Background Children who are large for gestational age at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing metabolic syndrome. This can be explained by exposure to high glucose and insulin levels in utero causing altered fetal adaptation and changes in normal fetal programming.
Objectives The aim of the study was to evaluate preclinical atherosclerosis begins in utero.
Methods We measured the umbilical artery wall thickness (ruWT) in the third trimester by obstetric ultrasound and umbilical artery intima media thickness (uIMT) in pathologic specimens of the umbilical cords obtained shortly after delivery and we investigated the relation between the these measurements and serum insulin, c-peptide level in cord blood and homeostasis model assessment of insulin resistance (HOMA-IR) in infants of diabetic mother (IDM). Study group divided into two groups as; large for gestational age (LGA)/IDM group, appropriate for gestational age (AGA)/IDM group and compared with control group.
Results The LGA/IDM group had significantly higher insulin (p<0.001), c-peptides (p=0.018) and HOMA-IR levels (p<0.001) compared to AGA/IDM group and controls. LGA/IDM group had significantly higher ruWT(p=0.013) and uIMT (p<0.001) values compared to AGA/IDM group and controls. LGA/IDM group has increased umbilical artery intima-media and wall thickness which correlates with severity of maternal hyperglycemia.
Conclusions Measurement of ruWT in third trimester is feasible, reproducible and strongly correlated with pathological measurements.