28 Evolving Fetal Obesity and Metabolic Control in Pregnancy Complicated by Insulin Dependent Diabetes Mellitus (IDDM)

SPO Abstracts

Volume 168 Number 1, Part 2

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TIE RELATIOISIIIP IEn.EEN IIIIAII FETAL GIIOIITH All) FETAL BUm LEVELS OF IIISUlIN-LIICE GIIOIITN FACTORS (lGF, , IGF ) THEIR BIIIIING Z PIIOI'EINS (.) All) RECEPTORS ~, lIiznitzer A, Le E, Behrman H., Depts. of OB/GYN, T....,le univ. School of Medicine, Phila., PA and Yale university School of Medicine, New Haven, CT. IllJEClIVE: Although fetal growth is a fl.ndamental characteristic for life and fetal well-being, the role and relationships of various growth pl"OIIIOters and fetal growth are poorly understood. The objective of this investigation is to study the relationship between normal fetal growth and the levels of IGFs, their BP and their receptors in both .ternal and fetal c~rtments. STII)Y DESIGN: Serllll saq>les were obtained from mothers (n=52) and thei r fetuses vi a cordocentesi s (n=32) between 21-34 weeks gestation (mean 29+4.3), and from term neonates (n=20) between 38-41 weeks (onean 39!9). Homogenates of placental saq>les, al iquots of anniotic fluid (AF) and serllll samples were analyzed for levels of insulin, IGF-l, IGF-2 and IGF-BP. IGF receptors were assayed from placental extracts of first trimester of terminations (TOP) and frOll te ... del iveries. Neonates were divided into two grOl4>S: weight above the onean for gestational age ("large"), and below the mean (· .... 11·). RESlJl.TS: Fetal IGF-l and IGF-2 concentrations r .... ined stable throughout most of the pregnancy (x !SD;56!.30 nu/..1 and 211! 95 nu/llli respectively), but significantly increased near term (x !SD;73!35 nu/ml and 319 !126 nu/..l) respectively. IGF·BP (BP3) levels also increased slightly toward term (0.7 + 0.3 ulml to 0.96 !0.2 U/IIII). At term, the levels of IGF-l and IGF-2 in the AF were not different frOll levels in the neonatal ser..., but were lower (p<0.005) than that in IIIternal blood. All placental tissue obtained frOlll first trimester TOP and term pregnancies were positive for insulin and IGF-l receptors. There was a direct correlation between fetal weight and the levels of IGF-l (p<0.002) and IGF-2 (p<0.010). There were no significant differences between fetal weights and IGF-BP, IIIternal insulin levels or IGF. conch.ion: These data demonstrate the bioavailabil Ity of growth promotors (IGF-l and IGF-2). their BP and receptors throughout pregnancy. There is also a direct correlation between fetal growth and fetal blood levels of IGF-l and IGF-2. IGFs NY be useful in the treat....,t of reduced fetal growth in the future.

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EVOLVING FETAL OBFJiITY AND METABOLIC CONTROL IN PREGNANCY COMPLICATFJ> BY INSULIN DEPENDENT DIABETES MELLrnJS (IDDM). J Keller. S Dooley. B MctzgcI". J Minogue'. C Niznik'. R Tamura, R Ssbbe&ba', Notthwesllml U Med School, Chicago OBJECTIVE: The purpose of thiJ p-ospeclive study was 10 relate multiple rncu...... of metabolic coolrol '" evolving fetal obesity in IDDM STUDY DESIGN: Thirty pelien" enrolled at 32 weeks). Obesity at birth (n=13) wu defined u symmetry index (SI) ~1.2 ([weight/ weight @ SOth cenlile) / [length / length @ SOth cenlile)) with expected Sl = 1.0 for symmetrically grown (nonohese) infan... Intrauterine SI (lUSI) for 20. 26, 32 weeks was limJarly calculat
30 THE EFFECT OF VELAMENTOUS CORD INSERTIONS ON THE ETIOLOGY OF 'IWIN-'IWIN TRANSFUSION SYNDROME. M Fries R. Goldstein~ S.Kilpatrick, M.Golbus~ P. Callen~R. Filly~ Univ. of Calif., San Francisco OBJECTIVE: The null hypothesis is that velamentous cord insertions are not found more frequently in pregnancies complicated by twin-twin transfusion syndrome (TITS). STUDY DESIGN: All cases (3012) of placentas referred for pathologic evaluation at UCSF from 1984-1992 were reviewed for the citation of monochorionic-diamniotic twins. Pathology reports were evaluated for the presence of velamentous cord insertions. Maternal and infant records were studied for sonographic and fetal evidence of TITS. RESULTS: 38 cases of monochorionic-diamniotic twins were identified. with 11 cases of TITS among this group. The frequency of velamentous cord insertion in the TITS subset was 63,9% compared to 18.7% in those monochorionic-diamniotic twins without TITS (sign. at p <.01). TITS cases with velamentous insertions were delivered significantly more prematurely than TITS cases without velamentous insertions; they were also more likely to have been treated prenatally and had fewer surviving infants, although these findings were not significantly different. CONCLUSIONS: Velamentous cord insertious are frequent in cases of TITS and may contribute to the development of amniotic fluid volume disparity by the ease at which the membranously insened cord can be compressed, reduciug blood flow to one twin and shunting it to the other.

n

multiple

linear

regression

was

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perfonned 01\ non-CIass FR pstien" U (n=23) with. SI as the dependent u, variable. The following variables were 'c=if.-----1F==--f---+ent= glucose means, and HgA values. Only mean glucose at 21-26 wks had a significant independent effect on SI (~ = .SOO7, R' = .251, p = .0149). CONCLUSIONS: Melabolic control during the period of fetal pancreatic islet development (20-26 wit) il a determinant of fetal obesity. Strategies for more effeclivc pnovenlion of accelerated fetal growth in pnognancy complicated by lDDM should concentralc on this earli..- period in gestation.

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INCREASED NEONATAL FAT IS ASSOCIATED WITH RISK FOR CESAREAN SECTION IN INFANTS OF MOTHERS WITH GESTATIONAL DIABETES I.M. Bernstein and Patrick M. Catalano Dept Ob/Gyn, Univ. of VT., Burl, VT. OBJECTIVE We hypothesized that increased body fat in infants of mothers with gestational diabetes (GDM) is associated with increased perinatal morbidity. This study examines if increased fat as opposed to bodyweight is associated with an elevated risk of cesarean section. STUDY DESIGN We examined 166 infants of mothers with gestational diabetes. One hundred and ten had vaginal delivery (V) (91 spontaneous, 19 instrumented), and 56 delivered by cesarean section. Anthropometric estimates of newborn body composition were performed within 24 hours of birth. We compared birthweight, ponderal index (PI), sum of triceps and subscapular skinfolds (SS) and percent body fat (%BF) between those with V (n=110), and those who had primary cesarean sections (CS) in labor (n=29). RESULTS There was no difference in birthweight between those delivered by primary cesarean section or per vagina (V=3374±559, CS=3520±456 g. p>O.10 (mean ± s.d.». However, there were significant differences between groups (p