This thesis consists of personal observations made upon
96 children of diabetic women from their intrauterine life
up to the age of ten years, and of information about their
mothers and their siblings.
The curious morphology shared by the infants of pre - diabetic and diabetic women includes foetal overgrowth,
pancreatic islet hyperplasia, extramedullary haemopoiesis and
possible adrenal enlargement. The principal autopsy finding,
in neonatal deaths is pulmonary hyaline membrane.
Animal experiments and the observations of others on these babies suggest that the morphology is due to an anterior
pituitary disorder and to an excess of Pituitary Growth Hormone in particular. The personal observations in this series
suggest that the morphology results from the action of a aternal diabetogenic growth factor, to which the influence
of adrenal corticosteroids, and later of hyperglycaemia, may
e added. Neither the growth factor nor the hyperglycaemia
appear to be the principal causes of foetal death, but the
utter probably contributes to it.
Failure of placental function is probably responsible
or intra-uterine death, for interference with growth stimuation, and for the hypoxia which, with the perinatal circuatory changes, is responsible for much of the neonatal
orbidity and mortality. The premature placental failure
occurs in many, but not in all, pre -diabetic and diabetic
women, and it may be caused by adrenal corticosteroids.
The laboratory studies which form part of this thesis
establish the normal range of the blood sugar level during
each of the first ten days of life and prove that the hypoglycaemia, which occurs so commonly in infants of diabetic
omen, is not responsible for the neonatal clinical disturance and that it does not cause irreversible cerebral damage.
They also suggest that increased adrenocortical activity
exists in the foetus.
Important congenital malformations occur no more commonly
in these babies than they do in children of non -diabetic
women, and no significant difference in growth or in the
incidence of diabetes mellitus has been noted up to the age
of ten years.
Further observations of such a group over a period of
twenty years or more will probably be necessary before the
risk of such children becoming diabetic can be fully assessed.