Newborns' large for gestational age status (LGA) may result from (1) parental factors, mainly high maternal height, (2) bad control of hyperglycemia in diabetic mothers, (3) undetected gestational diabetes mellitus (GDM). Maternal hyperglycemia might lead to specific profiles of biochemical markers in cord blood, which allow detection of this metabolic dysregulation in pregnancy even after birth of an LGA infant. Prospective observational study over a 5-months period. 127 mother-infant-dyads were enrolled: 63 with GDM, 17 with fetal macrosomia (FM), 47 in the control group (C). The GDM group comprised 6 LGA newborns (GDM-LGA) vs. 57 without LGA (GDM-non-LGA). Measurement of IGF-1, insulin, leptin, fructosamine and retinol-binding protein 4 from cord blood by ELISA. Collection of data on maternal medical history, oral glucose tolerance testing and fetal ultrasound. Anthropometric and metabolic data collected from mother and infant dyads. IGF-1 and leptin were significantly higher in FM vs. GDM, and higher than in GDM-non-LGA and C. Of all groups, GDM-LGA newborns revealed the highest levels of IGF-1, leptin, and insulin; their IGF-1 levels were even significantly higher than in GDM-non-LGA and C. None of the five biochemical parameters differed significantly between GDM and C. Elevated IGF-1 and leptin levels were associated with fetal macrosomia. IGF-1 turned out to be significantly different between LGA and non-LGA newborns of diabetic mothers, even though there were only 6 LGA cases. Metabolic differences between GDM and C infants may not be detectable with tight control of diabetes during pregnancy.
Krause et al. (Tue,) studied this question.