Abstract
Introduction
Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important
during intrauterine life, a time when it can result in macrosomia, but also at delivery,
since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question
is, how long before delivery does maternal glycemic control contribute to newborn
insulinemia in GDM?
Methods
In 72 women with GDM, we calculated Spearman's rank (rs) correlations between umbilical cord blood C-peptide at birth (a biomarker of insulin
secretion), and both maternal glycosylated hemoglobin (HbA1c) and mean blood glucose
(MBG) recorded in the last two visits prior to delivery. Iterative correlations were
done between umbilical cord blood C-peptide at birth, and maternal glucose control,
at 0, 1, 2, 3, 4, and 5 weeks before delivery.
Results
At an early visit (32.95 ± 1.8 weeks), rs = 0.353 (P = 0.07) between HbA1c and C-peptide, whereas rs = 0.244 (P = 0.186) between MBG and C-peptide. At the latest visit (35.04 ± 1.6 weeks), rs = 0.456 (P = 0.004) between HbA1c versus C-peptide, and rs = 0.359 (P = 0.023) between MBG versus C-peptide. Iterative correlations between MBG and C-peptide
became significant at 2 weeks before delivery.
Conclusion
To further reduce the risk of hypoglycemia and hyperbilirubinemia in infants born
to women with GDM, besides applying a strict in-patient glucose control protocol at
delivery, it is necessary to improve even more the quality of maternal glucose control
during the last 2 weeks prior to delivery.
Résumé
Objectif
L'hyperinsulinisme fœtal causé par le diabète sucré gestationnel (DSG) est un facteur
important durant la vie intra-utérine, moment où il peut entraîner une macrosomie,
mais également à l'accouchement, car il peut provoquer une hypoglycémie et d'une hyperbilirubinémie
néonatales. Il convient donc de se poser la question suivante : à partir de combien
de temps avant l'accouchement la régulation glycémique d'une femme atteinte de DSG
contribue-t-elle à l'insulinémie du nouveau-né ?
Méthodologie
Nous avons calculé, chez 72 femmes atteintes de DSG, la corrélation de Spearman entre
le taux de peptide C du sang de cordon à la naissance (un biomarqueur de la sécrétion
d'insuline) et l'hémoglobine glyquée (HbA1c) et la glycémie moyenne (GM) maternelles
aux deux dernières consultations avant l'accouchement. Les corrélations itératives
entre le taux de peptide C du sang de cordon à la naissance et la régulation glycémique
maternelle ont été calculées à l'accouchement, ainsi qu'une, deux, trois, quatre et
cinq semaines avant celui-ci.
Résultats
Lors de visites à un âge gestationnel peu avancé (32,95 ± 1,8 semaines), la corrélation
de Spearman entre l'HbA1c et le peptide C était de 0,353 (P = 0,07), tandis que celle entre la GM et le peptide C était de 0,244 (P = 0,186). Lors de visites à un âge gestationnel plus avancé (35,04 ± 1,6 semaines),
ces corrélations étaient de 0,456 (P = 0,004) et de 0,359 (P = 0,023), respectivement. Les corrélations itératives entre la GM et le peptide C
devenaient significatives deux semaines avant l'accouchement.
Conclusion
Pour réduire davantage le risque d'hypoglycémie et d'hyperbilirubinémie chez les nouveau-nés
de femmes atteintes de DSG, il convient d'appliquer un protocole de régulation glycémique
strict à l'accouchement, mais également d'améliorer encore la qualité de cette régulation
pendant les deux dernières semaines de grossesse.
Key Words
Abbreviations:
GDM (gestational diabetes mellitus), HbA1c (glycosylated hemoglobin), MBG (mean blood glucose), MDI (multiple-dose insulin therapy), OGTT (oral glucose tolerance test)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 15,
2018
Received:
October 17,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
