Clinical and biochemical profile of babies born to mothers with gestational diabetes mellitus

Abstract

Background: Diabetes is one of the most common endocrine disorder affecting women during pregnancy. The incidence of pregestational and gestational diabetes is increasing in India. Gestational diabetes mellitus (GDM) can be a predictor of future overt diabetes in mother and a predictor for metabolic syndrome in the baby in future. Diabetic control is key factor in determining fetal and maternal outcome during pregnancy. As gestational diabetes has got a very significant impact on the mother and the baby, we aim at studying the clinical and biochemical profile of babies born to mothers with GDM. The data indicates that perinatal morbidity and mortality in the offspring of women with diabetes mellitus have improved with dietary management and insulin therapy. However, complication may still arise in the infant including hypoglycemia, hypocalcemia, hypomagnesemia, perinatal asphyxia, respiratory distress syndrome, cardiac abnormalities, polycythemia, hyperbilirubinemia, macrosomia, birth injuries, and congenital malformation. Aims and Objectives: The aim of the study was to study the clinical and biochemical profile of babies born to mothers with GDM. Materials and Methods: This study is a hospital-based, retrospective, and observational study which includes all the babies born to mothers with GDM, in Sree Utradam Thirunal Academy of Medical Sciences during the 12-month period from November 1, 2014, to October 31, 2015. Results: Most of our mothers with GDM were of the age group 20–30 years, were from below poverty line families, and were mostly from urban areas. Most of our mothers were primigravida. The majority had controlled blood sugar. GDM was most frequently detected in the second trimester (64.9%). In terms of treatment, a significant number of GDM patients are with diet (44.6%), while 39.2% required insulin. The most common mode of delivery included vaginal (58.1%) followed by lower segment caesarean section (LSCS). The most common indications for LSCS were a previous cesarean section (12.2%) and failed induction (9.5%). Most of the babies born to diabetic mothers in our study cried immediately after birth and did not need any resuscitation. A significant proportion of babies born to diabetic mothers experienced hypoglycemia, with 4.1% showing symptomatic signs. A substantial number had birth weights within the normal range. The majority had favorable 1 min and 5 min APGAR scores, and most did not have congenital anomalies. About 55.4% were exclusively breastfed, while 43.2% received a combination of breast milk and formula. Majority had serum bilirubin levels below 11 mg/dL (55.4%). In terms of thyroid function (TSH), the majority of babies had TSH levels below 16 (89.2%). Most babies had hemoglobin levels below 22 g/dL (97.3%), and their serum calcium levels (Calcium) were mostly >9 mg/dL (56.8%). Conclusion: Pre-pregnancy counseling and screening for pre-GDM help women to maintain optimal blood sugar levels. This helps in better antenatal, intrapartum, and postnatal outcome. Babies of diabetic mothers with optimal blood sugar control have better obstetric and neonatal outcome. Complications are less among these patients.