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Erythropoiesis in infants of diabetic mothers
Insights
Neonatal polycythemia in infants of diabetic mothers (IDM) is not linked to abnormal erythropoiesis. Erythropoietin (EP) levels are typically normal, suggesting polycythemia is an adaptive response.
Area of Science:
- Perinatal Medicine
- Hematology
- Endocrinology
Background:
- Neonatal polycythemia is a known complication in infants of diabetic mothers (IDM).
- The regulation of erythropoiesis in these infants requires further investigation.
Purpose of the Study:
- To investigate the regulation of erythropoiesis in infants of diabetic mothers (IDM).
- To measure cord blood erythropoietin (EP) levels and assess erythroid progenitor colony growth in IDM and control infants.
Main Methods:
- Radioimmune assay was used to measure cord blood erythropoietin (EP) levels.
- Erythroid progenitor colony growth was examined in IDM and control infants.
- Glycemic control in diabetic mothers was assessed via glycosylated hemoglobin values.
Main Results:
- Cord blood EP levels were generally normal in IDM infants whose mothers maintained good glycemic control.
- EP levels were influenced by perinatal events, such as maternal labor and umbilical artery pH.
- Erythroid progenitor response to EP was normal in IDM infants, not correlating with EP levels or hematocrit.
Conclusions:
- Umbilical cord blood EP levels are typically normal in IDM infants with well-controlled maternal diabetes.
- Perinatal factors significantly influence cord blood EP levels.
- The erythropoietic response to EP is intrinsically normal in IDM, suggesting polycythemia is adaptive, not due to primary erythropoiesis abnormalities.
Abstract:
Neonatal polycythemia is a well-established perinatal complication in infants of diabetic mothers (IDM). To investigate the regulation of erythropoiesis in these infants, we measured cord blood erythropoietin (EP) levels by a sensitive radioimmune assay and examined the growth of erythroid progenitor colonies in a series of IDM and control infants. Fifteen of 18 diabetic mothers were managed on a protocol emphasizing careful glycemic control throughout pregnancy; 10 had glycosolated hemoglobin values within the normal, nondiabetic range during the third trimester. Cord blood EP was elevated in one of 18 IDM and in two of 13 controls (p = NS). In IDM, cord blood EP values were higher in infants delivered following maternal labor and were inversely correlated with umbilical artery pH (r = -0.72; p = 0.006). Growth of burst forming units-erythroid was similar in IDM and controls in the presence of 0.1 to 2.0 U of exogenous EP per ml of methylcellulose medium. Individual infants tended to respond consistently over the entire range of EP doses tested. The number of burst forming units-erythroid observed did not correlate with cord blood EP, birth weight, or neonatal hematocrits. We conclude that: umbilical cord blood EP levels are generally normal in IDM delivered by mothers in whom good glycemic control is maintained throughout gestation, cord blood EP values are strongly influenced by perinatal events, and the response of erythroid progenitors to EP is intrinsically normal in IDM. These data suggest that polycythemia is an adaptive response in IDM and is not associated with a primary abnormality in erythropoiesis.(ABSTRACT TRUNCATED AT 250 WORDS)