Copeptin and MR-proADM in umbilical cord plasma reflect perinatal stress in neonates born to mothers with diabetes and MR-proANP reflects maternal diabetes.

AIM: To examine concentrations of three cardiovascular propeptides in umbilical cord plasma of neonates born to mothers with Type 1, Type 2 and gestational diabetes. Measurement of cardiovascular markers in umbilical cord plasma may potentially help identify neonates at risk of postnatal complications. Neonates born to mothers with diabetes have an increased risk of neonatal morbidity and mortality, and measurement of these new biomarkers may potentially help identify neonates at risk of these complications. SUBJECTS & METHODS: Copeptin, midregional proadrenomedullin (MR-proADM) and mid-regional pro-A-type natriuretic peptide (MR-proANP) were measured in cord plasma of neonates (n = 63) born to mothers with the three types of diabetes. Associations with maternal glycemic control, mode of delivery and neonatal metabolic acidosis were examined. RESULTS: Umbilical cord plasma copeptin concentrations were lowest in neonates after elective cesarean sections (6.1 pmol/l; interquartile range [IQR]: 4.5-9.1) compared with emergency cesarean sections (156 pmol/l; IQR: 9.6-311; p = 0.019) and vaginal delivery (831 pmol/l; IQR: 107-2407; p < 0.0001). MR-proADM was also affected by mode of delivery; however, this seemed more likely to be caused by an inverse association with the acid-base balance. In this population, only MR-proANP plasma concentrations were related to type of diabetes. Neonates born to mothers with Type 1 diabetes had higher concentrations (median 260 pmol/l; IQR: 222-318) compared with Type 2 diabetes (175 pmol/l; IQR: 169-200; p = 0.003) and gestational diabetes (200 pmol/l; IQR: 149-276; p = 0.009). CONCLUSION: Umbilical cord plasma copeptin and MR-proADM concentrations primarily reflect perinatal stress associated with mode of delivery and the degree of fetal acidosis, whereas MR-proANP concentrations are higher in neonates born to mothers with Type 1 diabetes.

Increased plasma pro-B-type natriuretic peptide in infants of women with type 1 diabetes.

BACKGROUND: Up to 40% of newborn infants of women with type 1 diabetes have echocardiographic signs of cardiomyopathy. Increased plasma concentrations of B-type natriuretic peptide (BNP) and its precursor (proBNP) are markers of cardiac failure and hypoxia in adults. In this study, we investigated whether plasma concentrations of proBNP and/or BNP are increased in infants of women with type 1 diabetes. METHODS: Plasma BNP and proBNP were measured with RIAs. The proBNP assay measures both intact proBNP and NH(2)-terminal fragments derived from this precursor, whereas the BNP assay measures only BNP-32 and not proBNP. RESULTS: Infants of women with diabetes and hemoglobin A(1c) (Hb A(1c)) > or =6.2% before delivery had a higher median plasma proBNP concentration (31 pmol/L; interquartile range, 21-47 pmol/L; n = 16) than infants of healthy women [16 (9-32) pmol/L; n = 21; P = 0.01]. Infants of women with diabetes and Hb A(1c) <6.2% (n = 15) had intermediate values. The plasma BNP and proBNP concentrations were closely associated (r(2) = 0.80; P < 0.0001); within the group of infants of women with diabetes and Hb A(1c) > or =6.2%, both correlated with the degree of fetal stress during labor. CONCLUSIONS: Maternal diabetes and suboptimal metabolic control may affect the fetal heart and predominantly stimulate proBNP secretion in conjunction with perinatal stress.