Fetal macrosomia, fetal insulin, and insulin-like growth factor- 1 among neonates in Lagos, Nigeria: A case-control study.

PURPOSE: Fetal macrosomia is associated with perinatal injuries. The purpose of this study was to assess the relationship between fetal insulin, insulin-like Growth factor-1(IGF-1), and macrosomia in a resource-limited setting. METHOD: This was a case-control study at tertiary and secondary health facilities in Lagos, Nigeria. One hundred and fifty mother-neonate pairs were recruited, and their socio-demographic and obstetric history was recorded. Fetal cord venous blood was collected at birth, and neonatal anthropometry was measured within 24hrs of life. Insulin and IGF-1 assay were measured with Enzyme-Linked Immunosorbent Assay (ELISA). Pearson's Chi-square was used to assess the association between categorical variables and macrosomia. Spearman's rank correlation of insulin, IGF-1, and fetal anthropometry was performed. Multivariable logistic regression was used to evaluate the association of insulin and IGF-1 with fetal birth weight. A statistically significant level was set at P-value < 0.05. RESULTS: Macrosomic neonates had mean fetal weight, fetal length, and occipitofrontal circumference (OFC) of 4.15±0.26kg, 50.85±2.09cm and 36.35± 1.22cm respectively. The median Insulin (P = 0.023) and IGF-1 (P < 0.0001) were significantly higher among macrosomic neonates as compared to normal weight babies. Maternal BMI at birth (p = 0.003), neonate's gender (p < 0.001), fetal cord serum IGF-1 (p < 0.001) and insulin assay (P-value = 0.027) were significant predictors of fetal macrosomia. There was positive correlation between cord blood IGF-1 and birth weight (r = 0.47, P-value < 0.001), fetal length (r = 0.30, P-value = 0.0002) and OFC (r = 0.37, P-value < 0.001). CONCLUSION: Among participating mother-neonate dyad, maternal BMI at birth, neonate's gender, and fetal cord serum IGF-1 and serum insulin are significantly associated with fetal macrosomia.

Relationship between plasma osteocalcin, glycaemic control and components of metabolic syndrome in adult Nigerians with type 2 diabetes mellitus.

AIMS: To determine the levels of plasma osteocalcin (OC) in Nigerians with type 2 diabetes mellitus (DM) and compare these to levels in non-diabetic controls (NDM). To assess the relationship of OC to glycaemic control and parameters of metabolic syndrome (MetS) and compare its levels in Nigerians with and without MetS. METHODS: The waist circumference (WC), body mass index (BMI) and blood pressure of 200 study participants were taken. Plasma osteocalcin, fasting glucose (FPG), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-c) and triglyceride (TG) levels were determined. Metabolic syndrome was defined by the International Diabetes Federation criteria. Statistical significance was set at 0.05. RESULTS: Osteocalcin levels were lower in the DM group (p=0.002) and inversely related to FPG (r=-0.198, p=0.003), HbA1c (r=-0.313, p<0.001), BMI (r=-0.331, p<0.001), WC (r=-0.339, p<0.001) and TG (r=-0.145, p=0.040), but directly related to HDL-c levels (r=0.166, p=0.019). Osteocalcin was higher in participants without MetS (Median 8.75ng/mL IQR[5.48-12.68]ng/mL) than in those with MetS (Median 4.74ng/Ml, IQR[2.80-9.12]ng/mL), p<0.001. CONCLUSIONS: Plasma osteocalcin levels are inversely associated with good glycaemic control and components of MetS and are lower in individuals with DM and in those with MetS. These findings support a vital role of the bone, in the regulation of glucose and energy metabolism, in Nigerians. Further extensive studies are required to explore the potentials of OC in the management of DM and MetS.