Clinical and metabolic profile of neonates of diabetic mothers

Wasim Rafiq, Sheikh Quyoom Hussain, Muzzafer Jan, Bilal Ahmad Najar

Abstract


Background: Diabetes mellitus is the most common metabolic disorder complicating pregnancy. About 1-14% of all pregnancies are complicated by diabetes mellitus, 90% of them are Gestational Diabetes Mellitus (GDM). The present study was undertaken to describe clinical outcome & metabolic profile of neonates born to mothers with diabetes mellitus.

Methods: It was a hospital based prospective, non-randomized study conducted at department of paediatrics in G.B. pant hospital (neonatology section) an associated hospital of GMC Srinagar. The hospital is a referral tertiary care hospital of entire Kashmir valley. All infants born to diabetic mothers admitted at G.B. Pant hospital during the study period of one year (March 2011 to February 2012) were included in study.

Results: A total of 96 new-borns of diabetic mothers were included in study. 38 (40%) of these new-borns were large for gestational (LGA), 56 (58%) were Appropriate for Gestational Age (AGA) & two (2%) were Small for Gestational Age (SGA). Hypoglycemia was the leading morbidity & occurred in 34 (36%) of these new-borns. Hyperbilirubinemia (26 babies - 27%), Hypocalcemia (5 babies - 5%) & Hypomagnesemia (5 babies - 5%) were other morbidities present. Out of all babies respiratory distress syndrome occurred in 12 (13%), birth asphyxia in 10 babies (12%), polycythemia in 9(10%), congenital heart disease in 3 babies (3%) & other congenital malformations in 3 babies (3%), viz - myelomeningocele, tracheoesophageal fistula, cleft lip & palate respectively. All these morbidities were managed as per standard protocols outlined for these conditions. Out of these 96 study neonates death occurred in 1 neonate having congenital heart disease (mortality of ≈1/100 cases).

Conclusions: Infants born to diabetic mothers remain at high risk for development of clinical &metabolic complications. Optimal care of these infants is based on prevention, anticipation, early recognition & treatment of these conditions. 


Keywords


Infants of diabetic mothers, Hypoglycemia, Respiratory distress syndrome, Hypocalcemia1. Daftary NS, Chakravarti S. Diabetes in pregnancy. In: Daftary NS, Chakravarti S, eds. Manual of Obstetrics. 1st ed. New Delhi: Elsevier; 2004: 107. 2. Dutta DC. Diabe

Full Text:

PDF

References


Daftary NS, Chakravarti S. Diabetes in pregnancy. In: Daftary NS, Chakravarti S, eds. Manual of Obstetrics. 1st ed. New Delhi: Elsevier; 2004: 107.

Dutta DC. Diabetes mellitus in pregnancy. In: Dutta DC, eds. Textbook of Obstetrics. 6th ed. New Delhi: Jaypee Brothers Medical Publishers; 2004: 284.

Butle NF. Carbohydrate and lipid metabolism in pregnancy - normal compared with gestational diabetes mellitus. Am J Clin Nutr. 2000;71(5):12565-615.

Stoll BJ. Infant of diabetic mothers. In: Stoll BJ, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2008: 783.

Gladys AR, Thomas RM. Endocrine disorders in pregnancy. In: Gladys AR, Thomas RM, eds. Avery’s Diseases of New-born. 9th ed. Philadelphia: Saunders; 2012: 75-82.

Leandro C, Sergio H, Mark B, Steven G. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998;152:249.

London MB, Gabbe SG, Piana R, Mamuti MT, Main EK. Neonatal morbidity in pregnancy complicated by diabetes mellitus. Am J Obstet Gynaecol. 1987;156:1089-95.

Hod M, Merlob R, Friedman S, Schoenfeld A, Ovadia J. Gestational diabetes mellitus. A survey of perinatal complications in 1980`s. Diabetes. 1991;40:74-8.

Cordero L, Landon MB. Infant of the diabetic mother. Clin Perinatol. 1993;20:635-48.

Nasrat HA, Salleh M, Ardawi M and Ghafouri H. Outcome of pregnancy in diabetic mothers. Int J Gynaecol Obstet. 1993;43:29-34.

Otoloron EO, Famiyiwa O, Bello AF, Dawood AH. Reproductive performance following active management of diabetic pregnancies at Ibadan, Nigeria. Afr J Med Sci. 1985;14(3-4):155-60.

Engelgau MM, Nerman NH, Smith PJ, German RR. The epidemiology of diabetes and pregnancy in US. Diabetes Care. 1995;18(7):1029-33.

Jahrig D, Jahrig K, Stiete S, Beyersdorff E, Poser H, Hopp H. Neonatal jaundice in infants of diabetic mothers. Acta Pediatr Scand. 1989;(Suppl 360):101-7.

Cloherty PJ. Manual of neonatal care. In: Cloherty PJ, eds. A Book. 7th ed. North America: LWW; 2012: 11-22, 297, 303, 572.

Sann L. Neonatal hypoglycemia. Biol Neonate. 1990;58:16-21.

Lilien LD, Pildes RS, Srinivasan G. Treatment of neonatal hypoglycemia with minibolus and IV glucose infusion. J Pediatr. 1980;97:295-8.

Lemons JA, Vargas P, Delaney JJ. Infants of diabetic mothers: review of 225 cases. Obstet Gyneacol. 1981;57(2):187-92.

Alam M, Raza SJ, Sherali AR, Akhtar AS. Neonatal complications in Infants born to diabetic mothers. J Coll Physicians Surg Pak. 2006;16(3):212-5.

Deorari AK, Kabra SK, Paul VK Singh M. Perinatal outcome of infants born to diabetic mothers. Indian Pediatr. 1991;28:1271-5.

Miodovnik M, Mimouni F, Dignon PS, Berk MA, Ballard JL, Siddiqi TA, et al. Major malformations in infants of IDDM women - vasculopathy & early first trimester poor glycemic control. Diabetes Care. 1988;11:713-8.