Increased fetal cardiac natriuretic peptide secretion in type-1 diabetic pregnancies.
BACKGROUND
We hypothesised that human fetal cardiac natriuretic peptide secretion is increased in type-1 diabetic pregnancies with normal placental hemodynamics, and this increase is related to the first trimester maternal glycemic control.


METHODS
Thirty-two neonates of type-1 diabetic mothers and 60 neonates born after uncomplicated pregnancy and labour (control group) were included in this study. Diabetic pregnancies were divided into two subgroups based on the first trimester HbA1c value. Group 1 pregnancies (n =22) had a good glycemic control (HbA1c <7.5%) and Group 2 pregnancies (n =10) had a poor glycemic control (HbA1c > or =7.5%). At delivery, an umbilical artery (UA) blood sample was obtained for assessment of N-terminal peptide of proatrial (NT-proANP) and proB-type (NT-proBNP) natriuretic peptide levels. In diabetic pregnancies, each fetus had normal UA Doppler velocimetry for gestational age.


RESULTS
The newborn UA NT-proANP and NT-proBNP concentrations were significantly higher in type-1 diabetic pregnancies than in the control group. Group 2 fetuses with poor glycemic control showed significantly higher UA NT-proANP levels than Group 1 fetuses. UA NT-proANP levels correlated significantly with maternal HbA1c values in the first, second and third trimesters, while UA NT-proBNP levels did not correlate with maternal HbA1c values.


CONCLUSIONS
In type-1 diabetic pregnancies, fetal cardiac natriuretic peptide secretion is increased, even in the presence of good glycemic control and normal placental hemodynamics. In addition, fetal NT-proANP levels are already related to maternal glycemic control in the first trimester of pregnancy.
Girsen
Anna
A
Department of Obstetrics and Gynecology, Biocenter Oulu, University of Oulu, Oulu, Finland.
Ala-Kopsala
Minna
M
Mäkikallio
Kaarin
K
Vuolteenaho
Olli
O
Räsänen
Juha
J
D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000378:metabolism; D001783:Blood Flow Velocity / Q000502:physiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000378:metabolism; D010446:Peptide Fragments / Q000097:blood* / Q000378:metabolism; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011498:Protein Precursors / Q000097:blood* / Q000378:metabolism; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
C099254:N-terminal proatrial natriuretic peptide; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor