A study of clinical, metabolic and hematological profile in infants of diabetic mothers

Abstract

Background:Diabetes has long been associated with maternal and perinatal mobidity and mortality. Infants of diabetic mothers (IDMs) have higher risks for serious problems during pregnancy, delivery and early neonatal period. Abnormal fetal metabolism during pregnancy which is complicated by maternal diabetes mellitus results in multiple neonatal sequelae. Objective: To study the clinical, metabolic and hematological profile in infants of diabetic mothers and to compare the neonatal outcome in gestational and pregestational (overt) diabetic mothers. Methods: 69 neonates born to diabetic mothers were enrolled in the study. Gestational age, birth weight, relevant perinatal history and examination findings were recorded. Blood samples were collected to perform relevant biochemical tests and managed as per unit protocol. Echocardiography and ultrasound abdomen was done routinely in all neonates. Results: Of the 69 neonates, 71.01% (49/69) were born to mothers with gestational diabetes mellitus (GDM), while the remaining 28.99% (20/69) were born to mothers with pregestational (overt) diabetes mellitus (PGDM). 53.63% (37/69) of mothers had poor glycemic control. Most of the neonates (73.91% - 51/69) were delivered by cesarean section. 88.40% (61/69) of the babies were born at term. Majority of them (85.50% - 59/69) were appropriate for gestational age with mean birth weight of 3.06±0.82kgs. Hypoglycemia was the most common metabolic abnormality seen in 73.91% (51/69) of neonates. Polycythemia was seen in 60.80% (42/69) of neonates. Congenital malformations were seen in 17.40% (12/69) of neonates, of which most of them had congenital heart disease. 11.60% (8/69) of the babies had suffered birth injuries. 5.80% (4/69) of neonates died in the early neonatal period. Occurrence of hypoglycemia, polycythemia, hyperbilirubinemia, congenital anomalies and birth injuries were significantly higher in infants born to mothers with GDM, whereas hypocalcemia and hypomagnesemia were significantly higher in infants of mothers with PGDM. Conclusions: Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia and polycythemia remain the most common biochemical and hematological abnormality respectively. Congenital heart disease forms a major proportion of the congenital anomalies seen in IDMs. Mortality rate is higher in infants born to mothers with GDM.

Metabolic and Haematological Profile of Infants Born to Gestational and Pregestational Diabetic Mothers

“…In the present study, incidence of polycythemia and hyperbilirubinemia was significantly higher in IGDMs. Similar observation was seen in the studies conducted by Mohsin et al 20 But these findings are contrast to the studies done by Deorari AK et al and Firouzeh N et al; they did not find any statistically significant difference between the two groups. 25,26 Conclusion: Infants born to diabetic mothers remain at high risk for development of metabolic and haematological complications.…”

“…The incidence of hypoglycaemia in infants of PGDM ranges from 14.5% to 42%and in case of infants of gestational diabetic mother is 12.9% to 59.4%. [18][19][20] If mothers with PGDM had good glycemic control as they were diagnosed before pregnancy and were advised regarding the complications during pregnancy which probably prevent fetal hyperinsulinism and significant hypoglycemia.…”

“…The incidence of hypocalcemia in infants of PGDM ranges from 24% to 25% and in case of gestational diabetic mothers is 6.7% to 17.4%. 19,20 The incidence of polycythaemia in infants of GDMs ranges from 25.8% to 49.2% as compared to infants of PGDMs is 9.5 to 11.5%. 18,20 The incidence of hyperbilirubinemia in infants of PGDMs ranges from 29% to 33.3% and in case of gestational diabetic mothers is 31.8% to 49.3%.…”

“…19,20 The incidence of polycythaemia in infants of GDMs ranges from 25.8% to 49.2% as compared to infants of PGDMs is 9.5 to 11.5%. 18,20 The incidence of hyperbilirubinemia in infants of PGDMs ranges from 29% to 33.3% and in case of gestational diabetic mothers is 31.8% to 49.3%. 19,20 Worldwide several studies done over the infants of diabetic mothers to see the metabolic and haematological profile, but there is scarcity of data regarding these profiles in infant of GDM and PGDM diabetic mothers in Bangladesh.…”

“…18,20 The incidence of hyperbilirubinemia in infants of PGDMs ranges from 29% to 33.3% and in case of gestational diabetic mothers is 31.8% to 49.3%. 19,20 Worldwide several studies done over the infants of diabetic mothers to see the metabolic and haematological profile, but there is scarcity of data regarding these profiles in infant of GDM and PGDM diabetic mothers in Bangladesh. The present study focuses on the consequence of neonates born to diabetic mothers with special reference to their metabolic and hematological profile and to compare the profile between the two groups (GDM & PGDM) which will help to reduce neonatal mortality & morbidity.…”