Neonatal Outcome of Diabetic Pregnancy

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. Maternal 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.