Anthropometric Parameters in Infants of Gestational Diabetic Women and Diabetic Mellitus Women in Albania

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1 Article ID: WMC ISSN Anthropometric Parameters in Infants of Gestational Diabetic Women and Diabetic Mellitus Women in Albania Peer review status: No Corresponding Author: Ms. Klodiana A Poshi, Faculty of Technical Medical Sciences, Department of Anatomy, Albania Submitting Author: Ms. Klodiana A Poshi, Faculty of Technical Medical Sciences, Department of Anatomy, Albania Other Authors: Prof. Etleva Rustami, Faculty, Departmant of Neonatology Faculty of Technical Medical Sciences - Albania Prof. Alma Nurce, Faculty, Departmant of neonatology,faculty of Technical Medical Sciences - Albania Dr. Sofika Qamirami, Faculty, Departmant of Morfology,Section,Anatomy, University of Medicine - Albania Article ID: WMC Article Type: Original Articles Submitted on:03-jul-2014, 11:44:48 PM GMT Article URL: Subject Categories:ANATOMY Published on: 04-Jul-2014, 10:48:06 AM GMT Keywords:Anthropometric measures. Gestational Diabetes, Diabetes Mellitus, Newborns How to cite the article:poshi KA, Rustami E, Nurce A, Qamirami S. Anthropometric Parameters in Infants of Gestational Diabetic Women and Diabetic Mellitus Women in Albania. WebmedCentral ANATOMY 2014;5(7):WMC Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: None Competing Interests: None WebmedCentral > Original Articles Page 1 of 11

2 Anthropometric Parameters in Infants of Gestational Diabetic Women and Diabetic Mellitus Women in Albania Author(s): Poshi KA, Rustami E, Nurce A, Qamirami S Abstract The aim: This study is to compare the anthropometric parameters in newborn infants from Gestational Diabetic (GDM) women and Diabetes Mellitus (DM). Methodology: The present study is retrospective. 110 women and their babies were included in this study. 38 women ( 34.5%) had Diabetes Mellitus and 72 women ( 65.5% ) Gestational Diabetes. GDM was diagnosed by Oral Glucose Tolerance Test. Anthropometric parameters of infants were recorded in two groups within 24 of delivery. All women were primipare deliveries with self-monitoring of very good glycemia level. Low pre-pregnancy HbA1C and normal levels during pregnancy. Only three women underwent vaginal delivery. Anthropometric measures were conducted in mothers and their infants. Results: Actual BMI of DG monthers is essentialy higher compared to BMI. BMI of infants of DM mothers is strongly and significantly connected to the infant's head, thorax, and abdomen, whereas in infants of DG mothers this is not noticed. Naturally, the head is positively, strongly and significantly linked to the thorax and abdomen for both DM and DG infants. Current and initial BMIs of DM and DG mothers are loosely and insignificantly connected to infants' s (all anthropometric measures). Key words: Anthropometric measures. Gestational Diabetes, Diabetes Mellitus, Newborns Introduction Gestational Diabetes is a condition of any degree glucose intolerance, characterized by diagnosis or screening during pregnancy. In many countries, nearly 50 % of women diagnosed with DMG do not pose risk factors. Selective screening is proposed based on age criteria, at least 30 years old, but recently, The American College of Obstetricians and Gynecologists recommends screening of all pregnant women. Patients posing risk factors, including previous pregnancies with DM, may profit when examined at a younger pregnancy age. It the results are normal, the tests should be repeated between 24 and 28 weeks. Screening is conducted by prescribing 50 gr of oral glucose and measuring the blood glucose level after 1 hour. The test can be conducted at any time during the day and independent of the time the patient has had a meal, however, the testing sensibility is improved if conducted on a patient who has had nothing to eat. Patient undergo the following: glucose levels equal to or higher than 140 mg/dl,1 hour after being prescribed glucose are considered abnormal and require further exanimation through the 3 hour glucose tolerance test (GTT). Some centers consider normal values those ranging from 130 to 135 mg/dl. In addition, a high glucose result of 185 mg/d is considered as helpful for diagnosis purposes and the 3 hour GTT is not necessary. The latter is conducted by prescribing 100 gr of oral glucose, solved in at least 400ml water, after a night when the patient has not eaten anything for 8 to 14 hours. Normal GTT values which should not be exceeded are: fasting blood glucose level of 105mg/dL, fasting glucose level after one hour 190mg/dL, fasting glucose level after 2 hours 165mg/dL, and fasting glucose level after 3 hours 145mg/dL. The diagnosis is considered confirmed if two of the above mentioned values are met. The highest risks during Diabetes Mellitus and Gestational Diabetes pathology in delivering infants are a) LGA, and b) IUGR Based on pregnancy age, there is: Preterm, Term, and post-term or serotine) Delivered before the 37 th week of pregnancy the infant shall be considered as Preterm, delivered between the weeks of pregnancy the infant shall be considered in Term. All those delivered after 42 weeks of pregnancy as post-term. Appropriate to pregnancy age (or AGA), small for pregnancy age (or SGA), or large for pregnancy age (or LGA). Results The study conducted during January February 2013 included 38 women with Diabetes Mellitus and WebmedCentral > Original Articles Page 2 of 11

3 72 women with Gestational Diabetes, average of DM women is ± 4.51 and DGM women: ± (P=0.003) Original BMI for DM women was ± 9.35, during the ninth month of pregnancy became 3.89 ± For DGM women, the following values of initial were presented: ± and the current one: ± It resulted that DGM mothers had BM I >BMI of DM mothers where P value 0,028 with DM women P value Table 1: See Illustration 1 DG mothers age is significantly older compared to the average age DM mothers. In addition, actual BMI of DG mothers is significantly higher compared to the current average BMI of DM mothers. The other differences are insignificant.(tab.1) With regards to sex, both groups had more males than females newborn infants were 20 Males and 18 Females to DM women and 45 males and 27 females to DG women. Newborn infants to DM mothers presented the following weight average value 4050 ± 501 and height average value ± 1.48, Newborn infants to DG mothers presented birth weight average value: 3900 ± 550 and height average value ± With regards to pregnancy age, there resulted 30 LGA(macrosom) 11 AGA and only 2 IUGR 15 From DM mothers, 47 LGA, 23 AGA and 2 IUGR. Ponderal index (PI). Average values for all newborn anthropometric parameters are given in (Tab 2) The differences of the above parameters among babies delivered from DM and DG mothers are statistically insignificant. (Tab 2) Table 2: See Illustration 2 Differences of the above mentioned parameters among infants delivered from DM and DG mothers are statistically insignificant. Table 3: See Illustration 3 One can notice that there is a weak correlation between initial and current BMI with infant PI (0.095 and 0.118, respectively). The data is insignificant. Table 4: See Illustration 4 It can be noticed that there is a weak correlation between pre-pregnancy and current BMI of mother to infant PI even when they are examined separately as per the type of diabetes. Among DM women such values are and , respectively, and among DG women such values are and 0.139, respectively. No correlation results to be statistically significant. Even correlations to infant sex result insignificant(tab.4) Table 5: See Illustration 5 Here,(Tab.5) it can be noticed that infant IP of DM mothers is strongly and significantly correlated to the head, thorax and abdomen s of the infant, whereas among babies of DG mothers such correlation is not noticed. Naturally, head is positively, strongly and significantly correlated to thorax and abdomen for both DM and DG babies. Current and pre-pregnancy BMI of DM and DG mothers are weakly and insignificantly correlated to infant s (all anthropometric measures). Discussion Gestational Diabetes Mellitus is a heterozygote disorder characterized by carbohydrates intolerance and high glycemia values. Pregnancy is a physiological process accompanied by resistance to insulin; therefore it is necessary to perform the glucose challenge test. Some international studies 410,1213,, recommend screening of pregnant women older than 29 years old as well as those presenting risk factors. From the study, there resulted macrosomic infants 3,11, from diabetic women and 30(sex) from GD women 47(sex). Various studies refer to delivery of macrosomic infants from diabetic women as a result of repeated glucose passing through the placenta, even though a mother having high glycemia values may cause fetus hyperglycemia. Fetus pancreas increases the response for releasing insulin. Fetus stimuli for insulin release influences the formation of a large fetus, resulting in a macrosomic delivery. Macrosomic infants are prone to asphyxia, hyperglycemia and respiratory distress. In our study, we met only three cases of asphyxia delivered vaginally from DG mothers, other mothers voluntarily chose the cesarean way. We noticed low values of newborn infants in IUGR 16 and the same had low PI. In such cases some articles show that there is a direct correlation of mother nutrition to the ponderal index. 16 In the conducted study, it results that infant PI of DM mothers is strongly and significantly correlated with baby head, thorax and abdomen, whereas among infants of DG mothers this is not the case. Naturally, the head and thorax is positively, strongly and significantly correlated for both DM and DG babies. Pre-pregnancy and current BMI of DM and DG mothers are weakly and insignificantly correlated to infant s. As a conclusion, no statistically significant changes were found during the comparison of anthropometric WebmedCentral > Original Articles Page 3 of 11

4 values (head, thorax and abdomen ) in newborn infants from long time diabetic mothers as well as gestational diabetic mothers (we underline that all were primipare deliveries). The study emphasizes that during a perfect pregnancy checkup, even though women result to have gestational diabetes or when diabetic mothers get pregnant, the newborn infant results to have normal anthropometric parameters. 19 References 1. Alva RA, Ordonez RB: Programa de detecci6n y control de la diabetes sacarina en el Instituto Mexicano del Seguro Carpenter MW, Coustan DR: Criteria for screening tests for gestational diabetes. Am ) Obstet Gynecol 144:768-73, Contreras J, Mata-Ca>denas B, Avila A, Gonza'lez-Quiroga G, Forsbach G: Hemoglobina glucosilada y curva de tolerancia a la glucosa en madres de recie'n nacidos macrosomicos. Rev Med Inst Mex Seguro Soc 24: , Combs CA, Gunderson E, Kitzmiller JL, Gavin LA, Main EK. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy. Diabetes Care 1992;15: Gabbe SG: Management of diabetes mellitus in pregnancy.am J Obstet Gynecol 153:824-28, Gabbe SG: Gestational diabetes mellitus. N Engl j Med 315: , Hanson U, Persson B. Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus. Br J Obstet Gynaecol 1996;103: Jensen DM, Sorensen B, Feilberg-Jorgensen N, Wester gaard JG, Beck-Nielsen H, et al. Maternal and perinatal outcomes in 143 Danish women with gestational diabe tes mellitus and 143 controls with a similar risk profile. Diabet Med 2000; 17: Jovanovic L, Knopp R, Kim H, Cefalu W, Zhu X, Lee Y, et al. Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic preg nancy: evidence for a protective adaptation in diabetes. Diabetes Care 2005; Knowler WC, Pettit DJ, Savage PJ, Bennett PH: Diabetic incidence in Pima Indians: contributions of obesity and parental diabetes. Am j Epidemiol 113:144-56, McFarland KF, Case CA: The relationship of maternal age on gestational diabetes. Diabetes Care 8: , McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern-Fetal Med 1998;7: National Diabetes Data Group: Classification and diagnosisof diabetes mellitus and other categories of glucose 13.intolerance. Diabetes 28: , Sullivan JB, Charles D, Mahan CM, Dandrow RV: Gestational diabetes and perinatal mortality rate. Am I Obstet Gynecol 116: , Peck RW, Price GD, Lang J, MacVicar K. Hearnshaw JR. Birth weight of babies born to mothers with type 1 diabetes: is it related to blood glucose control in the first trimester? Diabet Med 1991;8: Ponderal Index of Low Birth Weight Babies- a Hospital Based Study.Dure Samin Akram, Fehmina Arif Department of Paediatrics, Dow University of Health Sciences and Civil Hospital, Karachi. 1993:341: Snedecor GW, Cochran WG: Statistical Methods. 6th ed.ames, Iowa State Univ. Press, 1976, p Schmidt M, Duncan B, Reichelt A, Branchtein L, Matos M, Costa F, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care 2001; 24: Salim R, Hasanein J, Nachum Z, Shalev E. Anthropometric parameters in infants of gestational diabetic women with strict glycemic control. Obstet Gynecol 2004;104: WebmedCentral > Original Articles Page 4 of 11

5 Illustrations Illustration 1 Table 1: General data on Diabetes Mellitus and Gestational Diabetes mothers Type of Diabetes Variable Diabetes Mellitus Gestational Diabetes Total P value Age (years) ± ± ± Pre-pregnancy weight (kg) ± ± ± Current weight (kg) ± ± ± Height (cm) ± ± ± Pre-pregnancy BMI ± ± ± Current BMI ± ± ± Average value ± standard deviation (SD) * Absolute number and percentage as per columns (in brackets) P value as per the non-parametric Mann-Whitney U test WebmedCentral > Original Articles Page 5 of 11

6 Illustration 2 Table 2: General data for infants of diabetes mellitus and gestational diabetes mothers Type of diabetes Variable Diabetes Mellitus Gestational Diabetes Total P value Infant sex Male 20 (52.6) * 45 (62.5) 65 (59.1) Female 18 (47.4) 27 (37.5) 45 (40.9) Infant weight (gr) 4050 ± ± ± Infant height (cm) ± ± ± Infant BMI ± ± ± Ponderal Index 2.81 ± ± ± Head Perimeter (cm) ± ± ± Thorax Perimeter (cm) ± ± ± Abdomen Perimeter (cm) ± ± ± Pregnancy age (in weeks) ± ± ± WebmedCentral > Original Articles Page 6 of 11

7 Condition with regards to pregnancy age LGA AGA 30 (78.9) * 6 (15.8) 47 (65.3) 23 (31.9) 77 (70.0) 29 (26.4) IUGR 2 (5.3) 2 (2.8) 4 (3.6) * Absolute number and percentage as per columns (in brackets) Average value ± Standard deviation (SD) P value as per the chi-squared test P value as per non parametric Mann Whitney U test WebmedCentral > Original Articles Page 7 of 11

8 Illustration 3 Table 3 Bivariant correlations between mother BMI and infant Index Ponderal(IP) Pearson correlation coefficient Pre-pregnancy BMI Current BMI of mother Pre-pregnancy BMI Pearson Correlation 1.876(**).096 Sig. (2-tailed) Ponderal Index Current BMI of mother Pearson Correlation. 876(**) Sig. (2-tailed) Ponderal index Pearson Correlation Sig. (2-tailed) ** Correlation is significant at the 0.01 level (2-tailed). WebmedCentral > Original Articles Page 8 of 11

9 Illustration 4 Table 4.Correlation as per the type of mother diabetes Pre-pregnancy Current BMI Ponderal Diagnosis BMI of mother index Diabetes Mellitus Pre-pregnancy BMI Pearson Correlation 1.925(**).094 Sig. (2-tailed) Current BMI of mother Pearson Correlation.925(**) Sig. (2-tailed) Ponderal index Pearson Correlation Sig. (2-tailed) Gestational Diabetes Pre-pregnancy BMI Pearson Correlation 1.851(**).108 Sig. (2-tailed) Current BMI of mother Pearson Correlation.851(**) Sig. (2-tailed) Ponderal index Pearson Correlation Sig. (2-tailed) ** Correlation is significant at the 0.01 level (2-tailed). WebmedCentral > Original Articles Page 9 of 11

10 Illustration 5 Table 5 Mother s BMI - before Mother s BMI actual Baby s BMI Head Perimeter Thorax Abdomen Mother s BMI before ( (0.906) (0.523) (0.803) (0.897) Mother s BMI actual (0.506) (0.261) (0.788) (0.784) Diabetes mellitus Baby s IP ( ( Head ( Thorax 1.00 Abdomen (0.001) (0.016) (0.001) 1.00 Anthropometric measurmens in Baby s and mothers (DM & DG) WebmedCentral > Original Articles Page 10 of 11

11 Gestational diabetes Mother s BMI before ( (0.362) (0.666) (0.963) (0.281) Mother s BMI actual (0.244) (0.816) (0.776) (0.397) Baby s IP (0.148) (0.281) (0.397) Head Thorax Abdomen ( ( ( 1.00 ** Correlation is significant at the 0.01 level (2-tailed). ** Correlation is significant at the 0.05 level (2-tailed). WebmedCentral > Original Articles Page 11 of 11