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- Title
Maternal residual beta-cell function and the outcome of diabetic pregnancy.
- Authors
Pirttiaho, Heikki I.; Hartikainen-Sorri, Anna-Liisa; Kääpä, Pekka; Kaila, Jorma M.; Puukka, Raija
- Abstract
Preservation of own insulin production (residual pancreatic beta-cell function) has been shown to have a beneficial effect on glycemic control in insulin-dependent diabetic subjects, and its total lack has been suggested to be an independent risk factor during diabetic pregnancy. We studied the influence of residual beta-cell activity on the glucose control and the outcome of pregnancy in 29 diabetic women by sequentially measuring gestational postprandial plasma C-peptide (CPR) levels, diurnal blood glucose curves and blood glycosylated hemoglobin (Hb A1c) and by analyzing the morbidity and mortality of the offsprings. The 9 diabetics with moderate own insulin secretion (CPR levels over 1.0 µg/l, White classes B and C, later referred to as group I) had significantly better glucose control than the remaining 20 subjects with lower CPR values (White classes C, D and NF, later referred to as group II) (figure 1, table I). There were two intrauterine deaths, both in group II. These deaths (one caused by White classification is the cornerstone in predicting the outcome of diabetic pregnancy. However, it takes into account the age at the onset and the duration of diabetes and its vascular complications, but not the glucose control or factors influencing it. Hence, lack of residual beta-cell function has been suggested to be an independent risk factor, giving prognostic information not obtained by White classification [11]. In the present study, the evaluation of the independent predictive value of residual beta-cell function is difficult, although the two groups were well comparable in most respects. The distribution of White classes was uneven, however; class B was over-represented in group I which also included no subjects from classes D and NF. The finding was expectable since residual beta-cell function decreases with the duration of diabetes [7] which is also one of the main factors in White classification. In the previous study of STANGENBERG et al. [11] class B was also over-represented in the group with residual beta-cell function (three out of five subjects) as compared to those without measurable CPR values (one out of five subjects). Studies with larger groups matched for White classes are needed to eliminate the possible bias and to verify the independent value of CPR measurements in predicting the outcome of diabetic pregnancy. multiple congenital contracture syndrome and the other by severe intrauterine growth retardation without any evident cause) could not be straightly connected with diabetes. Respiratory distress syndrome was seen in group II only. There was no other significant difference in the neonatal morbidity between the two groups (table II). All mothers of RDS infants were in White class NF where the birthweight was also smaller than in classes B and C. These were the only differences in neonatal morbidity between the White classes (table III). In conclusion, moderate residual beta-cell function seemed to be clinically important in maintaining strict glucose control during gestation. Its value as an independent risk factor was less clear because of the uneven distribution of White classes in the two diabetic groups (all White B subjects in group I and all D and NF subjects in group II). Further studies are needed to ascertain whether the measurements of CPR can be employed to complete White classification and to help in assessing the prognosis of pregnancy more accurately.
- Publication
Journal of Perinatal Medicine, 1987, Vol 15, Issue 1, p83
- ISSN
0300-5577
- Publication type
Article