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The effect of diabetes during pregnancy on fetal renal parenchymal growth
Sonja Brennan1,2, Yogavijayan Kandasamy3,4,5, Donna M Rudd3
1Ultrasound Department, Townsville University Hospital, IMB 47, P.O. Box 670, Douglas, Townsville, QLD, 4810, Australia. sonja.brennan@my.jcu.edu.au.
Insights
Gestational diabetes in pregnancy led to thicker fetal kidney parenchyma, proportional to fetal size. Pregestational diabetes showed no significant difference, but suggested potential adverse effects on nephrogenesis.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Nephrology
- Endocrinology
Background:
- Diabetes in pregnancy, including gestational diabetes and pregestational diabetes, is rising globally.
- Maternal hyperglycemia poses risks to fetal development, particularly the kidneys.
- Limited understanding exists regarding the impact of hyperglycemia on fetal renal parenchyma and nephrogenesis.
Purpose of the Study:
- To measure fetal renal parenchymal thickness in pregnancies with diabetes.
- To evaluate the effect of diabetes during pregnancy on fetal kidney growth.
- To investigate the relationship between maternal hyperglycemia and fetal renal development.
Main Methods:
- Prospective, observational study utilizing serial ultrasound measurements.
- Comparison of fetal renal parenchymal growth between 55 pregnancies with diabetes and 72 control pregnancies.
- Analysis of data using mixed effects modeling.
Main Results:
- Fetal renal parenchyma was significantly thicker in the gestational diabetes group compared to controls, proportional to fetal size.
- No significant difference in renal parenchymal thickness was observed in the pregestational diabetes group, despite larger fetal size.
- A trend suggested slowed parenchymal growth with increasing abdominal circumference in pregestational diabetes, indicating potential adverse effects on nephrogenesis, though not statistically significant.
Conclusions:
- Diabetes during pregnancy influences fetal kidney growth, with gestational diabetes associated with thicker renal parenchyma.
- Effective management of diabetic pregnancies may reduce adverse impacts on fetal kidney development.
- Higher degrees of hyperglycemia, as seen in pregestational diabetes, may impact nephrogenesis, warranting further investigation in larger studies.
Aims/Hypothesis:
Diabetes in pregnancy is thought to adversely affect the developing fetal kidneys. The rate of gestational diabetes is increasing globally with major consequences for future renal function. Very little is known about the impact of hyperglycaemia on the fetal renal parenchyma which contains the developing nephrons. The aim of this study was to measure the fetal renal parenchymal thickness and evaluate whether diabetes during pregnancy affects the growth of the fetal kidneys.
Methods:
This prospective, observational study used serial ultrasound measurements to evaluate the fetal renal parenchymal growth of 55 pregnancies with diabetes compared to 72 control pregnancies. Mixed effects modelling was used to analyse the data.
Results:
The renal parenchyma of fetuses from mothers with gestational diabetes was significantly thicker than those from the control group (LR Chisq = 4.8, df = 1, p = 0.029), however, the difference was proportional to the larger size of these fetuses. Fetuses of pregestational diabetics demonstrated no significant difference in renal parenchymal thickness compared to the control group even though they were also larger fetuses. Parenchymal growth slowed with increasing abdominal circumference in the pregestational diabetic group, suggesting an adverse effect on nephrogenesis, however this did not reach statistical significance.
Conclusions/Interpretation:
Our study provides unique data on how diabetes during pregnancy influences fetal kidney growth. Appropriate management of diabetic pregnancies may mitigate some of the adverse effects on the fetal kidneys. Increasing degrees of hyperglycaemia, as seen sometimes in pregestational diabetes, may affect nephrogenesis; however larger studies are needed.
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