Effects of Gestational Diabetes on Children
Research Papers from Paper Masters can report that, left untreated, gestational diabetes mellitus can lead to short and long term health problems. Studies have shown that infants born to women with GDM are at higher risk for Respiratory Distress Syndrome, macrosomia or birth weight over the 90th percentile, congenital anomalies, and future obesity and Type II Diabetes.
Macrosomia has been defined as a birth weight greater than 4,000 to 4,500 g as well as a birth weight over the 90th percentile for population and sex specific growth curves. It is the result of higher concentrations of maternal glucose and metabolic fuels passed on to the fetus. According to Petersen’s Hypothesis, the increase in glucose transferred causes the fetus to make more insulin, add fat and gain weight. High levels of fasting blood glucose (FBG) >90 mg/dL indicate a greater risk for macrosomia even in non-obese mothers with optimal weight gain. Maternal body mass index (BMI) is another predictor of macrosomia. Obesity or higher BMI creates a greater risk for macrosomia.
Besides birth related traumas as a result of being large, macrosomia has been shown to lead to other long-term morbidities such as organomegaly or enlarged liver, pancreas, heart and adrenal glands. Other risks associated with macrosomia include pre-term deliveries, birth trauma associated with size, and cesarean section.
While many of the studies focus on high BMI or obesity, malnutrition in pregnant women can lead to changes in how glucose is metabolized. Maternal hypoglycemia has been linked to risks of fetal growth restrictions. A reduced intake of food results in a reduced glucose level and therefore slower fetal growth, a risk for fetal growth restriction, and low birth weight. Further, studies indicate that the risk of glucose intolerance or diabetes is two-fold for low-birth weight infants.
According to Spyer et al approximately 3% of white women with GDM have glucokinase mutations. The infants of these women carry an extra risk of inheriting the mutated glucokinase gene, which causes a reduction in the function of the glucokinaase enzyme, the pancreatic beta cell “glucose sensor” before and after birth, and can lead to a glucose-sensing defect. The result is that the infant with the mutated glucokinase gene will have reduced glucose sensing and therefore reduced fetal insulin secretion compared to an infant without the mutation in a similar glycemic environment. The result is a birth weight that is on average 518 g lighter than an unaffected infant in a similar situation (GDM mother). The glucokinase gene mutation can confound treatment depending on whether or not the fetus inherits the mutated gene or not. However, this determination is difficult to assess except possibly through an amniocentesis that is performed for another purpose. Genetic testing of women will reveal the mutation. Because the chances of passing the glucokinase gene mutation to a fetus are 50%, genetic counseling is highly recommended.