GLUCOSE-TOLERANCE AND INSULIN-SECRETION IN CHILDREN OF MOTHERS WITH PREGESTATIONAL IDDM OR GESTATIONAL DIABETES

The offspring of mothers with diabetes mellitus during pregnancy are p resumed to develop altered glucose homeostasis. We analysed metabolic parameters at birth and glucose tolerance and insulin secretion during oral glucose tolerance tests at 1-9 years of age in 129 children born to mothers with pregestational insulin-dependent diabetes (IDDM) and 69 infants of gestational diabetic mothers. Newborns of IDDM mothers d isplayed higher insulin (p < 0.001), glucose (p < 0.05), and insulin/g lucose ratios (p < 0.002) than newborns of gestational diabetic mother s. During childhood, frequencies of impaired glucose tolerance (IGT) r ose in infants of IDDM mothers from 9.4% at 1-4 years to 17.4% at 5-9 years of age, while in children of gestational diabetic mothers an inc rease from 11.1 % up to 20.0 % was observed. Offspring of gestational diabetic mothers displayed higher stimulated blood glucose (p < 0.025) than infants of IDDM mothers, while children of IDDM mothers showed h igher stimulated insulin (p < 0.025), accompanied by increased fasting and stimulated insulin/glucose ratios (p < 0.05 and p < 0.02, respect ively); Stimulated insulin in childhood was positively correlated to i nsulin at birth (p < 0.05). Furthermore, insulin/glucose ratio in chil dhood showed a positive correlation to insulin (p < 0.01) and insulin/ glucose ratio at birth (p < 0.005). In conclusion, a pathogenetic role of fetal and neonatal hyperinsulinism for the development of IGT in b oth groups of infants of diabetic mothers is suggested, in particular for early induction of insulin resistance in the offspring of mothers with pregestational IDDM.