humulin-s and Fetal-Macrosomia

We review the recent changes in diagnostic criteria of gestational diabetes mellitus (GDM), describe problems with maintaining and monitoring adequate blood glucose, especially in type 1 diabetes, and provide a brief overview of the currently approved glucose-lowering therapies in pregnancy.. After the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, the definition of GDM was revised under the auspices of the International Association of Diabetes and Pregnancy Study Groups. The guidelines, with minor modifications, were endorsed by WHO in 2013. Intensive debate continues, focused on the expected large increase in prevalence of GDM and shortage of experimental evidence of clinical benefits from the new diagnostic criteria. Despite a very good glycaemic control, the prevalence of macrosomia remains high. This indicates a serious deficiency in current monitoring tools and the available therapies. So far, the only glucose-lowering medications approved for use during pregnancy are insulins.. The HAPO study provides a very suggestive evidence for a strong, continuous association of maternal glucose levels with an increased risk of excessive foetal weight gain. The new definition of GDM results in higher healthcare expenditure, but remains cost-effective. The current therapeutic goals require careful revision to further reduce the risk of adverse outcomes. New glucose-monitoring strategies and markers, and approval of new pharmacotherapies are needed.

Topics: Combined Modality Therapy; Consensus; Diabetes, Gestational; Diet, Diabetic; Evidence-Based Medicine; Female; Fetal Macrosomia; Global Health; Health Transition; Humans; Hypoglycemic Agents; Insulin, Regular, Human; Maternal Nutritional Physiological Phenomena; Practice Guidelines as Topic; Pregnancy; Pregnancy in Diabetics; Prenatal Diagnosis; Recombinant Proteins; Risk

Topics: Adult; Blood Glucose; Diabetes, Gestational; Female; Fetal Macrosomia; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Infant, Newborn; Insulin; Insulin, Isophane; Insulin, Long-Acting; Insulin, Regular, Human; Insulin, Regular, Pork; Isophane Insulin, Human; Patient Compliance; Pregnancy; Pregnancy in Diabetics; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies

Fetal macrosomia is associated with perinatal injuries. The purpose of this study was to assess the relationship between fetal insulin, insulin-like Growth factor-1(IGF-1), and macrosomia in a resource-limited setting.. This was a case-control study at tertiary and secondary health facilities in Lagos, Nigeria. One hundred and fifty mother-neonate pairs were recruited, and their socio-demographic and obstetric history was recorded. Fetal cord venous blood was collected at birth, and neonatal anthropometry was measured within 24hrs of life. Insulin and IGF-1 assay were measured with Enzyme-Linked Immunosorbent Assay (ELISA). Pearson's Chi-square was used to assess the association between categorical variables and macrosomia. Spearman's rank correlation of insulin, IGF-1, and fetal anthropometry was performed. Multivariable logistic regression was used to evaluate the association of insulin and IGF-1 with fetal birth weight. A statistically significant level was set at P-value < 0.05.. Macrosomic neonates had mean fetal weight, fetal length, and occipitofrontal circumference (OFC) of 4.15±0.26kg, 50.85±2.09cm and 36.35± 1.22cm respectively. The median Insulin (P = 0.023) and IGF-1 (P < 0.0001) were significantly higher among macrosomic neonates as compared to normal weight babies. Maternal BMI at birth (p = 0.003), neonate's gender (p < 0.001), fetal cord serum IGF-1 (p < 0.001) and insulin assay (P-value = 0.027) were significant predictors of fetal macrosomia. There was positive correlation between cord blood IGF-1 and birth weight (r = 0.47, P-value < 0.001), fetal length (r = 0.30, P-value = 0.0002) and OFC (r = 0.37, P-value < 0.001).. Among participating mother-neonate dyad, maternal BMI at birth, neonate's gender, and fetal cord serum IGF-1 and serum insulin are significantly associated with fetal macrosomia.

Topics: Birth Weight; Case-Control Studies; Female; Fetal Blood; Fetal Macrosomia; Humans; Infant, Newborn; Insulin; Insulin-Like Growth Factor I; Insulin-Like Growth Factor II; Insulin, Regular, Human; Nigeria; Pregnancy; Weight Gain