Evidence of increased intrauterine bone resorption in term infants of mothers with insulin-dependent diabetes,☆☆,,★★

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Abstract

Infants of diabetic mothers (IDMs) have lower bone mineral content than control subjects at birth. We measured cord blood propeptide of type I procollagen (PICP), a marker of bone formation, and telopeptide of type I collagen (ICTP), a marker of bone resorption, in 25 term IDMs and 20 term control subjects. Concentrations of ICTP were higher in IDMs than in control subjects; there was no difference in PICP concentrations. We conclude that osteoclastic activity appears to be higher in IDMs than in control subjects in utero. (J P EDIATR 1995;126:796 8)

Section snippets

METHODS

Twenty-five term infants (gestational age, 38.8 ± 0.8 weeks; range, 38 to 41 weeks) born to women with insulin-dependent diabetes (class B-RT) from 1990 to 1993 were enrolled in the study. All women were entered prospectively during pregnancy and were followed in the diabetes clinic at the university hospital as part of a National Institutes of Health-sponsored diabetes-in-pregnancy program. The goals of glucose control were a fasting blood glucose value of less than 5.55 mmol/L (100 mg/dl) and

RESULTS

As expected, IDMs had a higher mean birth weight at term than normal infants (3854 ± 816 vs 3416 ± 378 gm; p = 0.005) and were more likely to be delivered by cesarean section (11/25 vs 0/20; p <0.0001). There was no difference in PICP serum concentrations between IDMs and control subjects: 1408 ± 489 versus 1407 ± 419 μg/L ( p = 0.99). Concentrations of ICTP were significantly higher in IDMs than in control subjects: 76.1 ± 17.3 versus 63.7 ± 13.5 μg/L ( p = 0.01). Both PICP and ICTP serum

DISCUSSION

Decreased BMC is a well-known complication of diabetes in children and adults, 5 and IDMs have been reported to have a decreased BMC in comparison with normal newborn infants, although the reason is not known. 1 We attempted to elucidate the mechanism for decreased BMC in IDMs by measuring cord blood concentrations of biochemical markers of bone formation and resorption. PICP is a marker of osteoblastic activity. Type I collagen represents approximately 90% of the organic matrix of bone,

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From the Perinatal Research Institute, Division of Neonatology, Departments of Pediatrics and of Obstetrics and Gynecology, University of Cincinnati Medical Center, Children's Hospital Medical Center, Cincinnati, Ohio

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Supported in part by the Diabetes in Pregnancy Program Project (HICHD 11725) and by a grant from the J. Miglierina Foundation, Varese, Italy (Dr. Demarini).

Reprint requests: Reginald C. Tsang, MBBS, Department of Pediatrics, University of Cincinnati Medical Center, 231 Bethesda Ave., ML 541, Cincinnati, OH 45267-0541.

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0022-3476/95/$3.00 + 0 9/24/62071

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