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Decreased urine albumin:creatinine ratios in infants of diabetic mothers: does exposure to diabetic pregnancies alter fetal renal development?

Published online by Cambridge University Press:  22 August 2011

R. F. Dyck ,
W. T. Bingham ,
H. Lim ,
Y. Jiang  and
N. D. Osgood
R. F. Dyck*
Affiliation:
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
W. T. Bingham
Affiliation:
Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
H. Lim
Affiliation:
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Y. Jiang
Affiliation:
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
N. D. Osgood
Affiliation:
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
*
*Address for correspondence: Dr R. F. Dyck, MD, Department of Medicine, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada. (Email roland.dyck@usask.ca)
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Abstract

Offspring of diabetic mothers experience an increased risk for type 2 diabetes but it is not known whether diabetic pregnancies also confer a higher inter-generational risk for diabetic complications. Because microalbuminuria is a sensitive indicator of glomerular damage, we compared the urine albumin:creatinine ratios (ACRs) between 65 infants of diabetic mothers (InfDM+) and 59 infants of non-diabetic mothers (InfDM−), and repeated the comparisons in 21 InfDM+ and 19 InfDM− when children were 5–19 months old. ACRs were higher among neonates compared with normal reference values for adults, but declined with increasing age. The only independent predictor of higher ACRs in a logistic regression model (⩾13 mg/mmol v. <13 mg/mmol) was the presence of delivery complications (odds ratio 2.95; P = 0.015). Neither high nor low birth weight was associated with higher neonatal ACRs. The most unique finding of the study was that InfDM+ had significantly lower ACRs than InfDM− [mean = 12.9 (median = 6.0) v. mean = 16.6 (median = 11.5), respectively at P = 0.05] even after adjusting for other variables using logistic regression (odds ratio 0.25; P = 0.001). In contrast, by 5–19 months, there was a trend toward higher ACRs among InfDM+ compared with InfDM− [mean = 6.3 mg/mmol (median = 1.9) v. mean = 3.0 mg/mmol (median = 2.5), respectively at P = 0.25]. Lower ACRs in InfDM+ may be due to developmental changes in fetal kidneys induced by hyperinsulinemia. Although the implications of this observation are unclear, it is possible that exposure to a diabetic intrauterine environment might influence the later risk for renal disease.

Keywords

aboriginaldiabetic pregnancymicroalbuminurianeonataloffspring of diabetic mothers
Type
Original Articles
Information
Journal of Developmental Origins of Health and Disease , Volume 2 , Issue 5 , October 2011 , pp. 265 - 271
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2011

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References

1.Dyck, RF, Osgood, ND, Lin, TH, Gao, A, Stang, MR. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. Can Med Assoc J. 2010; 182, 249–256.Google Scholar
2.Young, TK, Reading, J, Elias, B, O'Neil, J. Type 2 diabetes mellitus in Canada's First Nations: status of an epidemic in progress. Can Med Assoc J. 2000; 163, 561–566.Google Scholar
3.Dyck, RF, Osgood, ND, Lin, TH, Gao, A, Stang, MR. End-stage renal disease in people with diabetes: a comparison of First Nations people and other Saskatchewan residents from 1981–2005. Can J Diab. 2010; 34, 324–333.Google Scholar
4.Dyck, RF, Sidhu, N, Klomp, H, Cascagnette, PJ, Teare, GF. Differences in glycemic control and survival predict higher ESRD rates in diabetic First Nations people. Clin Invest Med. 2010; 33, E390–E397.CrossRefGoogle Scholar
5.Imperatore, G, Knowler, WC, Nelson, RG, Hanson, RL. Genetics of diabetic nephropathy in the Pima Indians. Curr Diab Rep. 2001; 1, 275–281.Google Scholar
6.Dabelea, DD, Pettitt, DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Ped Endo. 2001; 14, 1085–1091.Google Scholar
7.Osgood, ND, Dyck, RF, Grassmann, WK. The inter- and intra-generational impact of gestational diabetes on the epidemic of type 2 diabetes. Am J Public Health. 2011; 101, 173–179.Google Scholar
8.Nelson, RG, Morgenstern, H, Bennett, PH. Intrauterine diabetes exposure and the risk of renal disease in diabetic Pima Indians. Diabetes. 1998; 47, 1489–1493.Google Scholar
9.Dyck, RF, Klomp, H, Tan, LK, Stang, MR. An association of maternal age and birth weight with end-stage renal disease in Saskatchewan. Am J Nephrol. 2003; 23, 395–402.Google Scholar
10.Dyck, RF, Klomp, H, Tan, LK, Turnell, RW, Boctor, MA. A comparison of rates, risk factors and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district. Diab Care. 2002; 25, 487–493.CrossRefGoogle ScholarPubMed
11.Yap, C, Yap, HK, Chio, LF. Urine microalbumin/creatinine ratios in Singapore children. J Singapore Paediatr Soc. 1991; 33, 101–106.Google ScholarPubMed
12.Del Campo Balsa, MT, Tato Rocha, RE, Tenias Burillo, JM, Ramos Hernandez, YT. Evaluation of microalbuminuria in children. An Esp Pediatr. 1992; 37, 187–189.Google Scholar
13.Fell, JME, Thakkar, H, Newman, DJ, Price, CP. Measurement of albumin and low molecular weight proteins in the urine of newborn infants using a cotton wool ball collection method. Acta Paediatr. 1997; 86, 518–522.CrossRefGoogle ScholarPubMed
14.Dyck, RF, Bingham, WT, Bedard, V. Microalbuminuria in infants of diabetic mothers (Abstract). J Am Soc Nephrol. 2005; 16, 408A.Google Scholar
15.Viberti, GC, Hill, RD, Jarrett, RJ, et al. . Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet. 1982; 1, 1430–1432.Google Scholar
16.Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diab. 2008; 32(Suppl. 1), S126–S134.Google Scholar
17.Rademacher, ER, Sinaiko, AR. Albuminuria in children. Curr Opin Nephrol Hypertens. 2009; 18, 246–251.Google Scholar
18.Grisler, R, Botta, A, Forestieri, L, et al. . Incidence of microalbuminuria in childhood. Quad Sclavo Diagn. 1987; 23, 417–420.Google Scholar
19.Garcia-Bournissen, F, Feig, DS, Koren, G. Maternal-fetal transport of hypoglycaemic drugs. Clin Pharmacokinet. 2003; 42, 303–313.CrossRefGoogle ScholarPubMed
20.Pederson, J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol. 1954; 16, 330–342.Google Scholar
21.Freinkel, N. Of pregnancy and progeny. Diabetes. 1980; 29, 1023–1035.CrossRefGoogle ScholarPubMed
22.Lindsay, RS, Westgate, JA, Beattie, J, et al. . Inverse changes in fetal insulin-like growth factor (IGF)-1 and IGF binding protein-1 in association with higher birth weight in maternal diabetes. Clin Endocrinol. 2007; 66, 322–328.Google Scholar
23.Marsh, AC, Gibson, KJ, Wu, J, et al. . Insulin-like growth factor I alters renal function and stimulates renin secretion in late gestation fetal sheep. J Physiol. 2001; 530, 253–262.CrossRefGoogle ScholarPubMed
24.Marsh, AC, Gibson, KJ, Wu, J, et al. . Chronic effect of insulin-like growth factor I on renin synthesis, secretion and renal function in fetal sheep. Am J Physiol Regul Integr Comp Physiol. 2001; 281, R318–R326.Google Scholar
25.Tarantal, AF, Hunter, MK, Gargosky, SE. Direct administration of insulin-like growth factor to fetal Rhesus monkeys (Macca mulatta). Endocrinology. 1997; 138, 3349–3358.Google Scholar
26.Bell, CG, Teschendorff, AE, Rakyan, VK, et al. . Genome-wide DNA methylation analysis for diabetic nephropathy in type 2 diabetes. BMC Med Genom. 2010; 3, 33. http://www.biomedcentral.com/1755-8794/3/33Google Scholar