Amylin peptide levels are raised in infants of diabetic mothers.

BACKGROUND: Amylin is a novel 37 amino acid peptide hormone that is co-secreted with insulin from the pancreas in response to food intake. As a potent inhibitor of gastric emptying it plays an important role in the control of carbohydrate absorption. Feed intolerance is common in infants of diabetic mothers (IDM). AIMS: To establish a normal range of amylin levels in healthy neonates, and to determine whether serum amylin levels are raised in IDM. METHODS: A serial sample of 221 infants > or =28 weeks gestation was enrolled prior to delivery over a 12 month period. Blood samples collected immediately after birth (umbilical cord), and at the routine Guthrie test were analysed for amylin and insulin levels. RESULTS: Amylin levels in umbilical cord (n = 181) and Guthrie samples (n = 33) of healthy infants were 5.7 (3.0-9.1) and 6.9 (2.9-9.0) pmol/l respectively. IDM had significantly raised amylin levels in both cord (n = 31; 32.7 pmol/l, 25.9-48.1) and Guthrie samples (n = 8; 18.1 pmol/l, 15.3-23.6). Amylin correlated positively with insulin (n = 42; r = 0.67; 95% CI 0.4 to 0.81), birth weight (r = 0.22; 95% CI 0.08 to 0.36), and gestation (r = 0.18; 95% CI 0.03 to 0.32). Umbilical cord venous amylin levels showed agreement with arterial cord amylin levels (n = 34, mean bias -0.2, 95% CI 3.1 to -3.6). CONCLUSIONS: Amylin levels are significantly increased in the umbilical cord and Guthrie blood samples in IDM.     

Amylin peptide levels are raised in infants of diabetic mothers

Background: Amylin is a novel 37 amino acid peptide hormone that is co-secreted with insulin from the pancreas in response to food intake. As a potent inhibitor of gastric emptying it plays an important role in the control of carbohydrate absorption. Feed intolerance is common in infants of diabetic mothers (IDM). Aims: To establish a normal range of amylin levels in healthy neonates, and to determine whether serum amylin levels are raised in IDM. Methods: A serial sample of 221 infants ?28 weeks gestation was enrolled prior to delivery over a 12 month period. Blood samples collected immediately after birth (umbilical cord), and at the routine Guthrie test were analysed for amylin and insulin levels. Results: Amylin levels in umbilical cord (n = 181) and Guthrie samples (n = 33) of healthy infants were 5.7 (3.0–9.1) and 6.9 (2.9–9.0) pmol/l respectively. IDM had significantly raised amylin levels in both cord (n = 31; 32.7 pmol/l, 25.9–48.1) and Guthrie samples (n = 8; 18.1 pmol/l, 15.3–23.6). Amylin correlated positively with insulin (n = 42; r = 0.67; 95% CI 0.4 to 0.81), birth weight (r = 0.22; 95% CI 0.08 to 0.36), and gestation (r = 0.18; 95% CI 0.03 to 0.32). Umbilical cord venous amylin levels showed agreement with arterial cord amylin levels (n = 34, mean bias –0.2, 95% CI 3.1 to –3.6). Conclusions: Amylin levels are significantly increased in the umbilical cord and Guthrie blood samples in IDM.     

Transplacental passage of islet cell antibody in infants of diabetic mothers.

The incidence of pancreatic islet cell antibody (ICAb) was assessed in the cord blood and sera of infants of diabetic mothers (IDM). ICAb activity was detected in the cord blood of 10 of 36 (27.8%) consecutive IDM studied and in 0 of 111 (0%) cord bloods of normal control infants. In all instances, ICAb activity in the cord sera was of the immunoglobulin (IgG) class and was associated with ICAb in maternal sera at the time of delivery. No correlation was observed between the incidence of ICAb in IDM and alterations in fetal growth parameters, congenital malformation rates, cord blood insulin levels, or the incidence of neonatal complications. The evidence would support transplacental passage of ICAb from diabetic mothers to their offspring, but would not support a primary pathogenetic role for ICAb in the clinical or metabolic alterations observed in these infants.     

新生儿红细胞增多症的病因及其高危因素

目的 调查分析新生儿红细胞增多症的病因及其高危因素.方法 抽样调查2009年9月-2010年6月在本院分娩的新生儿2600例,测定新生儿正常断脐时间,并在12h后查其静脉血血常规,确定红细胞增多症患儿.筛查28项可导致红细胞增多症的危险因素,并填写调查表,通过单因素分析和Logistic回归分析出导致红细胞增多症发生的高危因素.结果 本研究共筛查2600名新生儿,其中红细胞增多症130例,检出率为5.5％.窒息、胎膜早破、妊娠高血压病、早产、低出生体质量、妊娠期糖尿病等6个因素为新生儿红细胞增多症发病的独立危险因素.Logistic多因素分析显示,当多种高危因素如产程缺氧、母体高危因素、胎儿高危因素混杂在一起时,本病发生的危险度增加.结论 新生儿红细胞增多症的病因复杂,宫内缺氧是发生红细胞增多症的高危因素.因而加强围生期监测及产程处理,尽快减少相关的危险因素是减少本病发生的关键.     

Hepatic Erythropoiesis in Infants of Diabetic Mothers: A Morphometric Study

Hepatic erythropoietic tissue is inversely proportional to the gestational age both in infants of diabetic mothers and in control cases. Hepatic erythropoietic and indices range from 17.8 in fetuses and babies before 28 week's gestational age to about 1.0 in fetuses and babies at 40-42 week's gestational age. The decline with gestational age is gradual in the last 10-12 weeks of in utero development. Infants of diabetic mothers who are normally grown have normal amounts of erythropoiesis in their livers. At term, large infants of diabetic mothers have excessive hepatic erythropoiesis. Hypoxia, a frequent feature in infants of diabetic mothers, is probably responsible for the increased erythropoiesis, but an alternate mechanism may be that hyperinsulinemia directly stimulates erythroid precursors or erythropoietin production.     

Postnatal changes in serum immunoreactive erythropoietin in relation to hypoxia before and after birth

To assess the immediate postnatal changes of serum immunoreactive erythropoietin (EP) in infants born after acute or chronic fetal hypoxia, and to estimate the rate of EP disappearance, we studied EP concentration, measured by double-antibody radioimmunoassay, in cord venous plasma and in serum at a mean age of 8 hours in a control group (n = 9) and in three patient groups: (1) infants with polycythemia (n = 10), (2) infants born to mothers with preeclampsia of pregnancy, without (n = 22) or with (n = 11) acidosis at birth, and (3) infants with acute birth asphyxia (n = 19), seven of whom had postnatal hypoxia. In all patient groups, cord venous EP was elevated in comparison with values in control infants. No change was found in EP level between birth and 8 hours in control infants (geometric mean in cord and 8-hour sample: 20 and 16 mU/ml, not significant) or in acutely asphyxiated infants with postnatal hypoxia (122 and 72 mU/ml, not significant), whereas the EP level decreased in all other groups: infants with polycythemia (123 to 24 mU/ml, p less than 0.001), nonacidotic infants (78 to 26 mU/ml, p less than 0.001) and acidotic infants (176 to 38 mU/ml, p less than 0.001) of the preeclampsia group, and acutely asphyxiated infants without postnatal hypoxia (58 to 30 mU/ml, p less than 0.001). The mean (+/- SD) half-time of EP disappearance was 2.6 +/- 0.5 hours in infants with polycythemia and 3.7 +/- 0.9 hours in infants of the preeclampsia group.     

Hepatic erythropoiesis in infants of diabetic mothers: a morphometric study

Hepatic erythropoietic tissue is inversely proportional to the gestational age both in infants of diabetic mothers and in control cases. Hepatic erythropoietic and indices range from 17.8 in fetuses and babies before 28 weeks' gestational age to about 1.0 in fetuses and babies at 40-42 weeks' gestational age. The decline with gestational age is gradual in the last 10-12 weeks of in utero development. Infants of diabetic mothers who are normally grown have normal amounts of erythropoiesis in their livers. At term, large infants of diabetic mothers have excessive hepatic erythropoiesis. Hypoxia, a frequent feature in infants of diabetic mothers, is probably responsible for the increased erythropoiesis, but an alternate mechanism may be that hyperinsulinemia directly stimulates erythroid precursors or erythropoietin production.     

Blood sugar,free fatty acids and triglycerides in infants of diabetic mothers

Blood sugar (BS), free fatty acids (FFA) and triglycerides (TG) were estimated in eighteen neonates of diabetic mothers (IDM) and 36 appropriate for gestational age (AGA) term newborns of non-diabetic mothers, delivered normally and having normal blood sugar levels (30 mg/dl and above) were taken as controls. Even though blood sugar levels in the cord blood were higher in IDM group, mean levels were much lower than controls in first few hours of birth and nearly 45 per cent them developed hypoglycemia. A rise in FFA from cord levels in first few hours of birth was seen in all the cases, but levels were lower in IDM as compared to controls. TG levels showed a steady and mild rise from birth onwards. Changes in BS and FFA in IDM can be explained on the basis of hyperinsulinemic state in them in utero and in immediate postnatal period.     

Surfactant protein D levels in umbilical cord blood and capillary blood of premature infants. The influence of perinatal factors

Surfactant protein D (SP-D) is a collectin that plays an important role in the innate immune system and takes part in the surfactant homeostasis by regulating the surfactant pool size. The aims of this study were to investigate the values of SP-D in umbilical cord blood and capillary blood of premature infants and to relate the levels to perinatal conditions. A total of 254 premature infants were enrolled in the present study. Umbilical cord blood was drawn at the time of birth and capillary blood at regular intervals throughout the admission. The concentration of SP-D in umbilical cord blood and capillary blood was measured using ELISA technique. The median concentration of SP-D in umbilical cord blood was twice as high as in mature infants, 769 ng/mL (range 140-2,551), with lowest values in infants with intrauterine growth retardation (IUGR) and rupture of membranes (ROM). The median concentration of SP-D in capillary blood day 1 was 1,466 ng/mL (range 410-5,051 ng/mL), with lowest values in infants born with ROM and delivered vaginally. High SP-D levels in umbilical cord blood and capillary blood on day 1 were found to be more likely in infants in need for respiratory support or surfactant treatment and susceptibility to infections. We conclude that SP-D concentrations in umbilical cord blood and capillary blood in premature infants are twice as high as in mature infants and depend on several perinatal conditions. High SP-D levels in umbilical cord blood and capillary blood on day 1 were found to be related to increased risk of RDS and infections.     

The usefulness of measuring fructosamine in the cord blood of the newborn infants of diabetic mothers

The aim of our study was to evaluate the usefulness of fructosamine measurement (Fram) in cord blood as an index of glucose metabolism in the last week of pregnancy in infants of diabetic mothers. In newborns and their respective mothers Fram values were surprisingly greater in N than in IDM and IGDM and neonatal and maternal values appeared to be strictly related. While intrauterine growth was associated with metabolic control indexes of 2nd and 3rd trimester gestation. Fram value appeared positively correlated to cord insulin. In conclusion Fram level appears as a good index of glucose metabolic control of the last week of pregnancy and it is associated to cord insulin level and to neonatal hypoglycemia.     

The effects of acute and chronic perinatal stress on plasma vasopressin concentration and renin activity at birth

The effects of acute and chronic intrauterine stress on plasma vasopressin (AVP) concentration and renin activity (PRA) in the cord blood of 36 newborn infants were studied. AVP concentrations in the umbilical artery were significantly higher than those in the umbilical vein in all infants, except in those delivered by elective cesarean section after normal pregnancy. AVP concentrations in the umbilical arterial blood after normal term pregnancy and vaginal delivery (779 pg/ml, log mean) were higher than those in the cord blood of infants delivered vaginally after maternal hypertensive disease (198 pg/ml). Compared to the values of the latter group, the AVP values were significantly lower (39 pg/ml) in infants delivered by cesarean section without labor because of severe growth retardation and decreased heart rate variability. The group of normal term infants delivered by elective cesarean section after normal pregnancy had the lowest AVP concentrations (13 pg/ml). PRA in the umbilical arterial blood was not different from that in the umbilical venous blood. The highest mean level of PRA (14.5 ng/ml/h) was observed in premature infants delivered by cesarean section because of fetal growth retardation and pathological heart rate variability, and the lowest mean level in term infants delivered by elective cesarean section (3.4 ng/ml/h). PRA was significantly increased in term infants delivered vaginally after normal pregnancy (7.8 ng/ml/h) or after hypertensive pregnancy (11.7 ng/ml/h) in comparison to that of term infants delivered by elective cesarean section.(ABSTRACT TRUNCATED AT 250 WORDS)     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH II.

ABSTRACT. Changes in plasma glycerol (FG), free fatty acids (FFA) and triglyceride (TG) were studied in 24 normo- and 8 hypoglycemic infants of diabetic mothers (IDM). In both groups a normal rise in plasma FG 2 hours after birth was found indicating unimpaired lipolysis. The rise in plasma FFA, however, was only about 50% of normal in normoglycemic IDM and about 25% of normal in hypoglycemic IDM. The rise in plasma TG was normal in normoglycemic and about 70% of normal in hypoglycemic IDM. The 2 hour rise in plasma FFA correlated with the 2 hour concentration of insulin and glucose, whereas the rise in plasma FG and TG did not. Maternal plasma FFA correlated with fetal FFA retention (unbilical vein minus artery (V-A) FFA concentrations). No correlations were found between maternal plasma FFA values and birth-weights nor between umbilical V-A FFA concentrations and birth-weights.     

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

Background

Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.

Methods

This was a retrospective study of LGA infants of ??36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006?C2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student??s t test were used for comparing variables.

Results

Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045).

Conclusions

The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.     

THE INFLUENCE OF THE METHOD OF DELIVERY AND THE CLAMPING TECHNIQUE ON THE RED CELL VOLUME IN INFANTS OF DIABETIC AND NON-DIABETIC MOTHERS

The red cell volume has been investigated in 35 infants of diabetic mothers and in 18 infants of non-diabetic mothers. It is shown that not only the clamping technique but also, the method of delivery has an influence on the red cell volume of the infant. Thus the red cell volume is less in infants delivered vaginally with early clamping, compared with infants delivered by caesarean section with early clamping. These findings support the theory that during vaginal delivery a temporary change in It is suggested that IDM during vaginal delivery with early clamping deposit more blood in the placenta than do the non-IDM, since we found a smaller red cell volume per kg the distrfbution of. the foeto-placental blood volume between placenta and child occurs.     

Follow-up of Children of Insulin-dependent and Gestational Diabetic Mothers: Neuropsychological Outcome

ABSTRACT. Ninety-four infants of 28 weeks gestation or more were born to 85 women, 64 type I and 21 gestational diabetics, between 1969–1972 at Sabbatsberg's Hospital, Stockholm. Perinatal mortality rate was 6.3%. The follow-up study was conducted when the children were approximately 5 years of age and included a physical and a neurological evaluation, IQ determination of mother and child, and an interview of mother by a psychologist. Fifty-three infants of insulin-dependent (IDM) and 20 infants of gestational diabetic mothers (IGDM) (83 %) participated, 3 families could not be traced and 12 were unwilling. The group lost to follow-up (13 IDM, 2 IGDM) had more perinatal complications induding congential malformations than the follow-up group. All children had normal physical and neurological development. IQ was normal, the majority were above 100, the average in IDM was 115 (range 89–144) and 112 in IGDM (range 95–133). No obvious relationship was found between maternal acetonuria during pregnancy, infant birthweight, blood glucose during first hours after birth or neonatal complications and IQ of the children. A correlation (r= 0.364, p<0.01) was found between maternal and child IQ. Mothers exhibiting emotional disorders (anxiety, depression) had significantly higher life stress scores based on 29 stress variables and reported more frequently about conduct and behavioural disorders in their children than mothers without emotional disturbances.     

Beta glucuronidase and hyperbilirubinaemia in breast fed infants of diabetic mothers.

A prospective study was performed comparing bilirubin concentrations in 10 breast fed term infants of diabetic mothers (IDM) to those of 10 breast fed normal term infants. The beta-glucuronidase concentrations in serum and breast milk were assayed in the respective mothers. Significantly higher bilirubin concentrations were noted in the IDM group. Serum and breast milk beta-glucuronidase concentrations were significantly higher in diabetic mothers as compared with those of non-diabetic mothers. We suggest that the high concentration of beta-glucuronidase in breast milk of diabetic mothers is an additional important cause leading to hyperbilirubinaemia in their breast fed infants.     

Cord plasma vasopressin, erythropoietin, and hypoxanthine as indices of asphyxia at birth

To assess the value of cord plasma arginine vasopressin (AVP), erythropoietin (EP), and hypoxanthine (HX) as indices of asphyxia, we studied 62 infants of mothers with preeclampsia, 34 acutely asphyxiated infants, with 5-min Apgar score less than or equal to 6 and/or umbilical arterial pH less than or equal to 7.05, and 38 control infants. Umbilical arterial AVP in the asphyxia group (geometric mean; 95% confidence interval: 180; 92-350 pg/ml) was higher than in the control group (23; 8-66, p = 0.002) and correlated with umbilical arterial pH (r = -0.447, p = 0.028). AVP levels in the preeclampsia group did not differ from controls. Cord venous EP was higher in infants delivered by elective cesarean section from women with severe preeclampsia (115; 75-177 mU/ml, p less than 0.001) than in control infants (23; 18-27); in the whole group EP correlated with pH (r = -0.493, p less than 0.001). EP in the asphyxia group was similar (46; 35-65) to controls (40; 33-47) and did not correlate with pH. Cord arterial HX in the preeclampsia group was similar to controls (12.3; 9.5-16.0 mumol/liter), but elevated in the asphyxia group (23.7; 17.6-31.8, p = 0.001), in which HX correlated with pH (r = 0.558, p = 0.008) and AVP (r = 0.588, p = 0.005). EP did not correlate with AVP or HX in any group, nor did any of the variables correlate with the Apgar score. We conclude that cord plasma AVP and HX reflect acute asphyxia, whereas EP is elevated after more prolonged hypoxia.     

Surfactant protein D in newborn infants: factors influencing surfactant protein D levels in umbilical cord blood and capillary blood

Surfactant protein D (SP-D) is a collectin that plays an important role in the innate immune system. The role of SP-D in the metabolism of surfactant is as yet quite unclear. The aims of this study were to establish normal values of SP-D in the umbilical cord blood and capillary blood of mature newborn infants and to assess the influence of perinatal conditions on these levels. A total of 458 infants were enrolled in the present study. Umbilical cord blood was drawn at the time of birth and capillary blood at age 4 to 10 d. The concentration of SP-D in umbilical cord blood and capillary blood was measured by enzyme-linked immunosorbent assay. The median concentration of SP-D in umbilical cord blood was 392.1 ng/mL and was found to be influenced by maternal smoking and labor. The median concentration of SP-D in capillary blood was 777.5 ng/mL and was found to be influenced by the mode of delivery, the highest levels being observed in infants born by cesarean section. It was concluded that SP-D concentrations in umbilical cord blood and capillary blood are highly variable and depend on several perinatal conditions. Further studies are needed to elucidate the effect of respiratory distress and infection on SP-D concentrations.     

Cord blood leptin levels: relationship to body weight, body mass index, sex and insulin and cortisol levels of maternal-newborn pairs at delivery

To investigate leptin and to which factors it is related during the perinatal period, we measured serum leptin levels of 46 mothers at delivery, umbilical cord blood and infants on the third day of life. Maternal leptin was higher than in cord (p < 0.001), and did not correlate with maternal age, body weight, body mass index, weight gain during pregnancy, serum glucose, cholesterol, triglycerides, CPE, cortisol or HbA1c levels, nor any biochemical values or anthropometric data of the newborns (p > 0.05). In cord blood, leptin was significantly higher than in 3 day-old infants (p < 0.05), and correlated only with maternal insulin and glucose (r = 0.5, p < 0.01 and r = 0.4, p < 0.05, respectively). In 3 day-old infants, leptin did not correlate with any clinical data (p > 0.05). Leptin was not different in the two sexes (p > 0.05). Serum leptin levels were not related to adiposity of the mother-infant pairs or neonatal growth, and were not different in the two sexes during the perinatal period.     

新生儿脐血pH和BE影响因素的研究

目的通过大样本收集新生儿脐血血气,研究脐血血气统计学参考值范围与不同影响因素的相关关系。方法选择2012年5～11月广东省妇幼保健院和新会妇幼保健院产科出生的新生儿进行前瞻性研究,选取其中1rainApgar评分〉7分者的脐血血气结果进行统计分析,了解正常新生儿脐血血气的统计学参考值范围;重点分析影响新生儿脐血pH和BE的因素。结果2000例新生儿中,1min Apgar评分≤7分11例,〉7分1989例,低Apgar评分组pH〈7．2的比例为45．5％,正常Apgar评分组pH〈7．2的比例为3．5％,差异有统计学意义（P〈0．001）;1800例足月单胎、体重适于或大于胎龄新生儿中,1794例1min Apgar评分〉7分者脐血pH和BE的统计学参考值范围分别是7．34±0．14（X±1．96S）和-3．53±6．57（X±1．96s）。单因素分析显示,宫内窘迫组、妊娠期并发症组pH值均低于对照组,剖宫产组pH和BE值均高于阴道分娩组,脐带绕颈组pH值降低,双胎组BE值高于单胎组;羊水性状对pH、BE值均无影响。多因素分析显示,宫内窘迫、分娩方式均对脐血血气有影响。结论足月单胎、体重适于或大于胎龄新生儿中,1min Apgar评分〉7分者脐血pH值和BE值的统计学参考值范围分别是7．34±0．14和-3．53±6．57;Apgar评分与脐血血气分析具有一致性,但单独使用Apgar评分诊断早产儿窒息可能会增加窒息的误诊率;宫内窘迫可能会增加新生儿酸中毒的发生率,不同分娩方式对脐血血气pH、BE值均有影响。