IMPAIRED GLUCOSE-TOLERANCE IN ADOLESCENT OFFSPRING OF DIABETIC MOTHERS - RELATIONSHIP TO FETAL HYPERINSULINISM

被引:450
作者
SILVERMAN, BL
METZGER, BE
CHO, NH
LOEB, CA
机构
[1] NORTHWESTERN UNIV,SCH MED,DEPT PEDIAT,CHICAGO,IL 60611
[2] NORTHWESTERN UNIV,SCH MED,DEPT MED,CHICAGO,IL 60611
[3] NORTHWESTERN UNIV,SCH MED,CTR ENDOCRINOL METAB & MOLEC MED,CHICAGO,IL 60611
关键词
D O I
10.2337/diacare.18.5.611
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE- To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero. RESEARCH DESIGN AND METHODS- We enrolled offspring of women with pregestational diabetes (this included insulin-dependent diabetes mellitus [IDDM] and non-insulin-dependent diabetes mellitus [NIDDM]) and gestational diabetes in a prospective study from 1977 through 1981. Fetal beta-cell function was assessed by measurement of amniotic fluid insulin (AFI) at 32-38 weeks gestation. Postnatally, plasma glucose and insulin were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose. Control subjects had a single oral glucose challenge at 10-16 years. RESULTS- In offspring of diabetic mothers, the prevalence of impaired glucose tolerance (IGT) (2-h glucose concentration >7.8 mmol/l) was: 1.2% at <5 years, 5.4% at 5-9 years, and 19.3% at 10-16 years. The 88 offspring of diabetic mothers (12.3 +/- 1.7 years), when compared with 80 control subjects of the same age and pubertal stage, had higher 2-h glucose (6.8 +/- 1.4 vs. 5.7 +/- 0.9 mmol/l, P < 0.001) and insulin (660 +/- 720 vs. 455 +/- 285 pmol/l, P < 0.03) concentrations. The 17 subjects with IGT at >10 years of age (9 boys and 8 girls) include one girl with NIDDM. IGT was not associated with the etiology of the mother's diabetes (gestational versus pregestational) or macrosomia at birth. IGT was found in only 3.7% (1 of 27) of adolescents whose AFI was normal (less than or equal to 100 pmol/l) and 33.3% (12 of 36) of those with elevated AFI (P < 0.001). Although most of the children with IGT are obese, AFI and obesity are independently associated with IGT by multiple logistic analysis. CONCLUSIONS- In confirmation of our original hypothesis, IGT in the offspring is a long-term complication of maternal diabetes. Excessive insulin secretion in utero, as assessed by AFI concentration, is a strong predictor of IGT in childhood.
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页码:611 / 617
页数:7
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共 38 条
  • [1] MATERNAL DIABETES DURING PREGNANCY - CONSEQUENCES FOR THE OFFSPRING
    AERTS, L
    HOLEMANS, K
    VANASSCHE, FA
    [J]. DIABETES-METABOLISM REVIEWS, 1990, 6 (03): : 147 - 167
  • [2] IMPORTANCE OF MATERNAL HISTORY OF NON-INSULIN-DEPENDENT DIABETIC-PATIENTS
    ALCOLADO, JC
    ALCOLADO, R
    [J]. BRITISH MEDICAL JOURNAL, 1991, 302 (6786) : 1178 - 1180
  • [3] AMENDT P, 1976, ENDOKRINOLOGIE, V67, P351
  • [4] ASAYAMA K, 1982, ENDOCRINOL JAPON, V29, P575
  • [5] ISLET FUNCTION IN OFFSPRING OF MOTHERS ON LOW-PROTEIN DIET DURING GESTATION
    DAHRI, S
    SNOECK, A
    REUSENSBILLEN, B
    REMACLE, C
    HOET, JJ
    [J]. DIABETES, 1991, 40 : 115 - 120
  • [6] CARBOHYDRATE-METABOLISM IN PREGNANCY .11. RESPONSE OF PLASMA GLUCAGON TO OVERNIGHT FAST AND ORAL GLUCOSE DURING NORMAL-PREGNANCY AND IN GESTATIONAL DIABETES
    DANIEL, RR
    METZGER, BE
    FREINKEL, N
    FALOONA, GR
    UNGER, RH
    NITZAN, M
    [J]. DIABETES, 1974, 23 (09) : 771 - 776
  • [7] DORNER G, 1976, ENDOKRINOLOGIE, V68, P121
  • [8] FRANCOIS R, 1974, BIOL NEONATE, V24, P1
  • [9] OF PREGNANCY AND PROGENY
    FREINKEL, N
    [J]. DIABETES, 1980, 29 (12) : 1023 - 1035
  • [10] INHERITANCE OF DIABETES-MELLITUS AS CONSEQUENCE OF GESTATIONAL HYPERGLYCEMIA IN RATS
    GAUGUIER, D
    BIHOREAU, MT
    KTORZA, A
    BERTHAULT, MF
    PICON, L
    [J]. DIABETES, 1990, 39 (06) : 734 - 739