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Exp Clin Endocrinol Diabetes 2005; 113(3): 160-166
DOI: 10.1055/s-2005-837517
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Perinatal Morbidity in Women with Undiagnosed Gestational Diabetes in Northern Thuringia in Germany

W. Hunger-Dathe1 , K. Volk4 , A. Braun1 , A. Sämann1 , U. A. Müller1 , G. Peiker2 , M. Hüller3
  • 1Department of Internal Medicine III (Head: Prof. Dr. med. G. Stein), Friedrich-Schiller University of Jena, Jena, Germany
  • 2Department of Gynaecology (Head: Prof. Dr. med. H. J. Seewald), Friedrich-Schiller University of Jena, Jena, Germany
  • 3Institute for Clinical Chemistry and Laboratory Diagnostics (Head: Prof. Dr. med. T. Deufel), Friedrich-Schiller University of Jena, Jena, Germany
  • 4Südharz-Hospital Norhausen gGmbH, Friedrich-Schiller University of Jena, Jena, Germany
Further Information

Publication History

Received: November 20, 2003 First decision: March 3, 2004

Accepted: September 9, 2004

Publication Date:
23 March 2005 (online)

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Abstract

Introduction: Undiagnosed gestational diabetes mellitus (GDM) is associated with severe perinatal complications.

Patients and Methods:Out of 970 women, infant and maternal morbidity was assessed in 114 mother-children-pairs with an infant birth weight over the 90th percentile ([Voigt et al., 1996]). It was the aim of this retrospective study to assess the number of mothers with undiagnosed GDM, who have born a macrosomic child.

Results: The macrosomia rate in newborns was 12 % in this study excluding macrosomic infants of mothers with preexisting diabetes mellitus. Maternal data: Age 28.3 ± 5.3 years, adipositas (body-mass-index > 30 kg/m2) in 42.1 % vs. 30.4 % in the peer group (p < 0.02), increase in weight > 15 kg during pregnancy in 57.9 % of the mothers who have given birth to a macrosomic child vs. 30.9 % in the peer group (p < 0.0001), family history of diabetes mellitus (28.0 % vs. 11.3 % in the peer group, p = 0.006), preeclampsia in 8.8 % vs. 2.7 % in the peer group (p = 0.002), cervical insufficiency in 2.6 % vs. 0.4 % in the peer group (p = 0.02). After delivery HbA1c was elevated in 38.6 % of the women having born macrosomic infant (mean HbA1c: 5.0 % ± 0.5). Infant data: neonatal jaundice 16.7 % vs. 4.5 % in the peer group, p < 0.0001. There were no statistically significant differences concerning perinatal condition and malformations. Neonatal hypoglycaemia occurred in 9.6 % of the macrosomic infants. Cord blood insulin levels were significantly elevated in comparison to the peer group of mothers without metabolic disorders and having born eutroph infants (8.4 mU/l [3.0 - 100.0] vs. 5.3 mU/l [3.0 - 30.7], p = 0.01). 11.4 % of all macrosomic infants had cord blood insulin levels above the normal range.

Conclusion: More than one third of the mothers having born one or more macrosomic infants had an impairment of glucose metabolism immediately after birth. The elevated prevalence of preeclampsia in this group confirms the relationship of hypertension and impaired glucose metabolism during pregnancy. The detection of hyperinsulinaemia, postnatal hypoglycaemia, elevated prevalence of neonatal jaundice with need of further therapy and diabetic fetopathy in macrosomic infants of mothers, whose metabolism was not monitored during pregnancy, pinpoint the need for a diagnostic screening for GDM.

Key words

Undiagnosed gestational diabetes mellitus - maternal and infant morbidity - fetal macrosomia - infant hyperinsulinaemia - diabetes screening

References

  • 1 Aberg A, Rydhström H, Kallen B, Kallen K. Impaired glucose tolerance during pregnancy is associated with increased fetal mortality in preciding sibs.  Acta Obstet Gynecol Scand. 1997;  76 212-217
    PubMedGoogle Scholar
  • 2 Aberg A, Westbom L. Association between maternal pre-existing or gestational diabetes and health problems in children.  Acta Paediatr. 2001;  90 746-750
    PubMedGoogle Scholar
  • 3 Adams K M, Li H, Nelson R L, Ogburn P L, Danilenko-Dixon D R. Sequelae of unrecognized gestational diabetes.  Am J Obstet Gynecol. 1998;  178 1321-1332
    PubMedGoogle Scholar
  • 4 American Academy of Pediatrics . Practice parameter: Management of hyperbilirubinemia in the healthy term newborn.  Pediatrics. 1994;  94 558-565
    Google Scholar
  • 28 Arbeitsgruppe Perinatologie/Neonatologie der Landesärztekammer Sachsens . Qualitätssicherung in der Perinatologie und Neonatologie im Freistaat Sachsen.  Ärzteblatt Sachsen. 2002;  12 1-16
    PubMedGoogle Scholar
  • 5 Briese V, Kerler B. Gestationsdiabetes - Diagnostik unter Berücksichtigung anamnestischer Risikofaktoren.  Gynecol Obstet Invest. 1997;  2 165-169
    PubMedGoogle Scholar
  • 6 Bühling K J, Stein U, Dudenhausen J W. Evaluation des 50 g-Glukose-Screeningtests an 1416 Schwangeren.  Geburtsh Frauenheilk. 1998;  58 100-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Catalano P M, Drago N M, Amini S B. Maternal carbohydrate metabolism and its relationship to fetal growth and body composition.  Am J Obstet Gynecol. 1995;  172 1464-1470
    CrossrefPubMedGoogle Scholar
  • 8 Deutsche Diabetesgesellschaft, AGMFM der DDG, Deutsche Gesellschaft für Perinatale Medizin . Empfehlung zur Diagnostik und Therapie des Gestationsdiabetes.  Frauenarzt. 2001;  42 891-899
    PubMedGoogle Scholar
  • 9 Djelmis J, Blajic J, Pfeifer D, Ivanisevic M, Kendic S, Votava-Raic A. Glycosylated hemoglobin and fetal growth in normal, gestational and insulin dependent diabetes mellitus pregnancies.  Coll Antropol. 1997;  21 621-629
    PubMedGoogle Scholar
  • 10 Düring P. Hypertensive Schwangerschaftserkrankungen. Schneider H, Husslein P, Schneider KTM Geburtshilfe. Berlin, Heidelberg; Springer 2000: 343-370
    Google Scholar
  • 11 Festa A, Schwarzmaier A, Bechter B, Grünberger W, Schernthaner G. Anwendung eines sensitiven Verfahrens zur Diagnostik des Gestationsdiabetes. Metabolische und klinische Ergebnisse.  Geburtsh Frauenheilk. 2001;  61 79-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Fraser R B, Bruce C. Amniotic fluid insulin levels identify the fetus at risk of neonatal hypoglycemia.  Diabet Med. 1999;  16 568-572
    CrossrefPubMedGoogle Scholar
  • 13 Griffin M E, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J. et al . Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestational at diagnosis and outcome.  Diabet Med. 2000;  17 26-32
    CrossrefPubMedGoogle Scholar
  • 14 Harms V. Biomathematik, Statistik und Dokumentation. 7. überarb. Aufl. Kiel-Mönkeberg; Harms 1998
    Google Scholar
  • 15 Hauner H. Körpergewicht. Nawroth PP, Ziegler R Klinische Endokrinologie und Stoffwechsel. Berlin, Heidelberg; Springer 2001: 575-602
    Google Scholar
  • 16 Heyl W, Rath W. Die Überwachung der schwangeren Diabetikerin.  Z Geburtsh Neonatol. 1995;  199 132-137
    PubMedGoogle Scholar
  • 17 Hiramatsu Y, Masuyama H, Mizutani Y, Kudo T, Oguni N, Oguni Y. Heavy-for-date infants: their backgrounds and relationship with gestational diabetes.  J Obstet Gynaecol Res. 2000;  26 193-198
    PubMedGoogle Scholar
  • 18 Hoegsberg B, Gruppuso P A, Coustan D R. Hyperinsulinemia in macrosomic infants of nondiabetic mothers.  Diabetes Care. 1993;  16 32-36
    PubMedGoogle Scholar
  • 19 Hopp H, Vollert W, Ragosch V, Pritze W, Ebert A, Entezami M. et al . Vermeidung kindlicher Risiken durch ein generelles Gestationsdiabetes-Screening, intensivierte Diagnostik und konsequente Therapie.  Geburtsh Frauenheilk. 1995;  55 28-31
    PubMedGoogle Scholar
  • 20 Jang H C, Min K H, Lee H K, Cho N H, Metzger B E. Short stature in Korean women: a contribution to the multifactorial predisposition to gestational diabetes mellitus.  Diabetologia. 1998;  41 778-783
    CrossrefPubMedGoogle Scholar
  • 21 Kleinwechter H. 75 g Glukose für jede Schwangere.  ÄP Gynäkologie. 1999;  9 17
    PubMedGoogle Scholar
  • 22 Köhler B. Statistische Ergebnisse der Perinatal- und Neonatalerhebung 1997.  Brandenburgisches Ärzteblatt. 1999;  8 296-298
    PubMedGoogle Scholar
  • 23 Kousseff B G. Gestational diabetes mellitus (class A): a human teratogen?.  Am J Med Genet. 1999;  83 402-408
    CrossrefPubMedGoogle Scholar
  • 24 Kunkel S, Briese V, Kluge K, Friese K, Koepcke E. Die Ermittlung von Referenzbereichen und der Einfluss von mütterlichen und kindlichen Faktoren auf Insulin- und C-Peptidspiegel im Nabelschnurblut.  Zentralbl Gynäkol. 1999;  121 488-494
    PubMedGoogle Scholar
  • 25 Kurishita M, Nakashima K, Kozu H. A retrospective study of glucose metabolism in mothers of large babies.  Diabetes Care. 1994;  17 649-652
    PubMedGoogle Scholar
  • 26 Metzger B E, Coustan D R. Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus.  Diabetes Care. 1998;  21 161-167
    PubMedGoogle Scholar
  • 27 Metzger B E, Freinkel N. Accelerated starvation in pregnancy: implications for dietary treatment of obesity and gestational diabetes mellitus.  Biol Neonate. 1987;  51 78-85
    PubMedGoogle Scholar
  • 29 Niesen M, Jährig D. Das Neugeborene der diabetischen Mutter.  Gynäkologe. 1998;  31 76-84
    CrossrefPubMedGoogle Scholar
  • 30 Okun N, Verma A, Mitchell B F, Flowerdew G. Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia.  J Matern Fetal Med. 1997;  6 285-290
    CrossrefPubMedGoogle Scholar
  • 31 Roach V J, Hin L Y, Tam W H, Ng K B, Rogers M S. The incidence of pregnancy induced hypertension among patients with carbohydrate intolerance.  Hypertens Pregnancy. 2000;  19 183-189
    CrossrefPubMedGoogle Scholar
  • 32 Roberts R N, Traub A I, Kennedy A L, Hadden D R. Glycosylated hemoglobin and hypertension arising in pregnancy.  Br J Obstet Gynecol. 1998;  105 1122-1124
    PubMedGoogle Scholar
  • 33 Robson S, Chan A, Keane R J, Luke C G. Subsequent birth outcomes after an unexplained stillbirth: preliminary population-based retrospective cohort study.  Aust N Z J Obstet Gynecol. 2001;  29-35
    PubMedGoogle Scholar
  • 34 Salvesen D R, Nicolaides K H. Findings from cordocentesis in diabetic pregnancies. Dornhorst A, Hadden DR Diabetes and Pregnancy: An International Approach to Diagnosis and Management. Chichester; Wiley & Son 1996: 207-220
    Google Scholar
  • 35 Sameshima H, Kamitomo M, Ibara S, Kajiya S, Kai M, Ikenoue T. Neonatal 24-hour urinary C-peptide and birth weight in infants of diabetic mothers.  J Matern Fetal Med. 1999;  8 57-60
    PubMedGoogle Scholar
  • 36 Schäfer U, Dupak J, Dudenhausen J, Vetter K. Postpartale Diagnose des Gestationsdiabetes bei makrosomen Neugeborenen - Vergleich zweier Untersuchungsmethoden.  Z Geburtsh Perinat. 1993;  197 257-261
    PubMedGoogle Scholar
  • 37 Schmitt S, Burger D, Kühl P G, Kiess W. Diabetische Fetopathie.  Monatsschr Kinderheilkd. 1996;  144 79-86
    PubMedGoogle Scholar
  • 38 Schrader H M, Jovanovic-Peterson L, Brevier W C, Peterson C M. Fasting plasma glucose and glycosylated plasma protein at 24 to 28 weeks of gestation predict macrosomia in the general obstetric population.  Am J Perinatol. 1995;  12 247-251
    PubMedGoogle Scholar
  • 39 Schwartz R, Gruppuso P A, Petzold K, Brambilla D, Hiilesmaa V, Teramo K A. Hyperinsulinemia and macrosomia in the fetus of the diabetic mother.  Diabetes Care. 1994;  17 640-648
    CrossrefPubMedGoogle Scholar
  • 40 Soares J AD, Dornhorstt A, Beard R W. Should we screen for gestational diabetes? The case for screening for gestational diabetes.  BMJ. 1997;  315 737-739
    PubMedGoogle Scholar
  • 41 Solomon C G, Willett W C, Carey V J, Rich-Edwards J, Hunter D J, Colditz G A. et al . A prospective study of pregravid determinants of gestational diabetes mellitus.  JAMA. 1997;  278 1078-1083
    CrossrefPubMedGoogle Scholar
  • 42 Stiete H, Stiete S, Jährig D, Briese V, Willich S N. Risikogruppen Neugeborener diabetischer Mütter in Abhängigkeit von ihrem somatischen Outcome und der mütterlichen diabetischen Stoffwechsellage in der Schwangerschaft.  Z Geburtsh Neonatol. 1995;  199 156-162
    PubMedGoogle Scholar
  • 43 Stiete S, Stiete H, Jährig D. Diabetes und Schwangerschaft: Babies auch postpartal überwachen.  Therapiewoche. 1993;  43 2260-2271
    PubMedGoogle Scholar
  • 44 Stoz F, Paulus W, Flock F, Kreienberg R. Diabetes-Screening bei Schwangeren mit unterschiedlichem Risiko.  Z Geburtsh Neonatol. 1995;  199 138-141
    PubMedGoogle Scholar
  • 45 Tyrala E E. The infant of the diabetic mother.  Obstet Gynecol Clin North Am. 1996;  23 221-241
    CrossrefPubMedGoogle Scholar
  • 46 van Assche F A, Spitz B. Beziehung zwischen Präeklampsie und Diabetes in der Schwangerschaft.  Gynäkologe. 1998;  31 162-164
    CrossrefPubMedGoogle Scholar
  • 47 Voigt M, Schneider K TM, Jährig K. Analyse des Geburtengutes des Jahrganges 1992 der Bundesrepublik Deutschland.  Geburtsh Frauenheilk. 1996;  56 550-558
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Weiss P AM. Klinische Bedeutung des Geburtsgewichts bei Diabetes mellitus.  Gynäkologe. 1998;  31 58-67
    CrossrefPubMedGoogle Scholar
  • 49 Weiss P AM, Kainer F, Haas J. Cord blood insulin to assess the quality of treatment in diabetic pregnancies.  Early Hum Dev. 1998;  51 187-195
    CrossrefPubMedGoogle Scholar
  • 50 Weiss P AM, Kainer F, Haeusler M CH, Pürstner P, Urasch R. Schnellmethode zum Diabetesscreening in der Schwangerschaft.  Geburtsh Frauenheilk. 1994;  54 697-701
    PubMedGoogle Scholar
  • 51 Weiss P AM, Walcher W, Scholz H S. Der vernachlässigte Gestationsdiabetes: Risiken und Folgen.  Geburtsh Frauenheilk. 1999;  59 535-544
    PubMedGoogle Scholar
  • 52 Wollschlaeger K, Nieder J, Koppe I, Hartlein K. A study of fetal macrosomia.  Arch Gynecol Obstet. 1999;  263 51-55
    CrossrefPubMedGoogle Scholar

Dr. med. W. Hunger-Dathe

University of Jena Medical School, Department of Internal Medicine III

Erlanger Allee 101

07740 Jena

Germany

Phone: + 49(0)36419324323

Fax: + 49 (0)3 64 19 32 43 22

Email: wilgard.hunger-dathe@med.uni-jena.de

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