RESUMO
Objectives: To determine whether infants of diabetic mothers have altered lipoprotein metabolism, whether these alterations persist or regress after one month of life and whether these alterations are genetically determined through Apolipoprotein E genotypes
Methods: The present study was performed in Ain Shams University, Neonatal Intensive Care Unit Childrens Hospital, and the follow up was done in the Newborn Clinic in the period from March 2002 to March 2003. The subjects were classified into the following groups: Group I: included 81 newborns of diabetic mothers [gestational or pregestational], 40 females and 41 males. Group II: included 76 full term healthy newborns to healthy mothers, 43 males and 33 females. They were subjected to: full history taking, thorough clinical examination, cord Serum lipid profiles [total cholesterol, triglyceride, HDL-c, LDL-c, Serum ApoA1, and ApoB100] serum glucose level, and serum insulin level for IDM. Follow up of only 33 newborns of group I and 23 newborns of group II after I month for repeating lipid profiles. ApoE genotyping by PCR was performed for 20 hyperlipidemic newborns of diabetic mothers [those with more than 2 SD increase in lipid profiles in the follow up samples after one month]
Results: There was a significantly higher cord blood lipids, lipoproteins and apolipoproteins concentrations in the IDM group compared to the control group. Both groups whether IDM and control group showed significant rise in lipid, lipoproteins and apolipoproteins levels at one month of life compared to their cord blood levels. But still there were significant higher levels in IDM group than the control group. Comparison between infants of gestational diabetic mothers and those of initially diabetic mothers as regard their lipid profiles at birth and at day 30 of life showed non significant difference. The frequency prevalence of Apo E alleles E2, E3 and E4 were 0, 75 and 25% respectively with Apo E 3 being the commonest allele followed by E4. No significant difference was detected as regards allele frequencies between the studied IDM. No significant difference was detected between IDMs with Apo E 4/3 genotype and those with Apo E 3/3 genotype as regard their lipid profiles whether at birth or after one month of life
Conclusion: IDM had altered lipid metabolism at birth, some of which persisted after one month and might play a role in the pathogenesis of diabetes and atherosclerosis in adulthood, however, these changes could not be related to Apo E genotyping as lipid metabolism is influenced by variety of environmental and physical factors
Recommendations: Longitudinal studies with prolonged follow up of lipid profile in IDM are needed to determine whether hyperlipidemia persists or disappears later in life