Background: Infants of diabetic mothers (IDM) are at increased risk for the development of obesity and metabolic syndrome (MS) in childhood. Maternal obesity, fetal macrosomy and early acceleration of postnatal growth may be additional risk factors. Objective: Aim of present study is to assess whether an increased weight gain can be detected in IDM and to define which biochemical markers of metabolism in the newborn and anthropometric parameters in the first year of life can be used to identify those IDM that are most subject to growth acceleration. Design/Methods: 56 infants of daibetic mothers both non insulin-treated (NIT-GDM) and insulin-treated (IT-GDM) have been recruited. Each newborn has been assessed for metabolic and nutritional status (Glycaemia, Electrolytes, Blood Urea Nitrogen, Retinol Binding Protein [RBP], Cholesterol, Triglycerides Total Fatty Acids) at 4+1 days of life. Anthropometric measurements (weight, length, head circumference, waist circumference, tricep skinfold) have been taken in the first year of life (at birth, 1, 3, 6 and 12 months). The most well known risk factors for obesity and MS in childhood and most frequent morbidities of GDM on fetus and newborn have been studied. Results: Premature NIT-GDM, at term NIT-GDM, premature IT-GDM and at term IT-GDM have been compared. Growth pattern has shown to be consistent with normal growth curves of the paediatric population. A greater weight gain in IT-GDM compared to NIT-GDM infants has been found. A reduced incidence of short term most frequent complications of ODM has been found in our sample, compared to literature reports. Greater values of RBP have been detected in IT-GDM infants (p=0.049). Also, RBP values appear to be positively correlated with parameters of waist circumference at 6 and 12 months and weight at 6 and 12 months (p=0.004; R2 0.19). Lipid metabolism was not found to be modified by insulin treatment, and it was not related to growth parameters at any age. Conclusions: The normality of growth parameters and the low incidence of complications in the short term are likely due to effective implementation of monitoring protocols and prevention in pregnancy and early neonatal period. The laboratory data support other findings according to which RBP can be used to identify those subjects that are at increased risk of developing MS in childhood and that are especially in need for an early nutritional intervention.

CRESCITA ED INDICI METABOLICI PRECOCI DELLO STATO NUTRIZIONALE IN FIGLI DI MADRE DIABETICA / G. Francescato ; tutor: Carlo Virginio Agostoni ; coordinatore: Anna Maria Di Giulio. - : . Università degli Studi di Milano, 2011 Jan 28. ((23. ciclo, Anno Accademico 2010. [10.13130/francescato-gaia_phd2011-01-28].

CRESCITA ED INDICI METABOLICI PRECOCI DELLO STATO NUTRIZIONALE IN FIGLI DI MADRE DIABETICA

G. Francescato
2011-01-28

Abstract

Background: Infants of diabetic mothers (IDM) are at increased risk for the development of obesity and metabolic syndrome (MS) in childhood. Maternal obesity, fetal macrosomy and early acceleration of postnatal growth may be additional risk factors. Objective: Aim of present study is to assess whether an increased weight gain can be detected in IDM and to define which biochemical markers of metabolism in the newborn and anthropometric parameters in the first year of life can be used to identify those IDM that are most subject to growth acceleration. Design/Methods: 56 infants of daibetic mothers both non insulin-treated (NIT-GDM) and insulin-treated (IT-GDM) have been recruited. Each newborn has been assessed for metabolic and nutritional status (Glycaemia, Electrolytes, Blood Urea Nitrogen, Retinol Binding Protein [RBP], Cholesterol, Triglycerides Total Fatty Acids) at 4+1 days of life. Anthropometric measurements (weight, length, head circumference, waist circumference, tricep skinfold) have been taken in the first year of life (at birth, 1, 3, 6 and 12 months). The most well known risk factors for obesity and MS in childhood and most frequent morbidities of GDM on fetus and newborn have been studied. Results: Premature NIT-GDM, at term NIT-GDM, premature IT-GDM and at term IT-GDM have been compared. Growth pattern has shown to be consistent with normal growth curves of the paediatric population. A greater weight gain in IT-GDM compared to NIT-GDM infants has been found. A reduced incidence of short term most frequent complications of ODM has been found in our sample, compared to literature reports. Greater values of RBP have been detected in IT-GDM infants (p=0.049). Also, RBP values appear to be positively correlated with parameters of waist circumference at 6 and 12 months and weight at 6 and 12 months (p=0.004; R2 0.19). Lipid metabolism was not found to be modified by insulin treatment, and it was not related to growth parameters at any age. Conclusions: The normality of growth parameters and the low incidence of complications in the short term are likely due to effective implementation of monitoring protocols and prevention in pregnancy and early neonatal period. The laboratory data support other findings according to which RBP can be used to identify those subjects that are at increased risk of developing MS in childhood and that are especially in need for an early nutritional intervention.
AGOSTONI, CARLO VIRGINIO
DI GIULIO, ANNA MARIA
infant of diabetic mother ; insulin ; metabolic syndrome ; growth acceleration ; retinol binding protein
Settore MED/38 - Pediatria Generale e Specialistica
CRESCITA ED INDICI METABOLICI PRECOCI DELLO STATO NUTRIZIONALE IN FIGLI DI MADRE DIABETICA / G. Francescato ; tutor: Carlo Virginio Agostoni ; coordinatore: Anna Maria Di Giulio. - : . Università degli Studi di Milano, 2011 Jan 28. ((23. ciclo, Anno Accademico 2010. [10.13130/francescato-gaia_phd2011-01-28].
Doctoral Thesis
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/151791
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