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The metabolic dimensions of pregnancy, in particular hyperglycemia, situational or gestational diabetes, as seen through all kind of equivalences, as overweight, in mothers and child

Many researchers would sometimes only refer to direct transmission of genes to explain ADHD or difficult temperaments. This idea could become a simple euphemism, especially when it neglects to talk about simple and foreseeable factors. Among the factors of risks, at the time of a pregnancy, everyone agrees about dangers of primary and secondary smoking, of alcoholism, of drugs, of malnutrition (related to poverty), of presence of mercury or lead (* 1) in water or food, but little is said or so well integrated about these dangers of overfeeding, a great evil that is endemic (ou epidemic) in Occident, but also a way of life, in some countries, where the pregnant woman must, according to customs, "eat for two" as if there were an inescapable food shortage in view, still feared as an unconscious, group instinct. In addition to instinctive regression proper to this period of life, there is a food problem that should require a constant medical guidance. One mother reasons  herself by saying, "I ate my emotions", while taking 50 kilo (100 pd) of weight, for a new-born baby of 4¾ kilo (10½ pd) or another, very small with her 50 kilo (100 pd), allowing 25 kilo (50 pd) and a kid of 4½ kilo (9½ pd), but forgiving herself her food binges saying, "I gave to herself a beautiful pregnancy", with obvious agreement of herdoctor. The first gestation, even of prediabetic type, will provoke a second, maybe a third, in more serious terms, if the medical approach remains the same.

It seems less obvious to work on overfeeding, like one of the most current factors, for not only securing mechanical complications of the prolonged delivery of a massive fetus, but also of the perverse effects of  various forms of gestational diabetes which leads finally to total eclampsia, when renal competence is missing and poisons mother as well.

The gestational diabetes is distinguished from diabetes type 1, completely insulin-dependant, an autoimmune disease of mostly genetic origin and also from the diabetes type 2, more situational and function of the diet and food, with a constitutional genetic vulnerability which increases the resistance to the own person insulin (still auto-immune dimension (* 2). At the 6th month of pregnancy, the placenta is secreting an hormone (Human Placenta Lactogen ou HPL) stimulating the fetus growing but neutralizing the insulin of the mother who has to provide up to thres times the previous level, almost to the point of pancreas exhaustion. It is then the danger of gestational diabetes which is, at the same time, independent of the other two forms but often potentated by diabetes type 2, as well overweight, obesity, inaction or sedantary life.

The insulin tranforms glucosis into immediate energy, allowing its passage across the cell membrane. Otherwise it accumulates into the blood, creating hyperglycemia, being toxic per se (glucotoxicity). The fetus responds to mother's hyperglycémia by secreting his own insulin, but mostly makes fat quickly and becomes soon bigger, not producing any energy output. Glucosis, contrary to mother's insulin, gets across the placenta barrier. At birth, the new born goes into hypoglycemia, pursuing his hypersecretion of insulin, that could help later to develop diabetes type 2. There is often an hungry child wanting solid food as soon as possible.

Anyone should then worry about any increase of weight in mothers, while she is pregnant, and make regular assessments of blood sugar, as a preventive measure, in order to avoid those metabolic diseases of mother and fetus, and moreover a simple mechanical blocking, at child delivery, by the fetus oversize (macrosomia). In these times of preventive withdrawals from work, emphazing the negative stresses, it would be convenient to keep the course on the fundamental conditions of health.

This dimension concerns a large percentage of mothers, in its final clinical form, that is to say, the triple of usual standard (1). But it seems obvious that the preclinic signs of gestational diabetes, as seen in overweight, obesity and the fetus size, are largely higher and should raise the concern of all persons in charge for public health sector.

Clinical medical resumes of children with difficult behaviors

1- Jolaine , 8 years
. birth at 4¾ kl; catch of weight of mother: 50 kl. No food medical guidance, during gestation: sugar refineries, chocolate, at will, "I ate my emotions", says the mother. Mother who always has a light need for sugar, like "always needing desserts". A diabetes identified in an uncle. Mother, 37 years, maintaining at 112 kl (240 pd).

2- Robert , 6 years
. new-born baby of 4 kl (8 pd). Catch of weight of mother: 25 kl, (50pd) with small size. Blocking of descent at 37 hours of delivery, then two hours of useless waiting, before making an episiotomy. "I treated to myself a beautiful pregnancy; I ate "dairy ice cream and the chocolate at will".

3- Sebastien , 6 years
. mother and parents diabetic, obesity. Preeclampsia in pregnancy. Father, obese since the 18 years old (weight up to 130 kl. (260pd).

4- Samantha , 9 years :
child: new-born baby of 7 pd 11 oz. Heart failure during the delivery and at 2 years, at the time of a fever of 105 F Grand-mother: diabetes, no 1 and great-grandmother; severe hypoglycemia: chronic disability, for sudden unconsciousness. Mother: pregnancy: coercive vomiting in repetition, over 6 months. Catch of weight, 50 lb; severe swelling of the lower limbs, (very probable preeclampsia). Delivery beginning at 42 weeks. Tendency to hypoglycemia, since the early childhood and now improved by "salt pinches" (trick of a pharmacist); asthma; attacks of panic.
Diagnosis: severe ADD, impulsiveness, night hallucinations (dissociation). January 2003

5- Priscilla , 9 years,
child: born at 6½ pd, at 38 weeks of pregnancy Maternal grandmother: diabetes no 2, at 45 years, with insulin. Aunt and grand-mother: multiple allergies penicillin, dairy products; asthma. Mother: easy gestation, but gestational diabetes discovered in the 5th month; catch of weight: 40 pd, (weights of 70 pd, with the two following pregnancies).
Dx- ADD, confabulation, opposition, delays in school. Still in her 1st primary grade

Comments :

These factors would be simple to contain, but are often neglected, as being too obvious. The physiology of a few women can allow significant variations in weight without bringing bad consequences. But it is never wise to accumulate many factors of risk, when already the mother nature, itself, does not give any chance, when thinking in terms of global genetics.

People who know some diabetic ancestors must be more careful and worry of any overfeeding in fat and sugar. Those which have hypoglycemic tendencies are difficult to identify: they generally have sudden impulses of sugar, a few hours after meals and must fight chronic fatigue. This last condition belongs to preclinic, nonmedical or gestational diabetes 2; it is seldom recognized like such, but is declined under various terms, as chronic fatigue syndrome, neurasthenia or the unipolar depression.

Nothing would replace a previous good health, in particular the regular physical exercise which has the benefit to improve the effectiveness of the person own insulin, in addition to decreasing overweight and preserving the muscular shape. It is well known that any individual should walk, at least, an equivalence of 4 kilometers a day. A useful exercice should be moderate and progressive, be done every day, once or better twice. The simplest way could be a fast walk on a rolling carpet or a stationnary cycling.

* 1: lead still exists in great amount, in old drains, in several antic cities or constructions. The replacement cost would be astronomical.

* 2 the autoimmune reaction generates a self-destruction of its own cells or hormones, the body ignoring its own parts or products, seeking to destroy them like a purely foreign body.

References:
1- Controversies in the diagnosis and treatment of gestational diabetes. Jovanovic L Cleve Covering joint J Med (United States), Jul 2000, 67(7) p481-2, 485-6, 488
2- Body Mass Index (BMI): (weight in kg/height in m 2)
3- Body Mass Index, Gestational Diabetes and Diabetes Mellitus in Three Northern Saskatchewan Aboriginal Communities
Roland F Dyck, Tan Leonard and Vern H. Hoeppner, chronic Diseases of Canada, vol. 16, No 1, 1995.
4- Gestational Diabetes: What it Means for Me and My Baby : American Academy of Family Physicians
5- Gestational Diabetes: The American Diabetes Association
6- Letters to the Editor, Gestational Diabetes Mellitus (GDM) in A sample of children referred for disruptive behavior disorders:
The Canadian review of child psychiatry, vol. 11, No 1, February 2002, by Pratibha N Reebye, M.D, and Dr. David Worling, ph.d. University of British Columbia
7- Maternal diabetes mellitus and infant malformations. Sheffield JS, Butler-Koster EL, Casey BM, et al.. Obstet Gynecol (United States), Nov. 2002, 100(5 Pt 1) p925-30
8- National Institute of Child Health and Human Development: Understanding Gestational Diabetes; A Practical Guide to Healthy Pregnancy  *****
9- Obesity Before Pregnancy Puts Women and Infants At Risk, by the Organization " March of Dimes ", fights about it against the diseases of the pregnancy and prematurity - the gestational diabetes
10- Perinatal complications in women with gestational diabetes mellitus. Svare JA, Hansen BB, Molsted-Pedersen L Acta Obstet Gynecol Scand (Denmark), Oct. 2001, 80(10) p899-904
11- Rates and risk factors for recurrence of gestational diabetes. MacNeill S, Dodds L, Hamilton cd., et al.. Diabetes Care (United States), Apr 2001, 24(4) p659-62

Claude Jolicoeur, M.D, Child Psychiatrist
January 2003
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