Heterogeneity of fetal growth in type 1 diabetic pregnancy.
OBJECTIVE
To investigate the frequency of macrosomia in an homogeneous cohort of type 1 diabetic mothers and to analyze the influence of maternal factors and glycemic control on the incidence of fetal macrosomia.


METHODS
Fifty-five consecutive type 1 diabetic first-pregnancies were prospectively studied. Macrosomia was defined by a ponderal index above the 90(th) percentile. Venous cord blood levels of insulin, C peptide and leptin were measured at delivery. The influence of HbA1c levels and other maternal variables on the occurrence of macrosomia and on the ponderal index was assessed using a stepwise regression logistic model.


RESULTS
The mean (+/- SD) birth weight was 3482 (+/- 497) g at 37.4 +/- 1.0 weeks gestation. Macrosomia occurred in 29 cases (53.7%). Fetal insulin, C peptide and leptin levels were significantly higher in macrosomic than in non macrosomic infants. Maternal age, duration of diabetes, pregravid body mass index, parity, weight gain during pregnancy, presence of a microangiopathy, nephropathy, smoking habits, gestational hypertension or preeclampsia, and HbA1c levels throughout pregnancy did not differed between mothers of macrosomic and non macrosomic infants. In the stepwise analysis none of these covariates was explanatory of the ponderal index.


CONCLUSIONS
The frequency of macrosomia remains very high in infants of type 1 diabetic mothers despite a reasonable degree of glycemic control. The variability of the fetal growth response to mild hyperglycemia prompts for the identification of other factors involved in the modulation of fetal growth.
Lepercq
J
J
Department of Obstetrics and Gynecology, Cochin-Saint Vincent-de-Paul Hospital, Paris. j.lepercq@svp.ap-hop-paris.fr
Taupin
P
P
Dubois-Laforgue
D
D
Duranteau
L
L
Lahlou
N
N
Boitard
C
C
Landais
P
P
Hauguel-De Mouzon
S
S
Timsit
J
J
D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D005314:Embryonic and Fetal Development; D005260:Female; D005320:Fetal Macrosomia / Q000097:blood / Q000453:epidemiology*; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008423:Maternal Age; D010920:Placenta / Q000033:anatomy & histology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D011446:Prospective Studies; D012016:Reference Values
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; D020738:Leptin