78 A Prospective Echocardiography Evaluation in Infants of Diabetic Mothers During the First Year of Life.

Abstract

Introduction. The obstetricians attitudes towards caesarean delivery at the threshold of viability were explored in a European project (EUROBS) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the UK.Methods. In each country, NICU-associated obstetrical units were selected through census or random sampling. An anonymous self-administered questionnaire explored the obstetricians attitudes regarding the lowest gestational age at which they would perform a caesarean delivery in case of acute foetal distress of a single, non-malformed and normally grown fetus given that: a) parents want everything possible done to save the baby; b) parents favour non-aggressive management for fear of disability; and c) the obstetrician him/herself is one of the parents. Data collection took place in [2001][2002]; 105 units and 1530 obstetricians participated (response rates 70% and 77% respectively).Results. At 24 weeks of gestational age, 71% of the German, 52% of the Swedish, and 27% of the Italian and British obstetricians would perform a caesarean delivery given parental agreement, compared with only 17% of the French, 14% of the Spanish, and less than 1% of the Dutch ones. The intervention would be postponed by an average of 3.8 days (95% CI 2.9 -4.7) in case of parental opposition to active management, and by 5.7 days (95% CI 4.1-7.3) if the obstetrician was one of the parents. Other factors significantly associated with a more advanced caesarean section threshold in a multivariate model were older age, being a woman, muslim and oriental religion, more pessimistic beliefs regarding neonatal prognosis, and consultation with neonatologist.Conclusions. The lowest gestational age at which obstetricians would perform a caesarean delivery for fetal indication only varies according to country, parental views, and personal physician characteristics and beliefs. These findings have implications for neonatologists subsequent actions, and for the international comparison of perinatal statistics.

Is the child at risk? Cardiovascular remodelling in children born to diabetic mothers

“…Changes associated with hypertrophic cardiomyopathy (such as thickened ventricular septum and/or free walls) are known to resolve in infants of diabetic mothers within the first few months of life. 20 This finding may be the result of a transient hyperglycaemic insult in utero that may cause hyperplasia and hypertrophy of myocardial cells, which is resolved in early life, 9,21 but there is lack of literature looking at cardiac morphology in older children. Our study adds to the evidence that cardiac morphological differences were not seen in appropriate-for-gestational-age children aged 2−5 years with similar exposure as these fetuses were likely exposed to a controlled hyperglycaemic state.…”