Maternal postprandial glucose levels and infant birth weight: The Diabetes in Early Pregnancy Study*

https://doi.org/10.1016/0002-9378(91)90637-7Get rights and content

The cause of macrosomia in the infant of the diabetic woman is still not completely defined. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study, which recruited insulin-dependent diabetic and control women before conception, provided an opportunity to address the relationship between maternal glycemia and percentile birth weight. Data were analyzed from 323 diabetic and 361 control women. Fasting and nonfasting venous plasma glucose were measured on alternate weeks in the first trimester and monthly thereafter. Glycosylated hemoglobin was measured weekly in the first trimester and monthly thereafter. More infants of the diabetic women were at or above the 90th percentile for birth weight than infants of control women (28.5% versus 13.1%, p < 0.001). Although first-trimester nonfasting glucose and glycosylated hemoglobin levels were positively correlated with infant birth weight (p < 0.001 and p = 0.008), when the analyses were adjusted for the variables of the subsequent trimesters the values became insignificant, whereas the third-trimester nonfasting glucose levels adjusted for values in prior trimesters emerged as the stronger predictor of percentile birth weight (p = 0.001). After adjusting for maternal hypertension, smoking, and ponderal index, the above relationships remained. In conclusion, monitoring of nonfasting glucose levels rather than the fasting levels, which are more commonly monitored in clinical practice, are necessary to prevent macrosomia.

References (29)

  • HA Verhaaren et al.

    Macrosomy despite well-controlled diabetic pregnancy

    Lancet

    (1984)
  • GHA Visser et al.

    Macrosomy despite well-controlled diabetic pregnancy

    Lancet

    (1984)
  • SG Gabbe et al.

    Management and outcome of pregnancy in diabetes mellitus, classes B to R

    Am J Obstet Gynecol

    (1977)
  • M Small et al.

    Macrosomia in pregnancy complicated by insulin-dependent diabetes mellitus

    Diabetes Care

    (1987)
  • Cited by (417)

    • Maternal Diabetes

      2023, Avery's Diseases of the Newborn
    • American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan—2022 Update

      2022, Endocrine Practice
      Citation Excerpt :

      The goals of preconception care should be tight glycemic control with an A1C <6.5%, without significant hypoglycemia, which will lower risks of congenital malformations, preeclampsia, and perinatal mortality.113 The HAPO study showed that increasing glycemia is associated with increased neonatal adverse outcomes such as macrosomia, neonatal hypoglycemia, and cesarean delivery.64,115-119 The targets for glycemic control during pregnancy for women with preexisting DM and GDM are based on the physiology of nondiabetic pregnancies.

    • Programming long-term health: Maternal and fetal nutritional and dietary needs

      2022, Early Nutrition and Long-Term Health: Mechanisms, Consequences, and Opportunities, Second Edition
    View all citing articles on Scopus
    *

    Supported by the National. Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study and Clinical Research Grants RR00037-28 and RR0047.

    a

    From the Samum Medical Research Foundation

    b

    the National Institute of Child Health and Human Development

    c

    Northwestern University

    d

    the University of Washington

    e

    the University of Pittsburgh.

    View full text