Original Articles
 

By Ms. Klodiana A Poshi , Prof. Etleva Rustami , Prof. Alma Nurce , Dr. Sofika Qamirami
Corresponding Author Ms. Klodiana A Poshi
Department of Anatomy, - Albania 0355
Submitting Author Ms. Klodiana A Poshi
Other Authors Prof. Etleva Rustami
Departmant of Neonatology Faculty of Technical Medical Sciences, - Albania

Prof. Alma Nurce
Departmant of neonatology,Faculty of Technical Medical Sciences, - Albania

Dr. Sofika Qamirami
Departmant of Morfology,Section ,Anatomy, University of Medicine, - Albania

ANATOMY

Anthropometric measures. Gestational Diabetes, Diabetes Mellitus, Newborns

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):WMC004654
doi: 10.9754/journal.wmc.2014.004654

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.
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Submitted on: 03 Jul 2014 11:44:48 PM GMT
Published on: 04 Jul 2014 10:48:06 AM GMT

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 perimeter, whereas in infants of DG mothers this is not noticed. Naturally, the head perimeter is positively, strongly and significantly linked to the thorax and abdomen perimeter for both DM and DG infants. Current and initial BMIs of DM and DG mothers are loosely and insignificantly connected to infants' perimeters (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 37th week of pregnancy the infant shall be considered as Preterm, delivered between the 37-42 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 2010 -February 2013 included 38 women with Diabetes Mellitus and 72 women with Gestational Diabetes, average of DM women is 30.68 ± 4.51and DGM women: 33.88 ± 5.72. (P=0.003) Original BMI for DM women was 68.53 ± 9.35, during the ninth month of pregnancy became 3.89 ± 8.33. For DGM women, the following values of initial were presented: 71.29 ± 10.04 and the current one: 87.65 ± 10.58. It resulted that DGM mothers had BM I >BMI of DM mothers where P value 0,028 with DM women P value 0.125.

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 52.39 ± 1.48, Newborn infants to DG mothers presented birth weight average value: 3900 ± 550  and height average value 51.29 ± 4.45. With regards to pregnancy age, there resulted 30 LGA(macrosom)11 AGA and only 2 IUGR15

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 0.020 and -0.111, respectively, and among DG women such values are 0.109 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 perimeter, thorax and abdomen perimeters of the infant, whereas among babies of DG mothers such correlation is not noticed. Naturally, head perimeter is positively, strongly and significantly correlated to thorax and abdomen perimeter for both DM and DG babies.

Current and pre-pregnancy BMI of DM and DG mothers are weakly and insignificantly correlated to infant perimeters (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 studies410,1213,, recommend screening of pregnant women older than 29 years old as well as those presenting risk factors. From the study, there resulted macrosomic infants3,11, 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 IUGR16 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 perimeter, whereas among infants of DG mothers this is not the case. Naturally, the head and thorax perimeter 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 perimeters.

As a conclusion, no statistically significant changes were found during the comparison of anthropometric values (head, thorax and abdomen perimeter) 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


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