Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During Gestation

L Milasinović ,Ivan Hrabovski,Mirjana Bogavac,Aleksandra Nikolić,Zorica Grujić

doi:10.2478/v10011-011-0042-2

Abstract

Biochemical and Physiological Characteristics of Neonates Born to Mothers with Diabetes During GestationThe aim of this study was to investigate how glucose homeostasis disorders influence biochemical homeostasis and fetal maturation. A prospective randomized study included 102 infants: 31 newborns of mothers with glucose homeostasis disorders (Group I) and 71 newborns of healthy mothers (Group II). In the pregnant women, the mean age, body weight and height, BMI, parity, duration of the disease and the mode of labor were estimated. The following procedures were performed in each newborn infant: physical examination, determination of Apgar score, measurements of birth weight and length, estimation of neurological status, clinical estimation of gestational age, ECG and ultrasonography of the brain, as well as the basic hematologic, biochemical and microbiological analyses. Newborn infants of diabetic pregnancies were small for gestational age and of high birth weight. The levels of Na+, K+and Cl-ions did not show significant differences between the investigated groups, whereas the levels of total Ca and Mg were significantly decreased (2.18±0.59 and 0.65±0.17 mmol/L) (p<0.001) in the investigated group relative to the control group (2.42±0.53 and 0.81±0.09 mmol/L). The newborn infants of diabetic pregnancies presented with significantly decreased values of phosphates, bicarbonates and pH, whereas the difference in total osmolality was not statistically significant. The level of glucose at birth in the infants of diabetic mothers was lower (2.91±0.51 mmol/L) (p<0.001) than in the infants of healthy pregnancies (3.94±0.29 mmol/L). Glycemia lower than 2 mmol/L was recorded in 6.5% of infants of the investigated group. The level of bilirubin was significantly increased (209.71±56.66 mmol/L) (p<0.001) in infants of diabetic mothers compared to those of the healthy ones (155.70±61.14 mmol/L), like the incidence of clinically manifested hyperbilirubinemia. Disorders of maternal glucose homeostasis cause biochemical disorders such as hypoglycemia, hypocalcemia, hyperbilirubinemia, hypomagne semia and are associated with impaired maturation and congenital malformations of the fetus.

Highlights

Today, 3–10% of pregnancies are affected by abnormal glucose regulation
The following procedures were performed in each newborn infant: physical examination, determination of Apgar score, measurements of birth weight and length, estimation of neurological status, clinical estimation of gestational age, ECG and ultrasonography of the brain, as well as the basic hematologic, biochemical and microbiological analyses
Newborn infants of diabetic pregnancies were small for gestational age and of high birth weight

Summary

Introduction

3–10% of pregnancies are affected by abnormal glucose regulation. Of these cases, 80% are related to gestational diabetes [1]. Fetal macrosomia is a consequence of the increased transfer of glucose, amino acids and fats through the fetoplacental membrane causing accelerated fetal growth [2]. It is defined by body weight above the 90th percentile on a standard growth curve (or body mass above 4500 g at term) [3, 4]. Small growth for gestational age occurs in pregnant women with chronic disorders of the blood vessels (vasculopathy), causing impaired nutrition of the fetus. It may occur in 20% of diabetic pregnancies. The newborns are hypotrophic, the birth weight is below the 10th percentile, the body mass 2500 g at term [5]

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