AJOG Reviews: Case Reports
Influence of maternal and fetal glucokinase mutations in gestational diabetes,☆☆

https://doi.org/10.1067/mob.2001.113127Get rights and content

Abstract

We report 2 insulin-treated pregnancies in a mother with hyperglycemia resulting from a glucokinase gene mutation. The inheritance of a glucokinase mutation in 1 child reduced his intrauterine growth (birth weight less than first percentile) by reducing fetal insulin secretion. We discuss the implications for obstetric management of patients with glucokinase mutations. (Am J Obstet Gynecol 2001;185:240-1.)

Section snippets

Case report

A 26-year-old woman was reviewed at 12 weeks of gestation during her first pregnancy because of persisting glycosuria. She was obese (body mass index, 39 kg/m2) and oral glucose tolerance testing confirmed impaired fasting glucose (fasting plasma glucose, 6.1 mmol/L; 1 hour, 12.2 mmol/L, and 2 hours, 6.9 mmol/L). She was treated initially with diet and subsequently insulin (up to 1 U/kg/d) from week 12. Glycemic control was assessed by serum fructosamine on 6 occasions between 18 and 35 weeks

Comment

We report 2 pregnancies in a patient with hyperglycemia resulting from a mutation in the glucokinase gene. Glucokinase mutations are found in approximately 3% of white women with gestational diabetes and are likely in patients with persistent fasting hyperglycemia, a small increment during an oral glucose tolerance test, and requiring insulin treatment during pregnancy.1 The mild phenotype (fasting blood glucose, 5.5-9 mmol/L from birth) means many of these patients will not be identified until

Acknowledgements

We thank Diabetes UK for funding the genetic analysis.

References (3)

  • S Ellard et al.

    A high prevalence of glucokinase mutations in gestational diabetic subjects by clinical criteria

    Diabetologia

    (2000)
There are more references available in the full text version of this article.

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Ghislaine Spyer, MBBS, is the recipient of a fellowship awarded by Novo Nordisk.

☆☆

Reprint requests: Ghislaine Spyer, MBBS, Department of Diabetes and Vascular Medicine, School of Postgraduate Medicine, Barrack Road,Exeter, UK.

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