Ann. Pak. Inst. Med. Sci. 2010; 6(2): 107-112

Objective: To observe and evaluate the significance of the complications seen in Infants of diabetic mothers
Study design: Observational, prospective.
Place and duration of study: Neonatology department of Pakistan Institute of Medical Sciences [PIMS], a tertiary care teaching hospital. The study period is from March 2009 to February 2010
Materials and Methods: All the infants born to the diabetic mother were admitted to the neonatal care department for evaluation. Materal history was taken and detailed physical examination of these babies was performed with special emphasis on the congenital anomalies and birth injuries. Laboratory investigations like blood sugar, serum calcium, hematocrit and echocardiography was done in all babies but serum bilirubin, X-ray chest and ECG was done where ever indicated. Results were analyzed using statistical package for social sciences (SPSS) version 11
Results: A total number of 11328 mothers were delivered out of which only 142 babies were born to the diabetic mothers. The median age of diabetic mothers was 29 years which included 20% primigravida and 35% multigravida mothers. Gestational diabetes was seen in 84% while pregestational diabetes was seen in 16%. Out of 142 newborn IDMs, 58% were male and 42% were female.
Hypoglycaemia at birth was documented in 28% of cases and hypocalcaemia was seen in 25% of cases. Asymmetrical septal hypertrophy [ASH} and macrosomia were strongly associated with hypoglycaemia. [p value= 0.001] .The low birth weight babies were 23% while the macrosomic babies were 16%. Birth injuries were seen in 13% in which the cephalhaematoma was seen in 9 cases and almost all injuries were due to macrosomia. Mothers with Glycosylated haemoglobin [HbA1c] of more than 8.5% were 58%. There was a strong association of high levels of HbA1c levels with hypoglycaemia, macrosomia, LGA and ASH. Congenital anomalies were observed in 34% cases. Cardiac anomalies were predominant and constituted about 94% [n=45] of all the congenital anomalies. ASH of the heart was seen in 32 of the total 45 cases of heart anomalies
Respiratory distress syndrome [RDS] was seen in 11 cases. Resuscitation at birth was required in 11% but significant asphyxia was seen in only 2 cases. It was encouraging to note that none of our IDM died because of complications.
Conclusion: The study showed a high percentage of neonatal complications due to poor glycemic control in pregnancy so a good glycemic control during the pregnancy is advocated. The deliveries should be attended by the paediatric team to minimize the morbidity and mortality.
Key Words: Gestational diabetes, Macrosomia, HbA1c, congenital heart malformations, hypoglycaemia


Introduction

Diabetes is a fairly common medical complication of pregnancy. It has been estimated that 0.2% to 0.3 % of all pregnancies are complicated by pre-existing diabetes mellitus and another 1-5 % represent gestational diabetes mellitus.¹ The Gestational diabetes mellitus (GDM) is seen in almost 80%, whereas around 12-15 % has pregestational diabetes (PGD)² Our local data from Karachi also reported an 8% prevalence of GDM.⁹ The prevalence of pregestational DM in Pakistan has been estimated to be 10% -14% in various regions of the country.³
The World Health Organization estimates that the number of people with diabetes mellitus (DM) will increase from 150 million to 333 million by the year 2025. This alarming increase in the prevalence of DM will occur mainly in the developing regions of the world and the child bearing age would be most affected.⁶
In the developed world the perinatal mortality of infants of diabetic mothers (IDMs) has declined dramatically from 250 per 1000 live births in the 1960s to almost 20 per 1000 live births in the 1980.⁹ This dramatic decrease in the mortality is because of the advances in the management of diabetes in the pregnancy. However in our part of the world the situation is not encouraging.⁵ Although many infants of diabetic mothers (IDMs) have an uneventful perinatal course, there is still an increased risk of complications including congenital malformations, macrosomia, hypoglycaemia and intrapartum asphyxia.¹⁰ Long term complications include an increased rate of adolescent obesity, impaired glucose tolerance or diabetes mellitus, and subtle neuropsychological dysfunctions.⁸
Studies have shown that strict control of maternal glucose during pregnancy has a favourable influence on the perinatal outcome.¹⁰ The objective of our study was to observe the range of complications and their significance in infants of diabetic mothers in our tertiary care setup.