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Blood Circulation Favors Placenta Over Brain in Fetuses of Mothers With Diabetes

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Highlights
  • Fetus of mother with diabetes is exposed to high blood sugar levels.
  • Fetuses of diabetic mothers had reduced proportion of blood flow to the brain than the placenta
  • Standard obstetric recommendations for strict glucose control and healthy lifestyle should be continued.

Blood Circulation Favors Placenta Over Brain in Fetuses of Mothers With Diabetes

Blood flows to the placenta instead of the brain in the fetuses of mothers with diabetes.

Previous research work conducted by Dr Aparna Kulkarni, a paediatric cardiologist from the Bronx-Lebanon Hospital Centre, New York, USA revealed subclinical changes in the heart muscle of fetuses of mothers with diabetes. In the current research study she investigated whether these fetuses had changes in blood circulation.

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The study included 2 groups
  • 14 fetuses of mothers with either type 1 or type 2 diabetes
  • 16 fetuses of mothers without diabetes i.e. control group
Methods used to control glucose levels in study participants (mothers) with diabetes include:
  • 9 of the diabetic mothers used insulin
  • Three took oral medications
  • Two made few diet modification to control blood glucose levels
Fetal Doppler echocardiography was used to measure the blood flow to the brain, heart, the aorta and the placenta.

The data was transferred to a computerized model that mimicked the fetal circulation. The model was developed by Dr Patricia Garcia-Canadilla in the Physense research laboratory of Dr Bart Bijnens at the University of Pompeu Fabra, Barcelona, Spain.
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The reason for blood flow to the placenta could be:

Diabetic mothers have changes in their blood vessels and are known to be large and therefore likely to receive more blood supply.

Dr Kulkarni said: "The computational model equivalent of the fetal circulation is an electrical circuit where there are resistances and compliances. It is easier for blood to flow to the placenta, and harder for blood to flow to the brain."

"The placenta gets taken away after a baby is born so it's no longer a part of the circulation," she said. "But it's possible that the reduced circulation to the brain in utero could affect the baby through life. We don't know enough about why this redistribution of blood flow occurs or the implications it might have. More research is needed to find out if this has any long-term impact on the health of the baby and whether anything can be done to prevent it."

She concluded: "At the present time, I don't think any changes should be made in management of pregnant women with diabetes mellitus based on these findings."

The research is presented today at EuroEcho-Imaging 2016.1

The annual meeting of the European Association of Cardiovascular Imaging (EACVI), a registered branch of the European Society of Cardiology (ESC), is held 7 to 10 December 2016 in Leipzig, Germany.

Diabetes and Pregnancy

Women may have diabetes during pregnancy in 2 ways
  • Women have type 1 diabetes before their pregnancy
  • Gestational diabetes (High blood sugar starts or first diagnosed during pregnancy); according to CDC the prevalence of gestational diabetes is as high as 9.2%
Babies born to mothers with diabetes are sometimes bigger due to uncontrolled diabetes or larger placenta. Larger babies make vaginal birth harder; C-sections are more likely.

The infant is more likely to have hypoglycemia (periods of low blood sugar) shortly after birth and during the few days of life.

Mothers with uncontrolled/poorly controlled diabetes are more likely to have a miscarriage or stillborn child.

Infants of mothers with diabetes are at an increased risk of birth defects.

References
  1. What is Gestational Diabetes? - ( http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html)
  2. Infant of Diabetic Mother - (https://medlineplus.gov/ency/article/001597.htm)


Source: Medindia
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