c-peptide and Infant--Newborn--Diseases

Two-hundred and two pregnant women with impaired glucose tolerance were randomized to treatment with diet or diet and insulin by stratified selection. Self-monitoring of blood glucose was performed six times a day, 3 days/wk. Dietary treatment was considered inappropriate if fasting and postprandial blood glucose values exceeded 7 and 9 mmol/L, respectively, in which case insulin therapy was instituted. Insulin doses were adjusted according to blood glucose values, aiming at fasting and postprandial values below 5 and 6.5 mmol/L, respectively. There were no perinatal deaths. The two treatment regimens disclosed no differences regarding achieved degree of maternal blood glucose control, hemoglobin A1c at delivery, obstetric or neonatal complications, infant's size at birth including skin-fold thickness, or C-peptide concentration in cord serum. Routine treatment of pregnant women with mild carbohydrate intolerance with insulin seems unnecessary. However, 15 patients (14%) in the diet group needed insulin to achieve acceptable blood glucose control, underlining the importance of monitoring blood glucose to detect those who are at risk of developing overt diabetes.

Topics: Adolescent; Adult; Blood Glucose; C-Peptide; Evaluation Studies as Topic; Female; Fetal Blood; Glycated Hemoglobin; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Middle Aged; Pregnancy; Pregnancy in Diabetics; Random Allocation

Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM?. In 72 women with GDM, we calculated Spearman's rank (r. At an early visit (32.95 ± 1.8 weeks), r. To further reduce the risk of hypoglycemia and hyperbilirubinemia in infants born to women with GDM, besides applying a strict in-patient glucose control protocol at delivery, it is necessary to improve even more the quality of maternal glucose control during the last 2 weeks prior to delivery.

Topics: Adult; Blood Glucose; C-Peptide; Diabetes, Gestational; Female; Fetal Blood; Fetal Diseases; Glycated Hemoglobin; Humans; Hyperinsulinism; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Longitudinal Studies; Pregnancy; Prospective Studies

Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) is a hereditary metabolic disease arising from biallelic mutations of SLC25A13. This study aimed to explore the characteristics of fasting blood glucose (FBG), fasting insulin (FINS) and C-peptide (C-P) levels in NICCD infants, analyze their SLC25A13 genetic mutations and further discuss the correlation between SLC25A13 genetic mutations and biochemical changes. Seventy-two cases of infants with cholestasis disease were gathered. Among them, 36 cases with NICCD diagnosis were case group. Meanwhile, 36 cases with unknown etiology but excluded NICCD were control group. FBG, FINS, C-P, ALT, AST, GGT, ALP, TG, HDL-C, LDL-C and Non-HDL-C were collected from all subjects, and DNA was extracted from venous blood for SLC25A13 mutations detection. The incidence of hypoglycemia was 3% in NICCD group. There were no significant statistical difference of FBG, FINS and C-P between NICCD and INC groups ( P > 0.05). ALT, LDL-C and Non-HDL-C levels in NICCD group were lower than the INC group, while SLC25A13 mutations were associated with the level of GGT ( P < 0.05). Ten different SLC25A13 genetic mutations were detected, among which, 851del4, IVS16ins3kb, IVS6+5 G > A and 1638ins23 mutations made up 82% of all mutations. The incidence of hypoglycemia may be higher in small gestational age infants with NICCD. Low LDL-C may be one of the characteristics of dyslipidemia in NICCD infants. There was a correlation between SLC25A13 gene mutations distribution and the GGT level, but the meaning of this finding remains to be further in-depth study. Impact statement This study aims to compare FBG, FINS, C-P, other biochemical and clinical manifestations between NICCD and non-NICCD infants, and discuss differential diagnosis of NICCD and INC beyond the genetic analysis. And investigate the correlation between SLC25A13 genetic mutations and biochemical changes. This work presented that incidence of hypoglycemia may be higher in small gestational age infants with NICCD. Low LDL-C may be one of the characteristics of dyslipidemia in NICCD infants. There was a correlation between SLC25A13 gene mutations distribution and the GGT level.

Topics: Blood Glucose; C-Peptide; Cholestasis; Citrullinemia; Diagnosis, Differential; Female; Humans; Hypoglycemia; Incidence; Infant; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Male; Mitochondrial Membrane Transport Proteins; Mutation

The goal was to describe the temporal pattern of neonatal plasma glucose levels and associations with maternal glucose levels, cord serum C-peptide levels, and neonatal size and adiposity.. A total of 17,094 mothers and infants were included in the Hyperglycemia and Adverse Pregnancy Outcome Study (15 centers in 9 countries). Mothers underwent a 75-g, 2-hour, oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Cord blood and neonatal blood samples were collected. Biochemical neonatal hypoglycemia was defined as glucose levels of <10th percentile (2.2 mmol/L). Clinically identified hypoglycemia was ascertained through medical record review and associations were assessed.. Plasma glucose concentrations were stable during the first 5 hours after birth. Maternal glucose levels were weakly positively associated with biochemical neonatal hypoglycemia (odds ratios: 1.07-1.14 for 1-SD higher OGTT glucose levels). Frequency of neonatal hypoglycemia was higher with higher cord C-peptide levels (odds ratio: 11.6 for highest versus lowest C-peptide category). Larger and/or fatter infants were more likely to have hypoglycemia (P < .001), and infants with hypoglycemia tended to have a higher frequency of cord C-peptide levels of >90th percentile.. Mean neonatal plasma glucose concentrations varied little in the first 5 hours after birth, which suggests normal postnatal adjustment. Biochemical and clinical hypoglycemia were weakly related to maternal OGTT glucose measurements but were strongly associated with elevated cord serum C-peptide levels. Larger and/or fatter infants were more likely to develop hypoglycemia and hyperinsulinemia. These relationships suggest physiologic relationships between maternal glycemia and fetal insulin production.

Topics: Adult; Blood Glucose; C-Peptide; Female; Glucose Tolerance Test; Humans; Hyperglycemia; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors

Tyrosinaemia type I (TT I) (McKusick 276700) is a heterogeneous disorder with a broad spectrum of clinical phenotypes. Although histological abnormalities of the pancreas are well recognized, there are only incidental reports of pancreatic dysfunction manifested as insulin-dependent diabetes mellitus. We report three subjects with TT I and acute liver dysfunction who had hyperinsulinism in early infancy. Hypoglycaemia persisted despite dietary treatment and one patient had inadequate lipolysis at the time of hypoglycaemia. All three patients were successfully treated with diazoxide (10 mg/kg per day) and chlorthiazide (35 mg/kg per day) and treatment was gradually withdrawn after 9, 13 and 34 months, respectively. The mechanism of pancreatic dysfunction in TT I is unknown but may be related to the toxic metabolites that accumulate in this condition. We conclude that hyperinsulinism is not a rare complication in TT I. In patients with persistent hypoglycaemia, C-peptide should always be measured. Treatment with diazoxide and chlorthiazide is highly effective, appears to be safe, and does not need to be continued lifelong.

Topics: Blood Glucose; C-Peptide; Chlorothiazide; Diazoxide; Diuretics; Humans; Hyperinsulinism; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Liver Diseases; Pancreatic Diseases; Sodium Chloride Symporter Inhibitors; Tyrosinemias

To investigate the influence of obstetric factors and indices of maternal metabolic control on perinatal morbidity and mortality, 88 diabetic pregnant Sudanese women (type 1, n=38; type 2, n=31; gestational diabetes, n=19) and 50 non-diabetic pregnant control women were studied. The mean fasting blood glucose was 11.1+/-2.8 mmol/l and the mean HbA(1c) at booking interview was 8.8+/-2.1% in the diabetic women. Pregnancy complications such as Caesarean sections, urinary tract infections, pregnancy-induced hypertension and intrauterine foetal death were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (54.4% vs. 20.0%; P<0.0001). Infants without complications and who were born to diabetic mothers had better Apgar scores at 5 min (9.8+/-0.5 vs. 8.9+/-1.6; P<0.01) and lower cord C-peptide when compared to infants with complications (P<0.05). In conclusion, the prevalence of maternal and neonatal complications among Sudanese diabetic women and their infants is high. Maternal hyperglycaemia is an important factor affecting maternal wellbeing and neonatal morbidity and mortality.

Topics: Adult; Blood Glucose; C-Peptide; Demography; Diabetes, Gestational; Female; Gestational Age; Glycated Hemoglobin; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy in Diabetics; Sudan; Surveys and Questionnaires

The content of hormones that regulate carbohydrate metabolism was studied during the early neonatal period in 80 full-term neonates with intrauterine hypotrophy. Early application to the breast (2 to 6 hours after the birth) was shown to promote the normalization of the hormonal content. The levels of blood serum C-peptide in the newborn depend on the degree of the rise of the mother's body weight during pregnancy and the presence of toxicosis. The levels of cortisol, somatotropic hormone, immunoreactive insulin and C-peptide were determined by the degree of morphological immaturity of the tissues whereas the content of STH and cortisol by the intensity of hypotrophy as well. The moment of the birth and the early neonatal period of children with intrauterine hypotrophy is characterized by a decrease of the activity of lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, creatine kinase and aspartate aminotransferase.

Topics: Blood Glucose; C-Peptide; Female; Fetal Growth Retardation; Growth Hormone-Releasing Hormone; Humans; Hydrocortisone; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Oxidoreductases; Pregnancy

Circulating insulin antibodies at birth and the degree of maternal metabolic control were measured in 68 infants of insulin-treated diabetic mothers. Their correlation with neonatal B cell function and with the clinical features of the infants was evaluated in order to better understand their influence on fetal outcome. Maternal metabolic control was assessed on the basis of blood glucose levels, glycosuria and the occurrence of hypoglycemia and/or ketonuria. All infants were clinically evaluated for gestational age, macrosomia, hypoglycemia, hyperbilirubinemia, hypocalcemia, and respiratory distress syndrome. Cord blood plasma glucose, C peptide, and IgG insulin antibodies were also measured. It was shown that poor maternal metabolic control was associated with a higher prevalence of fetal morbidity as well as with signs of B cell hyperfunction. Also the presence of circulating insulin antibodies correlated well with higher C peptide levels and with several neonatal complications. B cell hyperfunction, indicated by high C peptide levels in the infants of diabetic mothers, may possibly play a causal role in the pathogenesis of fetal morbidity. In conclusion, a good fetal outcome in insulin-treated diabetic pregnancies was associated with and may have depended upon: (1) good maternal metabolic control, and (2) absence or low levels of circulating insulin antibodies.

Topics: Adult; Blood Glucose; C-Peptide; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Fetal Blood; Glycated Hemoglobin; Glycosuria; Humans; Hypoglycemia; Immunoglobulin G; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Insulin Antibodies; Islets of Langerhans; Ketone Bodies; Pregnancy; Pregnancy in Diabetics

The predictive value of three parameters (amniotic fluid insulin and C-peptide, and HbA1) in prognosticating major neonatal symptomatology was investigated in 57 pregnancies of diabetic women. The prediction of a healthy neonate can be achieved with a 90% accuracy by measurement of the amniotic fluid insulin alone. The correct prognosis for a child with major neonatal problems due to maternal diabetes can be made with 70% certainty using the same method. All other parameters can be judged less valuable based on our results. By using more than one of those parameters mentioned, the prediction of a healthy child can be made more correctly with a certainty of almost 100%. The accuracy in predicting a child with major symptoms cannot be increased any further.

Topics: Amniotic Fluid; C-Peptide; Female; Glycated Hemoglobin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Pregnancy; Pregnancy in Diabetics; Prenatal Diagnosis; Prognosis

The influence on neonatal morbidity of factors such as maternal duration of diabetes, third trimester blood glucose control, gestational age at delivery, mode of delivery, and hypertension in pregnancy was analyzed in 92 consecutive diabetic pregnancies (White B35, C22, D26, F9). In a subgroup of 52 diabetic pregnancies the analysis was extended to the influence of hemoglobin A1c at the start and end of pregnancy, blood glucose control during delivery, and fetal insulin secretion at birth. The infants were divided into 3 groups according to the degree of neonatal morbidity: either no (n = 37), minor (n = 27), or severe morbidity (n = 28). There were no significant differences between the groups with no and minor morbidity. Compared to the no-morbidity group, the group with severe morbidity had significantly longer duration of maternal diabetes (p less than 0.05), shorter gestational age at delivery (p less than 0.025), higher frequency of cesarean section (p less than 0.05), and higher frequency of toxicosis (p less than 0.01). The 3 groups did not differ significantly with regard to maternal blood glucose control during pregnancy and delivery. Discriminant analysis revealed that the most significant (p less than 0.001) influence on severe morbidity came from gestational age at delivery. After correction for this factor, there were no other factors with a significant influence on severe morbidity. Within the actual range (mean values 3.9-8.5 mmol/l), blood glucose control during the third trimester had no significant influence on morbidity.

Topics: Adult; Blood Glucose; C-Peptide; Delivery, Obstetric; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy in Diabetics; Severity of Illness Index; Statistics as Topic

Monthly determination of glycohaemoglobins from the 5th month until delivery were determined in a group of diabetic pregnant women, and insuline and peptide-C levels were measured in their newborns. Women with pathological babies had higher glycohaemoglobin values at the end of gestation (8.92 +/- 1.9) than those with normal babies (6.47 +/- 1.02) and those in control group (6.37 +/- 0.76). The number of abnormal glycohaemoglobin levels in successive gestational months was significantly higher in the group with neonatal pathology. The peptide-C and insuline concentrations were higher in pathological newborn (6.37 +/- 9,3 ng/ml and 80 +/- 102 mcU/ml) than in normal babies (0.65 +/- +/- 0.53 ng/ml and 16.5 +/- 10.6 mcU/ml). A correlation between peptide-C concentration in newborns and levels of glycohaemoglobins in their mothers (p less than 0.05) was found. Authors conclude that monthly determination of glycohaemoglobin during gestation is a good index of metabolic control in the mother, and consequently useful in order to predict fetal pathology.

Topics: C-Peptide; Diabetes Mellitus; Female; Glycated Hemoglobin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Pregnancy; Pregnancy in Diabetics

Amniotic fluid (AF) volumes were determined by sodium p-aminohippurate (PAH) dilution in a consecutive series of 24 diabetic women at 34-35 weeks gestation. AF and maternal venous blood samples were analysed for C-peptide immunoreactivity (CPR). When the patients were subgrouped according to the presence (n = 17) or absence (n = 8) of neonatal morbidity, AF volumes (1340 +/- 236 ml vs 807 4/- 130 ml; mean +/- SEM), AF concentrations of CPR (1.38 +/- 0.54 nmol/l vs 0.61 +/- 0.14 nmol/l) and maternal blood glucose levels (5.3 +/- 0.2 nmol/l vs 4.8 +/- 0.3 nmol/l) during the last trimester of pregnancy were not different. The total content of CPR was significantly (P less than 0.05) greater in pregnancies with neonatal complications (1.25 +/- 0.31 nmol/ compared with that in pregnancies without neonatal complications (0.54 +/- 0.18 nmol). AF volumes were significantly (P less than 0.02) larger in pregnancies where feeding problems occurred (1546 +/- 307 ml, n = 9) compared with that in pregnancies without such problems (957 +/- 188 ml, n = 16). These findings indicate an impact of fetal hyperinsulinism on the functional maturation of the fetus. When the patients were subgrouped according to the presence or absence of detectable maternal plasma CPR, i.e. greater than 0.05 nmol/l, and to insulin dependent and gestational diabetes no differences of AF volumes, AF concentrations of CPR or total AF contents of CPR were found.

Topics: Amniotic Fluid; Birth Weight; Blood Glucose; Body Weight; C-Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Peptides; Pregnancy; Pregnancy in Diabetics

Possible relations between neonatal circulatory function and maternal diabetic control were investigated in 22 infants of strictly controlled diabetic mothers during the first 2 days after birth. Eleven infants were delivered vaginally (V) and 11 infants by elective cesarean section (S). Maternal diabetes was more severe in the latter group. Half of the infants had one or more episodes of neonatal morbidity although none presented symptomatic hypoglycemia. Plasma glucose FFA and C-peptide were measured at birth and 3-6 hours later together with skinfold thickness; heart size was determined by X-ray at 24-28 hours; stroke volume and cardiac output were repeatedly determined by transthoracic impedance and ECG. C-peptide at birth was higher in group S than in V. C-peptide in both groups were neither related to glucose or FFA nor to birthweight or skinfold thickness. Infants with neonatal complications including cardiomegaly had the highest C-peptide values. Skinfold was positively correlated to maternal pregnancy glucose level, birthweight percentile and infant heart volume. Mean values for stroke volume and cardiac output were similar in both groups and not different from normal controls when related to body weight. Heart volume and stroke volume were significantly related. ECG abnormalities were seen in 6 infants who showed cardiomegaly on X-ray. We suggest that the present finding of an association between elevated C-peptide concentration at birth and the occurrence of neonatal complications including cardiomegaly and ECG abnormalities could be the consequence of functional hyperinsulinism and that the cardiomegaly is of adaptive type.

Topics: Blood Glucose; C-Peptide; Cesarean Section; Fatty Acids, Nonesterified; Female; Fetal Blood; Hemodynamics; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy in Diabetics; Skinfold Thickness

Infants with transient neonatal diabetes mellitus are small for gestational age and fail to thrive postnatally unless insulin is administered. We have measured the concentrations of insulin-related growth factors in an infant girl with this condition to learn if deficiencies in one or more of these factors could be responsible for the impaired growth. Cord blood serum radioimmunoassayable insulin and somatomedin C/insulin-like growth factor I (SMC/IGF-I) were low, but insulin-like growth factor II (IGF-II) measured by a specific radioreceptor assay was normal. Insulin therapy begun on the fourth day of life resulted in a prompt increase in weight and a delayed rise in SMC/IFG-I. No significant changes in IGF-II were observed. After 2.5 months, insulin treatment was discontinued. At that time, endogenous insulin secretion was documented by increased urinary C-peptide. Normal growth and SMC/IFG-I levels persisted. We conclude that growth failure in this condition may be related not only to a lack of insulin but also to SMC/IGF-I deficiency. A deficiency in IGF-II is not involved.

Topics: Adult; Blood Glucose; Body Weight; C-Peptide; Diabetes Mellitus; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Insulin; Insulin Secretion; Insulin-Like Growth Factor I; Peptides; Somatomedins

Topics: Adenoma, Islet Cell; Blood Glucose; C-Peptide; Food; Food Deprivation; Glucose Tolerance Test; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Radioimmunoassay; Tolbutamide

Topics: Adult; B-Lymphocytes; Blood Glucose; C-Peptide; Female; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Insulin Antibodies; Pregnancy; Pregnancy in Diabetics; Proinsulin

C peptide is secreted by pancreatic beta cells in amounts equimolar with insulin, and its levels provide a direct indication of endogenous fetal levels of insulin despite the presence of maternal insulin antibodies. To determine the presence of hyperinsulinemia and its relation to the development of complications in infants of diabetic mothers, we measured cord serum levels of C peptide in 79 infants of diabetic mothers and 62 infants of nondiabetic mothers. Infants of diabetic mothers had higher cord levels of C peptide, which were significantly associated with neonatal hypoglycemia and macrosomia (P less than 0.001) but not with hyaline-membrane disease. Cord levels of C peptide in infants of diabetic mothers were elevated at the earliest gestational age studied (less than 34 weeks) and were directly related to the severity of maternal diabetes, as assessed by the White classification. We conclude that hyperinsulinemia is present in infants of diabetic mothers and that it is related to some major complications in such infants.

Topics: Birth Weight; C-Peptide; Female; Fetal Blood; Gestational Age; Humans; Hyaline Membrane Disease; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Peptides; Pregnancy; Pregnancy in Diabetics

Topics: C-Peptide; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Newborn, Diseases; Peptides; Pregnancy; Pregnancy in Diabetics; Time Factors