Problems and Immediate Outcome of Infants of Diabetic Mothers

Abstract

Objective: The present study was undertaken to evaluate the problems and immediate outcome of infants of diabetic mothers (IDMs) in early neonatal period and to compare the results between infants of gestational and pregestational diabetic mothers. Design: A hospital based prospective study. Setting: The study was done in Chittagong Medical College Hospital, a tertiary hospital in Chittagong city. Method: Within one hour of delivery 52 infants of diabetic [pregastational & gestational] mothers consecutively admitted were enrolled in the study. Study period was January 2002 to August 2002. Results: Total number of IDMs were 52. Among them 31 were gestational and 21 were of pregestational diabetic mothers. Significant number 82.6% of IDMs were delivered by caesarean section. The mean birth weight of IDMs was significantly high (3212±563g), 21% of IDMs had birth weight>4000 g. Total 23% of the IDMs developed perinatal asphyxia. The 23% of IDMs developed hypoglycaemia. The incidence of hypoglycaemia was higher in infants of pregestational diabetic mothers as compared to that of gestational diabetic mothers (38.09% and 12.9% respectively), the difference was statistically significant (P<0.05).In majority (66%) of IDMs cases hypoglycaemia was symptomatic. Significant number (19.2%) of IDMs had hypocalcaemia. The incidence of polycythaemia was higher in infants of gestatational diabetic mothers(GDMs) as compared to infants of pregestational diabetic mothers (25.8% and 9.5% respectively), difference was statistically significant (P<0.001). 3(5.7%) out of 52 IDMs had congenital malformation (each one in number polydactyly, cleft palate & preauricular skin tag). Total death was 3 (5.7%) all of them died within 72 hours of birth. Causes of death 1 each number: perinatal asphyxia, respiratory distress syndrome and meconium aspiration syndrome. 11 IDM was macrosomic, among them 1 had birth injury ( Erb's palsy), hypoglycaemia and meconium aspiration syndrome and expired within first 24 hours of life. Conclusion: Among the important problems the present study revealed perinatal asphyxia, hypoglycaemia, hypocalcaemia, polycythaemia top the list. These babies should be delivered at hospitals where special neonatal care available for management of high risks babies to reduce the morbidity and mortality. Screening for GDMs should be performed in all pregnant women. All diabetic women should have planned pregnancy and proper antenatal care in order to maintain strict glycaemic control, to have a satisfactory outcome in infants of diabetic mothers. DOI: 10.3329/jbcps.v26i2.4183 J Bangladesh Coll Phys Surg 2008; 26: 62-72