Abnormal Development - Maternal Diabetes
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Introduction
Diabetes during pregnancy in any form, whether pregestational (type 1 or type 2) or gestational, increases the risk for adverse maternal and infant outcomes and impacts developmentally on the same systems. In the USA for the year 2000 the most frequently reported medical risk factors were: pregnancy-associated hypertension (38.8 per 1,000 live births) and diabetes (29.3) follwed by anemia (23.9).
A tenfold increase in the prevalence of hypertension and a 10 percent incidence of gestational diabetes have been reported in obese pregnant women.
Note that in some countries reporting on diabetes on birth certificates has a field that indicates whether the "mother had diabetes during pregnancy", but does not necessarily whether this was gestational or a pre-existing diabetes.
Some Recent Findings
|
Recent References | References
Gestational Diabetes
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with the onset or first detection during pregnancy.
Women with gestational diabetes mellitus can progress to type 2 diabetes mellitus (progression rate 6% to 92%) have high birth weight babies and suffer birth trauma.
Well-controlled class A1 gestational diabetes (fasting blood sugar less than 105 mg/dL). Recent study shows no evidence clearly supports the practice of increased fetal surveillance in these pregnancies.
Blood glucose targets for most women with gestational diabetes
On awakening | not above 95 |
1 hour after a meal | not above 140 |
2 hours after a meal | not above 120 |
Table Data: NIDDK (NIH) - Gestational Diabetes
Australia
In Australia, changes to gestational diabetes mellitus (GDM) diagnostic criteria have been proposed following analysis of data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. A recent study has looked into the effects on clinical workload of implementing these diagnostic changes.[6]
Diabetes in pregnancy: its impact on Australian women and their babies 2010
AIHW Report[4]
- Diabetes in pregnancy is common, affecting about 1 in 20 pregnancies. Pre-existing diabetes in pregnancy affected less than 1% of pregnancies, and gestational diabetes mellitus (GDM) affected about 5% in 2005–07.
- Among Aboriginal and Torres Strait Islander mothers, pre-existing diabetes affecting pregnancy was 3 to 4 times as common, and GDM twice as common, as in non-Indigenous mothers. The rate of Type 2 diabetes in Indigenous mothers was 10 times as high.
- Mothers with pre-existing diabetes were more likely to have pre-term birth, pre-term induced labour, caesarean section, hypertension and longer stay in hospital than mothers with GDM or without diabetes in pregnancy.
- Babies of mothers with pre-existing diabetes had higher rates of stillbirth, pre-term birth, high birthweight, low Apgar score, high-level resuscitation, admission to special care nursery/neonatal intensive care unit, and longer stay in hospital than babies of mothers with GDM or without diabetes in pregnancy.
Gestational diabetes mellitus in Australia 2005-06
AIHW Report[7]
- 2005-06, 4.6% of women aged 15-49 years who gave birth in hospital were diagnosed with GDM (more than 12,400 women and their babies)
- 15-49 year age bracket incidence increased by over 20% between 2000-01 and 2005-06.
- Risk of being diagnosed with gestational diabetes increases with age - from 1% among 15-19 year old women to 13% among women 44-49 years of age.
- Women aged 30-34 years (age group that has the most babies) accounted for over 30% of GDM cases in 2005-06.
- Women born overseas are twice the incidence rate of women born in Australia.
- Women born in Southern Asia are at particularly high risk with an incidence rate 3.4 times the rate of Australian-born women.
- Aboriginal and Torres Strait Islander women rate 1.5 times as high as other Australian women and had a higher risk across all age groups.
- Links: Diabetes in pregnancy: its impact on Australian women and their babies 2010 | AIHW Report - Gestational diabetes mellitus in Australia, 2005-06
Spain
- Trends in deliveries in women with gestational diabetes in Spain, 2001-2008.[8] "We examined trends and characteristics of deliveries in women with gestational diabetes in Spain from 2001 to 2008. There were 101,643 deliveries with gestational diabetes among 2,782,369 delivery discharges (3.6%) with no increase over time. Rate of caesarean section increased (19-24.2%) and length of stay decreased."
Diabetes
Australian trends diabetes prevalence 19990-2008
Maternal Type 1 Diabetes
Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based cohort study[2]
- risk of perinatal complications in overweight and obese women with and without type 1 diabetes (T1DM)
- based on data from the Swedish Medical Birth Registry from 1998 to 2007 (3457 T1DM and 764 498 non-diabetic pregnancies)
- High pre-pregnancy BMI is an important risk factor for adverse outcome in type 1 diabetic pregnancies.
- The combined effect of both T1DM and overweight or obesity constitutes the greatest risk. It seems prudent to strive towards normal pre-pregnancy BMI in women with T1DM.
Percentage perinatal outcomes for pregnant women with or without type 1 diabetes and stratified on pre-pregnancy BMI (Modified from Table 2[2])
Percentage perinatal outcomes for pregnant women with or without type 1 diabetes and stratified on pre-pregnancy BMI (Modified from Table 2[2]) | ||||
---|---|---|---|---|
Body Mass Index | 18.5 - 24.9 | 25 - 29.9 | ≥30 | |
Large for Gestational Age | ||||
|
47 | 50 | 51 | |
|
8.2 | 13 | 18 | |
Major malformations | ||||
|
4.0 | 3.7 | 6.6 | |
|
1.7 | 1.9 | 2.0 | |
Pre-eclampsia | ||||
|
14 | 15 | 18 | |
|
2.1 | 3.3 | 5.8 | |
Preterm delivery | ||||
|
20 | 23 | 23 | |
|
4.5 | 4.7 | 5.7 | |
Perinatal mortality | ||||
|
0.85 | 1.3 | 0.97 | |
|
0.32 | 0.47 | 0.72 | |
Caesarean section | ||||
|
46 | 53 | 59 | |
|
13 | 17 | 22 | |
Neonatal overweight | ||||
|
21 | 24 | 27 | |
|
3 | 5 | 8 | |
Table Data are presented as percentages |
Diabetic Placenta
Maternal Type 1 diabetes can alter placental vascular development. Effects may be due to either maternal hyperglycaemia or fatal hyperinsulinaemia with high glucose and insulin shown in other systems to alter vascularity, increasing vascular endothelial growth factor (VEGF), nitric oxide (NO) and protein kinase C (PKC).[9][10]
Features of the placental vessels and villi include:
- Increased angiogenesis.
- altered junctional maturity and molecular occupancy.
- increased leakiness.
- increased surface area of the capillary wall (by elongation, enlargement of diameter).[3]
- higher branching of villous capillaries.[3]
- disruption of the stromal structure of terminal villi.[3]
In addition, a Russian histology study of placental villi in gestational diabetes and diabetes mellitus, showed greatest changes occurred in type 1 diabetes mellitus.[11]
- Links: Placenta Abnormalities
Cardiac Effects
Maternal diabetes induces congenital heart defects in mice by altering the expression of genes involved in cardiovascular development.[12] " It is suggested that the down-regulation of genes involved in development of cardiac neural crest could contribute to the pathogenesis of maternal diabetes-induced congenital heart defects."
Fetal Macrosomia
Fetal macrosomia is a clinical description for a fetus that is too large, condition increases steadily with advancing gestational age and defined by a variety of birthweights. In pregnant women, anywhere between 2 - 15% have birth weights of greater than 4000 grams (4 Kg, 8 lb 13 oz).
- Links: Birth
Animal Model
Zebrafish
Elevated glucose induces congenital heart defects by altering the expression of tbx5, tbx20, and has2 in developing zebrafish embryos [13] "Our data demonstrate that elevated glucose alone induces cardiac defects in zebrafish embryos by altering the expression pattern of tbx5, tbx20, and has2 in the heart. We also show the first evidence that cardiac looping is affected earliest during heart organogenesis."
- Links: Zebrafish Development
References
- ↑ <pubmed>18958289</pubmed>| PLoS ONE
- ↑ 2.0 2.1 2.2 2.3 <pubmed>22334581</pubmed>| BMJ Open.
- ↑ 3.0 3.1 3.2 3.3 <pubmed>22317894</pubmed>
- ↑ 4.0 4.1 Australian Institute of Health and Welfare 2010. Diabetes in pregnancy: its impact on Australian women and their babies. Diabetes series no. 14. Cat. no. CVD 52. Canberra: AIHW. AIHW | PDF
- ↑ <pubmed>22144986</pubmed>
- ↑ <pubmed>21039377</pubmed>
- ↑ AIHW: Templeton M & Pieris-Caldwell I 2008. Gestational diabetes mellitus in Australia, 2005–06. Diabetes series no. 10. Cat. no. CVD 44. Canberra: AIHW. AIHW Report - Gestational diabetes mellitus in Australia, 2005-06
- ↑ <pubmed>21035890</pubmed>
- ↑ <pubmed>21418381</pubmed>
- ↑ <pubmed>19563553</pubmed>
- ↑ <pubmed>22462069</pubmed>
- ↑ <pubmed>17967198</pubmed>
- ↑ <pubmed>20306498</pubmed>]
Journals
Reviews
20840259 <pubmed>20714459</pubmed> <pubmed>20500966</pubmed> <pubmed>20430355</pubmed> 20425587
Articles
<pubmed>21042439</pubmed> <pubmed>21067291</pubmed> <pubmed>21052542</pubmed> <pubmed>21030304</pubmed>
Search Pubmed
November 2010 "Maternal Diabetes"
Search Pubmed: Maternal Diabetes | Gestational Diabetes Mellitus | Gestational Diabetes | Macrosomia | Diabetic Placenta
External Links
External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.
- Medline Plus - diabetes and pregnancy
- NIDDK (NIH) - Gestational Diabetes
- Agency for Healthcare Research and Quality - Gestational Diabetes: A Guide for Pregnant Women
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Cite this page: Hill, M.A. (2024, June 10) Embryology Abnormal Development - Maternal Diabetes. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Maternal_Diabetes
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G