Influence of maternal HbA1C on fetal insulin levels




GDM, HbA1C, Insulin


Background: Gestational diabetes is the most common medical complication during pregnancy. The objective of this study was to study the effect of maternal HbA1C levels on fetal insulin levels.

Methods: Study was conducted at KIMS. 57 babies born to eligible diabetic pregnant women aged between19 to 40 years with gestational age between 35 and 42 weeks were recruited. Multiple births, gestational age <34 weeks, steroids given within 24 hours before birth, delay of >20 minutes in cord blood collection, delay of >60 minutes before freezing of plasma were excluded. Maternal investigations (HbA1C) were collected from maternal records. Umbilical cord blood was collected immediately after delivery and insulin levels were measured.

Results: In this study, mean cord blood insulin levels were 7.83±3.53 μU/ml, mother’s mean HbA1C levels were 6.47±1.26. Statistically significant association was found between maternal HbA1C levels and fetal insulin levels. (r 0.37; P 0.004).

Conclusions: Increased cord blood insulin levels were found in infants of diabetic mothers at birth, more so in large for gestation age babies, suggesting inutero fetal programming and hence strict control of maternal diabetes is recommended to decrease long-term fetal effects. 

Author Biographies

Yashoda H. T., Department of Pediatrics, KIMS, Bangalore, Karnataka, India

Pediatrics , junior resident

Swetha B., Department of Pediatrics, KIMS, Bangalore, Karnataka, India


Manasa G., Department of Pediatrics, KIMS, Bangalore, Karnataka, India



Anjana RM, Pradeepa R, Deepa M. Prevalence of diabetes and pre-diabetes impaired fasting glucose and/or impaired glucose tolerance in urban and rural India: Phase I results of the Indian Council of Medical Research-India diabetes (ICMR-India) study. Diabetol. 2011;54:3022-7.

American Diabetes Association. Management of diabetes in pregnancy. Sec.12. In Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39(Suppl. 1):S94-98.

Gary F. Cunningham, Leveno, Bloom. Williams Obstetrics ;24th Ed, Chapter 57; 2014:1125-1143.

Sapin R, Ongagna JC, Gasser F, Grucker D. Insulin measurements in haemolysed serum: influence of insulinase inhibitors. Clin Chim Acta. 1998;274:111-7.

Reimers TJ, McCann JP, Cowan RG, Concannon PW Effects of storage, hemolysis, and freezing and thawing on concentrations of thyroxine, cortisol, and insulin in blood samples. Proc Soc Exp Biol Med. 1982;170:509-16.

Brodal BP. The influence of haemolysis on the radioimmunoassay of insulin. Scand J Clin Lab Invest. 1971;28:287-90.

Simental-Mendía LE. Argelia, Birth-weight, insulin levels, and HOMA-IR in newborns at term, BMC Pediatrics. 2012;12:94.

Fall CHD, Stein CE, Kumaran K, Cox V, Osmond C, Barker DJP, et al. Size at birth, maternal weight, and type 2 diabetes in South India. Diabetic Med. 1998;15:220-7.

Catalano PM, Kirwan JP. Gestational diabetes and insulin resistance role in short and long term implications for mother and fetus. J Nutr. 2003;133:1674S-83S.

Jenny A. Westgate, Franzcog, Hyperinsulinemia in cord blood in mothers with type 2 diabetes and gestational diabetes mellitus in New Zealand. Diabetic Care. 2006;29(6):1345-50.

Lindsay RS, Walker JD. Insulin and insulin pro-peptides at birth in offspring of diabetic mothers. J Clin Endocrinol Metabol. 2002;88(4):1664-71.

Weiss, Hofmann. Fetal insulin balance; gestational diabetes and postpartal screening. Obstet Gynecol. 1984:64:65-68.

Shields BM, Bridget. Measurement of cord insulin and insulin-related peptides suggests that girls are more insulin resistant than boys at birth. Diabet Care. 2007;30(10):2661-66.






Original Research Articles