Diabetes in pregnancy

Differential expression of gangliosides in the ovary and uterus of streptozotocin-induced and db/db diabetic mice

Gangliosides are widely distributed in mammalian cells and play important roles in various functions such as cell differentiation and growth control. In addition, diabetes and obesity cause abnormal development of reproductive processes in a variety of species. However, the mechanisms underlying these effects, and how they are related, are not fully understood. This study examined whether the differential expression of gangliosides is implicated in the abnormal follicular development and uterine architecture of streptozotocin (STZ)-induced and db/db diabetic mice. Based upon the mobility on high-performance thin-layer chromatography, mouse ovary consisted of at least five different ganglioside components, mainly gangliosides GM3, GM1, GD1a and GT1b, and diabetic ovary exhibited a significant reduction in ganglioside expression with apparent changes in the major gangliosides. A prominent immunofluorescence microscopy showed a dramatic loss of ganglioside GD1a expression in the primary, secondary and Graafian follicles of STZ-induced and db/db diabetic mice. A significant decrease in ganglioside GD3 expression was also observed in the ovary of db/db mice. In the uterus of STZ-induced diabetic mice, expression of gangliosides GD1a and GT1b was obviously reduced, but gangliosides GM1, GM2 and GD3 expression was increased. In contrast, the uterus of db/db mice showed a significant increase in gangliosides GM1, GD1a and GD3 expression. Taken together, a complex pattern of ganglioside expression was seen in the ovary and uterus of normoglycemic ICR and db/+ mice, and the correspoding tissues in diabetic mice are characterized by appreciable changes of the major ganglioside expression. These results suggest that alterations in ganglioside expression caused by diabetes mellitus may be implicated in abnormal ovarian development and uterine structure.

Expressional changes of ganglioside GM3 during ovarian maturation and early embryonic development in db/db mice

Diabetes and obesity cause abnormal development of reproductive processes in a variety of species, but the mechanisms that underlie this effect have not been fully elucidated. This study examined the expressional changes of ganglioside GM3 during ovarian maturation, in vitro fertilization (IVF) and early embryonic development in diabetic/obese db/db mice. In high-performance thin-layer chromatography studies, GM3 expression was conspicuously low in the ovaries of db/db mice compared to non-diabetic db/+ mice. Signal detected by anti-GM3 monoclonal antibody was greatly reduced in the primary, secondary and graffian follicles of db/db mice compared to control mice. Results from IVF with ova and sperm from db/db mice showed that GM3 expression during early embryonic development was obviously decreased compared to db/+ mice. This study also elucidated the effects of high glucose (20 and 30 mm) on early embryonic development in ICR strain mice. High glucose caused a decrease in GM3 expression during early embryonic development. Taken together, the results of this study indicate decreased GM3 expression during ovarian maturation and embryonic development of db/db mice, suggesting that alteration of ganglioside expression induced by the diabetic condition may be implicated in the abnormal follicular embryonic development.

Unilateral bowing of long bones and multiple congenital anomalies in a child born to a mother with gestational diabetes

We report on a new-born girl with multiple congenital anomalies consisting of major skeletal anomalies restricted to the left side, cleft palate, ventricular and atrial septal defect, retromicrognathia, short neck, dysplastic low-set ears and large birth weight. The left-side bony anomalies include shortening and bowing of the femur and tibia, hypoplasia of the fibula, hip dislocation, clubfoot and mild shortening of the long tubular bones in the left arm with elbow dislocation. The pregnancy was complicated by insulin-dependent gestational diabetes mellitus in the mother. The radiographic features were not consistent with the diagnosis of campomelic dysplasia, kyphomelic dysplasia or other skeletal dysplasias characterized by bowing and shortening of the long bones. To our knowledge, the multiple congenital anomalies, including major skeletal malformations, present in our case have never been simultaneously reported until now. A maternal diabetes syndrome in this infant is probable. The occurrence of major congenital malformations in offspring of women with gestational diabetes is reviewed and discussed. We provide evidence that gestational diabetes mellitus could be teratogenic. We recommend a careful diabetic control in every woman with a history of gestational diabetes.

Predictive factors and incidence of complications in apparently healthy full term infants of diabetic mothers

AIM

To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early.

METHODS

A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours.

RESULTS

One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively.

CONCLUSION

Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

Statistical analysis of perinatal outcomes in pregnancy complicated with diabetes mellitus

OBJECTIVE

To evaluate the outcomes of pregnancies complicated with diabetes mellitus (DM) in the maternal and perinatal center of Tokyo Women's Medical College (TWMC), and compare the results with reports of other countries.

METHODS

A retrospective study of 482 cases of DM pregnancies were included over a 13-year period in a tertiary care hospital in Tokyo. Information were obtained from medical records of both mothers and babies.

RESULTS

The prevalence of pregnancies complicated with DM was 5.1%. Preeclampsia developed in 124 cases at a rate of 25.8%. Incidence of preterm delivery was 16.6%. Caesarean sections were performed in 36.7% patients. There were significant differences of caesarean section rates between diabetic complication group (retinopathy and nephropathy) and non-complication group (69.5% vs 30.5%, p < 0.0001), and between preterm and term deliveries (60.0% vs 32.1%, p < 0.0001). Maternal backgrounds significantly involved with preterm delivery were DM nephropathy and severe preeclampsia. Babies with heavy for gestational age (HGA) were observed at a rate of 21% in all. There were 3 perinatal deaths (intrauterine fetal deaths, IUFD) with the perinatal mortality rate of 6.1/1,000 births. The incidence of caesarean section and perinatal mortality rate of non-DM pregnancies in our center during the same study period were 16.3% and 7.7/1,000 births respectively.

CONCLUSIONS

The perinatal outcome in our study was better compared to other worldwide reports. With accurate perinatal management, perinatal mortality rate of DM pregnancies in the current study was almost same as that of non-DM pregnancies in our center. The main factors to promote adverse perinatal outcomes were presence of DM nephropathy and severe preeclampsia.

Growth and endocrine function after near total pancreatectomy for hyperinsulinaemic hypoglycaemia

Seven children, with a mean (SD) age of 4.6 (2.1) years, who as infants (21 (7.5) days) underwent near total (95-98%) pancreatectomy for persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI) were studied. At birth all the infants were macrosomic. Four infants had been born after a difficult labour, of whom three had moderate birth asphyxia and respiratory distress. All had normal thyroid function. After surgery transient hyperglycaemia was manifest in six of the children and required insulin treatment for 5.8 (3.8) weeks, and transient hypoglycaemia was encountered in one child and responded well to increased carbohydrate intake and diazoxide for three weeks. Six of the children rapidly crossed down their length and weight centiles during the first year after surgery. At the end of the first year these children were at or below the 5th centile of height and weight for their age and gender. After a period of 4.6 (2.1) years, their mean (SD) height score was -2.57 (0.5), growth velocity 3.9 (0.75) cm/year, and growth velocity SD score -2.1 (0.55)l these were significantly low and denoted significant growth retardation. The growth hormone peak responses to provocation with clonidine were normal (13.5 (2.8) micrograms/l). However, the circulating insulin-like growth factor-I (IGF-I) concentrations were significantly decreased (79 (34) ng/ml). Three of the children developed diabetes at two and a half, five, and seven years after surgery, two others had impaired oral glucose tolerance and six out of the seven children had an impaired C peptide response to glucagon. Defective insulin secretion in these children might directly inhibit IGF-I synthesis in the liver. The body mass index of the pancreatectomised children was 14.9 (0.5) and was normal for age and gender; they had a normal 72 hour faecal fat content and normal serum albumin concentration. These data indicated grossly adequate exocrine pancreatic function. It appears that children requiring near total pancreatectomy for PHHI have normal developmental milestones but defective linear growth with impaired insulin secretion and low IGF-I production despite normal growth hormone response to provocation.