title: Umbilical artery intima-media and wall thickness in infants of diabetic mothers.
abstract: BACKGROUND
  Large for gestational age (LAG) neonates who had been exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing the metabolic syndrome. This can be explained by exposure to high glucose and insulin levels in utero which alter fetal adaptation and programming.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the onset of preclinical atherosclerosis in utero.
  
  
  METHODS
  We measured umbilical artery wall thickness (ruWT) in the third trimester by obstetric ultrasound and umbilical artery intima-media thickness (uIMT) in pathologic specimens of umbilical cords obtained shortly after delivery and investigated the relation between these measurements and serum insulin level and C-peptide level in cord blood and assessed insulin resistance with the homeostasis model assessment of insulin resistance (HOMA-IR) in infants of diabetic mothers (IDMs), i.e. the study group, which was divided into a large for gestational age group (LGA)-IDM group and an appropriate for gestational age group (AGA)-IDM group and compared with a control group.
  
  
  RESULTS
  The LGA-IDM group had significantly higher insulin (p < 0.001), C-peptide (p = 0.018) and HOMA-IR levels (p < 0.001) compared with the AGA-IDM and control groups. The LGA-IDM group had significantly larger ruWT (p = 0.013) and uIMT (p < 0.001) compared with the AGA-IDM and the control groups. The LGA-IDM group had increased uIMT and ruWT that correlated with the severity of maternal hyperglycemia.
  
  
  CONCLUSIONS
  Measurement of ruWT in the third trimester is feasible, reproducible and strongly correlated with pathological serum insulin, C-peptide in cord blood and HOMA-IR levels.
authors: Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
authors: Yusuf Unal
authors: YU
authors: Sarikabadayi
authors: Ozge
authors: O
authors: Aydemir
authors: Gozde
authors: G
authors: Kanmaz
authors: Cumhur
authors: C
authors: Aydemir
authors: Serife Suna
authors: SS
authors: Oguz
authors: Omer
authors: O
authors: Erdeve
authors: Elif Gul Yapar
authors: EG
authors: Eyi
authors: Sema
authors: S
authors: Zergeroglu
authors: Ugur
authors: U
authors: Dilmen
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D002096:C-Peptide / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016640:Diabetes, Gestational / Q000097:blood / Q000000981:diagnostic imaging*; D003925:Diabetic Angiopathies / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014421:Turkey; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
chemical_list: D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human