Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria,
Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
Neonatology. 2023;120(6):768-775. doi: 10.1159/000533335. Epub 2023 Aug 29.
There are data linking gestational diabetes mellitus (GDM) with adverse neurodevelopmental outcome in the offspring. We investigated the effect of GDM on microstructural brain development and neurodevelopmental outcome of very preterm infants.
Preterm infants <32 gestational weeks of mothers with GDM obtained cerebral magnetic resonance imaging (MRI) including diffusion-tensor imaging at term-equivalent age. For every infant, two gestational age-, sex-, and MRI scanner type-matched controls were included. Brain injury was assessed and fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measured in 14 defined cerebral regions. Neurodevelopmental outcome was quantified at the corrected age of 24 months using the Bayley Scales of Infant Development.
We included 47 infants of mothers with GDM and 94 controls. There were no differences in neonatal morbidity between the groups, nor in any type of brain injury. The GDM group showed significantly higher FA values in the centrum semiovale, the posterior limb of the internal capsule and the pons bilaterally, in the corpus callosum and the right occipital white matter, as well as lower ADC values in the right centrum semiovale, the right occipital white matter and the corpus callosum. Neurodevelopmental outcome did not differ between the groups.
We found no impairment of brain development in GDM-exposed infants compared to matched controls, but differences in white matter microstructure in specific regions indicating an enhanced maturation. However, neurodevelopmental outcome was equal in both groups. Further studies are needed to better understand brain maturation in preterm infants exposed to GDM.
有数据表明，妊娠期糖尿病（GDM）与后代不良神经发育结局有关。我们研究了 GDM 对极早产儿脑微观结构发育和神经发育结局的影响。
对患有 GDM 的母亲所生的 <32 孕周的早产儿，在胎龄相当的年龄进行脑磁共振成像（MRI），包括弥散张量成像。每例婴儿纳入 2 例性别、胎龄和 MRI 扫描仪类型相匹配的对照。评估脑损伤，并在 14 个定义明确的脑区测量各向异性分数（FA）和表观扩散系数（ADC）。在矫正年龄 24 个月时，使用贝利婴幼儿发育量表评估神经发育结局。
共纳入 47 例 GDM 母亲所生婴儿和 94 例对照。两组间新生儿发病率、任何类型脑损伤均无差异。GDM 组双侧大脑脚、内囊后肢、脑桥、胼胝体和右侧枕叶白质 FA 值较高，右侧大脑脚、右侧枕叶白质和胼胝体 ADC 值较低。两组间神经发育结局无差异。
与匹配对照相比，我们未发现 GDM 暴露婴儿脑发育受损，但在特定区域的白质微观结构存在差异，提示成熟度增强。然而，两组间神经发育结局相当。需要进一步研究以更好地了解 GDM 暴露的早产儿的脑成熟情况。
