Changes Of Glucose Level, Insulin And Cortisol In Infants Of Gestational Diabetic Mothers And Macrosomia Of Healthy Mothers

Background and Objective:Gestational diabetes mellitus(GDM) is defined as glucose intolerance that begins during pregancy or is first recognized during pregnancy. Its pathogenesis is unclear, but may be related to autoimmune, gene, hormonal imbalance, cytokines and others.Being obese or overweight before pregnancy and gaining excessive weight during pregnancy can also increase the risk of gestational diabetes. It may occur birth trauma, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, congenital malformations in infants of diabetic mothers.A commonly accepted definition for macrosomia is birth weight> 4000g. There is a risk of birth trauma,asphyxia of newborn and other complications in macrosomia that is similar to infants of diabetic mothers. Both infants of diabetic mothers and healthy macrosomia are prone to obesity, impaired glucose tolerance, type 2 diabetes, hypertension,and other chronic diseases in their adolescence and adulthood.We all know that change of glucocorticoid in fetal period is closely related to fetal original of adult disease. In this sdudy,we detected blood glucose level, serum insulin and cortisol in infants of gestational diabetic mother and healthy macrosomia to know the changes of endocrine system and the impact of these two kinds of infants.Subjects and methods:We selected 37 neonates of mothers with GDM as study group,39 full-term newborns of mother without diseases (born weight>4kg) entered in macrosomia group and 45 neonates of mother without diseases (weight≥2500g and≤4000g entered in normal control group. All the neonates were born in maternity of provincial hospital affiliated to shandong university.There were 21 male and 16 female in GDM group,22 cases were cesarean section and 15 cases were natural labor,including 11 cases whose birth weight> 4000g with 7 male and 4 female. The macrosomia group included 23 male and 16 female,33 cases were cesarean section and 6 cases were natural labor.The control group consisted of 24 male and 21 female,33 cases were cesarean section and 6 cases were natural labor. Recorded general situation of mothers of three groups,including age, height, pre-pregnancy weight,weight before delivery and gestational age. Calculated pre-pregnancy body mass index (BMI), BMI weight (kg)/height2 (m2).All research objects were measured birth weight after born using the same one electronic scale and peripheral blood was adopted to measure blood glucose with trace method in 30 minute. Upper limbs or scalp venous blood was adopted and serum was centrifuged to detect levels of serum insulin and cortisol during 7:30～8:00 in the morning born in 24～48 hours by eletrochemiluminescence immunoassay.Results:1. The general situation of mothers of three groups:Compared with control group, pre-pregnancy body mass index(BMI) and gaining weight during pregnancy of GDM group and macrosomia group were both significantly higher (P<0.05), but there were no statistical significance in age and gestational age (P>0.05).2. Levels of blood glucose,serum insulin and cortisol of GDM group,macrosomia group and control group. Compared with control group, blood glucose level of GDM group and macrosomia group was significantly lower whereas insulin and cortisol level were significantly higher (all P<0.05).3. Levels of blood glucose,serum insulin and cortisol of macrosomia in GDM group and macrosomia group. Compared with macrosomia group, blood glucose level of macrosomias in GDM group was significantly lower and insulin level was significantly higher (P<0.01). Although cortisol level was higher in macrosomias in GDM group, but there was no statistical significance (P>0.05).4. Levels of blood glucose,serum insulin and cortisol of macrosomias in GDM group and neonates with normal weight in GDM group. Compared with neonates with normal weight in GDM group, blood glucose level of macrosomias in GDM group was significantly lower and insulin level was significantly higher (P<0.05). Although cortisol level was higher in macrosomias in GDM group, but there was no statistical significance (P>0.05).5.The correlation between blood glucose level and birth weight of neonates in GDM group and macrosomia group:inverse correlation of blood glucose level and birth weight were both significant in GDM group and macrosomia group.(r1=-0.479, r2=-0.564,both P<0.01).5. The correlation between birth weight and serum insulin level of neonates in GDM group and macrosomia group: positive correlation of birth weight and serum insulin level were both significant in GDM group and macrosomia group.(r3=0.413, r2=0.708,both P<0.05).Conclusion:1.The incidences of GDM and macrosomia are both associated with pre-pregnancy body mass index and gaining weight during pregnancy.2.Neonates of GDM and macrosomias are prone to hypoglycemia, hyperinsulinemia and high cortisol level.3.Compared with neonates whose birth weight is normal of GDM and healthy macrosomias,macrosomias of GDM are more likely to hypoglycemia and hyperinsulinemia.4.To neonates of GDM and macrosomias,the higher serum insulin level is,the larger birth weight appears, causing easier and more serious hypoglycemia.