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Hyperinsulinemia and Macrosomia in the Fetus of the Diabetic Mother
Abstract
OBJECTIVE: To determine 1) whether macrosomia in the fetus of the diabetic mother is related to fetal hyperinsulinemia and 2) whether hyperinsulinemia and macrosomia are related to maternal metabolic control. RESEARCH DESIGN AND METHODS: Normal pregnant women (n = 95) were compared with insulin-treated pregnant women (n = 155), who were subdivided according to White's class, hypertension, and mode of delivery. All women were treated to achieve optimal metabolic control. HbA1c was determined at each visit. At delivery, umbilical plasma was analyzed for glucose, insulin antibodies, total insulin, free insulin, C-peptide, proinsulin components, and total and individual amino acids. RESULTS: Macrosomia, defined as > 2 standard deviation units (97.75%), was found in 10-27% of the diabetic groups. It was not related to maternal mass or size, but was significantly correlated with umbilical total insulin, free insulin, and C-peptide. Proinsulin components were not different among groups. Amino acids also were not different. Glycosylated hemoglobin was a weak predictor of birth weight and fetal hyperinsulinism. CONCLUSIONS: Macrosomia in the fetus of the diabetic mother remains inadequately explained. In a large population of pregnant women with strict metabolic control, macrosomia was mainly independent of glycosylated hemoglobin. Nevertheless, fetal hyperinsulinism remains the driving force for excessive fetal growth. The stimulus for fetal insulin excess in humans remains to be defined.
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“Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant.”
From The Pathophysiology of Gestational Diabetes Mellitus (2018) · cites this paper as [61]
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“suggesting macrosomia, a common outcome of newborns born to diabetic mothers47.”
From Self-assembling human heart organoids for the modeling of cardiac development and congenital heart disease (2021) · cites this paper as [47]
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Metadata
- Authors
- Schwartz, R., Gruppuso, P. A., Petzold, K., Brambilla, D., Hiilesmaa, V., & Teramo, K. A.
- Affiliations
- University of Helsinki (FI)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1994-07-01
- Volume
- 17
- Issue
- 7
- Pages
- 640-648
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2061129895
- Cited by
- 193
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 9 · 2022: 12 · 2021: 11 · 2020: 19 · 2019: 4 · 2018: 8 · 2017: 6 · 2016: 9 · 2015: 6 · 2014: 10 · 2013: 2 · 2012: 4
- FWCI
- 1.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD 11343)
- Eurostars
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- macrosomia, fetal hyperinsulinemia, maternal diabetes, HbA1c, C-peptide, proinsulin, amino acids, birth weight, fetal growth
- MeSH terms
- Birth Weight, Diabetes Mellitus, Type 1, Female, Fetal Macrosomia, Gestational Age, Glycated Hemoglobin, Humans, Hyperinsulinism, Infant, Newborn, Male, Pregnancy, Pregnancy in Diabetics, Reference Values, Regression Analysis, Body Mass Index, Diabetes, Gestational
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