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Gestational diabetes and offspring body disproportion
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Gustafsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Gustafsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Gustafsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnendokrinologisk forskning/Gustafsson)
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2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 1, 89-93 p.Article in journal (Refereed) Published
Abstract [en]

Aim:   It has been demonstrated that females born large for gestational age   (LGA) in weight but not length are at increased risk of being obese at   childbearing age. We addressed the question whether women with   gestational diabetes mellitus (GDM) are at increased risk of giving   birth to such infants.   Methods:   Birth characteristics of 884 267 infants of non-diabetic mothers and   7817 of mothers with GDM were analysed. LGA was defined as birth weight   or birth length > 2 standard deviation scores for gestational age.   Multiple logistic regression analysis was performed.   Results:   The odds ratio (OR) for a woman with GDM to give birth to an LGA infant   that was heavy alone was four times increased (OR: 3.71, 95% CI:   3.41-4.04). Furthermore, in the population of mothers giving birth to   LGA infants, the proportion heavy alone was 68% in the group of women   with GDM compared with 64.4% in the group of non-diabetic women. The   risks were independent of gender of the foetus.   Conclusion:   Women with GDM have an almost four times higher risk of delivering an   LGA infant that is heavy alone. The noted disproportion between weight   and length in infants of such mothers may have an impact on the risk of   later obesity.

Place, publisher, year, edition, pages
2010. Vol. 99, no 1, 89-93 p.
Keyword [en]
Body disproportion, Gestational diabetes, Large for gestational age, Newborn and obesity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97383DOI: 10.1111/j.1651-2227.2009.01532.xISI: 000272565800025PubMedID: 19814749OAI: oai:DiVA.org:uu-97383DiVA: diva2:172313
Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2010-06-21Bibliographically approved
In thesis
1. Being Born Large for Gestational Age: Metabolic and Epidemiological Studies
Open this publication in new window or tab >>Being Born Large for Gestational Age: Metabolic and Epidemiological Studies
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.

We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.

To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket, 2008. 83 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 363
Keyword
large for gestational, glucose production, lipolysis, insulin resistance, intergenerational, gestational diabetes mellitus, stable isotopes, pregnant women, newborn infant
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-9135 (URN)978-91-554-7246-7 (ISBN)
Public defence
2008-09-12, Rosénsalen, Akademiska Sjukhuset, Ingång 95/96, Uppsala, 09:15
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Supervisors
Available from: 2008-08-18 Created: 2008-08-18Bibliographically approved

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