Deficient counterregulation: a possible risk factor for excessive fetal growth in IDDM pregnancies.
Diabetes Care
; 20(5): 872-4, 1997 May.
Article
en En
| MEDLINE
| ID: mdl-9135959
ABSTRACT
OBJECTIVE:
The rate of macrosomia in infants born to women with IDDM remains high despite intensive insulin therapy and good glycemic control. We hypothesized that one of the factors contributing to this high rate of macrosomia is deficient counterregulatory hormonal responses to hypoglycemia. RESEARCH DESIGN ANDMETHODS:
Hypoglycemia was induced in 17 women with IDDM and 10 normal control subjects at 24-28 and at 32-34 weeks' gestation, using the hypoglycemic clamp technique. Plasma glucose concentrations were decreased to 3.3 mmol/l and maintained at this level for 1 h. Blood samples were drawn every 15 min for measurement of counterregulatory hormone concentrations.RESULTS:
All 17 women with IDDM had diminished epinephrine responses to hypoglycemia, compared with control subjects. Eight of the women with IDDM (nonresponders) had minimal or no responses (< 165 pmol/l above baseline) and nine women (responders) had a moderate response (244-764 pmol/l). Of the eight nonresponders, seven had large infants (birth weight in the upper quartile), while only three of the nine responders had large infants (P < 0.05).CONCLUSIONS:
Severely impaired counterregulatory epinephrine responses to hypoglycemia in pregnant women with IDDM may be a factor contributing to excessive fetal growth. We speculate that in these women, recurrent episodes of hypoglycemia may result in frequent bouts of increased caloric intake, with repeated episodes of transient hyperglycemia leading to fetal hyperinsulinism and excessive fetal growth.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Embarazo en Diabéticas
/
Glucemia
/
Macrosomía Fetal
/
Epinefrina
/
Diabetes Mellitus Tipo 1
/
Desarrollo Embrionario y Fetal
/
Hipoglucemia
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Newborn
/
Pregnancy
Idioma:
En
Revista:
Diabetes Care
Año:
1997
Tipo del documento:
Article
País de afiliación:
Estados Unidos