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Gestational Diabetes: Glycemic Control in the Last Two Weeks Before Delivery Contributes to Newborn Insulinemia

  • Pablo R. Olmos
    Correspondence
    Corresponding Author: Dr. Pablo R. Olmos, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
    Affiliations
    First Center of Biomedical Engineering, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Department of Obstetrics & Gynecology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Department of Nutrition, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Gisella R. Borzone
    Affiliations
    Department of Respiratory Diseases, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Andrés Poblete
    Affiliations
    Department of Obstetrics & Gynecology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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      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)
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