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The Caloric Cost and Sources of Energy in Diabetic Pregnancy

From the Departments of Medicine and Obstetrics and Gynecology of Harvard Medical School, the Peter Bent Brigham Hospital, and the Boston Hospital for Women (Lying-in Division), Boston, Massachusetts

Abstract

The total cumulative extra energy expenditure solely attributable to pregnancy, as measured by indirect calorimetry, was significantly increased in -1 insulin-treated diabetics (32,770 ± 1285 kcal at 36 weeks) as compared to 2 diabetics on diet alone or acetohexamide (28,332 ± 1502 kcal at 38 weeks) and 10 nondiabetic controls (27,121 ± 2175 kcal at 40 weeks). Fetal and placental weights and maternal chorionic somatomammotropin levels at the earlier gestational period in the diabetic patients tested exceeded those of the normal patients at full term. It is proposed that the increase in available energy leads to more rapid growth and maturation of the products of conception, thus providing a rational basis for the early termination of pregnancy in diabetics. Fetal fat accumulation was in direct proportion to the degree of stimulation of fetal insulin production by either maternal hyperglycemia or acetohexamide. The central aim of the management of pregnancy in diabetics should be the prevention of fetal hyperinsulinemia through proper regulation of maternal insulin and diet. The use of insulinogenic drugs is contraindicated.