(r=0.43,P＜0.01).其中LGA组(1.01±0.03)显著高于AGA组(0.97±0.02),SGA组(0.93±0.03)显著低于AGA组,差异均有极显著性(P＜0.01).(2)母血瘦素水平为(14.22±7.66)μg/L,与新生儿体重无相关关系(r=0.11,P＞0.05).(3)新生儿脐血瘦素水平为(7.58±5.15)μg/L,与新生儿体重呈显著正相关关系(r=0.57,P＜0.01),其中LGA组脐血瘦素水平为(13.38±6.75)μg/L,显著高于AGA组的(7.40±4.45)μg/L,SGA组为(2.79±1.54)μg/L,显著低于AGA组,差异有极显著性(P＜0.01).结论脐血及胎盘组织中瘦素水平与胎儿生长发育状态密切相关;母血瘦素水平与新生儿体重无关;孕期胎儿瘦素的重要来源是胎盘组织.     

Alterations of maternal metabolism in normal and diabetic pregnancies: differences in insulin-dependent, non-insulin-dependent, and gestational diabetes

In normal and diabetic pregnancies, the placenta functions as a complex endocrine gland that modulates all classes of maternal nutrients to the fetus. The metabolic alterations of normal pregnancy are diabetogenic and associated with modest resistance to endogenous insulin. Pregnant women with carbohydrate intolerance represent three metabolically heterogeneous groups: type I (insulin-dependent), type II (non-insulin-dependent), and gestational diabetes. Patients with type I diabetes are at risk for ketosis and require replacement therapy because of a deficient production of insulin. They have decreased 24-hour, around-the-clock levels of C-peptide and glucagon, and lower nocturnal cortisol values and higher 24-hour prolactin levels than those of women with type II diabetes. Type II pregnant diabetic patients are not prone to ketosis and are more resistant to endogenous and exogenous insulin. They have higher fasting and meal-stimulated levels of C-peptide, accentuated fasting hypertriglyceridemia, and significantly lower high-density lipoprotein cholesterol levels than those of normal or type I women. In gestational diabetes, the metabolic stress of pregnancy evokes reversible hyperglycemia which may be associated with either a surfeit or a deficiency of insulin. These metabolic differences among diabetic pregnant women could have implications for placental structure and function that might influence fetal growth.     

Plasma adrenomedullin levels in pregnancies with appropriate for gestational age and small for gestational age infants.

AIMS: To evaluate whether maternal and fetal plasma adrenomedullin levels in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants. METHODS: Maternal and fetal circulating adrenomedullin levels were compared between 62 pregnancies with AGA (43 delivered vaginally and 19 delivered by elective cesarean section) and 28 pregnancies with SGA (20 delivered vaginally and 8 delivered by elective cesarean section) at birth. Plasma adrenomedullin levels were measured from maternal and cord venous blood samples using a radioimmunoassay. Umbilical artery blood pH was also measured. RESULTS: There were no significant differences for maternal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. There were also no significant differences for fetal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. In the AGA group delivered vaginally, fetal mature/total adrenomedullin ratio (mean +/- standard error, 16.6 +/- 0.7%) was significantly higher than the maternal ratio (13.8 +/- 0.6%) (p < 0.05). In the SGA group delivered vaginally, fetal mature/total adrenomedullin ratio (18.5 +/- 1.0%) was also significantly higher than the maternal ratio (14.5 +/- 0.6%) (p < 0.05). There was no significant difference in umbilical artery blood pH among the groups. CONCLUSIONS: These results suggest that maternal and fetal plasma circulating adrenomedullin levels may play a role in maternal and fetal cardiovascular adaptation during delivery in pregnancies with both AGA and SGA infants.     

妊娠期糖尿病孕妇血清肿瘤坏死因子α水平变化与胰岛素抵抗关系的研究

目的　探讨妊娠期糖尿病孕妇血清肿瘤坏死因子α(TNF α)水平变化与胰岛素抵抗的关系。方法　采用酶联免疫吸附试验测定 4 2例妊娠期糖尿病孕妇 (GDM组 )、4 0例正常妊娠晚期孕妇 (正常妊娠组 )空腹血清TNF α水平 ;同时测定两组孕妇空腹血糖、C肽、胰岛素、糖化血红蛋白(HbA1c)水平。并且根据公式计算两组孕妇的胰岛素敏感指数 (ISI) ,以评价胰岛素抵抗程度。结果(1)GDM组孕妇空腹血清TNF α水平为 (5 2± 1 6 )ng/L ,正常妊娠组孕妇为 (4 5± 0 5 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇ISI为 - 4 3± 0 4 ,正常妊娠组为 - 3 8± 0 3,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )GDM组孕妇空腹血糖、胰岛素、C肽水平分别为 (5 5± 0 7)mmol/L、(13 4± 3 8)mU/L、(1 6± 0 4 )nmol/L ,正常妊娠组孕妇空腹血糖、胰岛素、C肽水平分别为(4 9± 0 4 )mmol/L、(9 3± 2 5 )mU/L、(1 2± 0 3)nmol,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇HbA1c为 (5 6± 0 5 ) % ,正常妊娠组孕妇为 (5 3± 0 5 ) % ,两组比较 ,差异有显著性(P <0 0 5 )。 (3)GDM组孕妇空腹血清TNF α水平与ISI呈显著负相关 (r=- 0 70 3,P <0 0 1) ,分别与空腹血糖、C肽、HbA1c呈显著正相关 (r     

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.
Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.
Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes. Customised and population birthweight centiles were calculated; pregnancy details and neonatal outcomes were compared between groups that delivered infants who were SGA (birthweight < 10th customised centile) and appropriate weight for gestational age (AGA) (birthweight 10–90th customised centile).
Results: Fifteen (7%) babies were SGA by population centiles and 32 (15%) by customised centiles. Two babies of Indian women were reclassified from SGA to AGA by customised centiles. Nineteen babies were reclassified from AGA to SGA by customised centiles; of these, 15 (79%) were born to Polynesian women, five (26%) were born less than 32 weeks and two (11%) were stillborn. Customised SGA infants, compared with AGA infants, were more likely to be born preterm (19 (59%) vs 20 (16%), P  < 0.001) and more likely to be stillborn (4 (13%) vs 0 P  = 0.001). After excluding still births, admission to the neonatal unit was also more common (19 of 28 (68%) vs 43 of 127 (34%), P  < 0.001).
Conclusions: In our population more babies were classified as SGA by customised compared with population centiles. These customised SGA babies have high rates of morbidity.