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.)

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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.

Cited by (0)

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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