Infants Of Non-diabetic Mothers Research Articles

Echocardiographic Evaluation of Infants Born to Mothers with Gestational Diabetes Mellitus: A Cross-sectional Analytical Study

Introduction: Gestational Diabetes Mellitus (GDM) is a chronic and progressive disease characterised by changes in the metabolism of carbohydrates, lipids, and proteins, leading to glucose intolerance. The foetal heart in GDM is affected throughout the gestational period, which may result in hyperplasia and hypertrophy of myocardial cells. Aim: To determine the cardiac function and structural changes in infants of gestational diabetic mothers using Dopplerechocardiographic data. Materials and Methods: A cross-sectional analytical study was conducted on 30 infants of mothers with GDM and 30 infants of non diabetic mothers at the Department of Physiology, R.G. Kar Medical College and Hospital, in collaboration with the Departments of Paediatric Medicine and Cardiology from January 2023 to August 2023. Neonatal screening echocardiography was performed by a cardiologist using a Philips Echocardiograph machine, Model: EPIQ 7C, Software Version: 4.0.2, with a linear convex probe of S8-3 MHz frequency to assess cardiac structure and function using 2D, M mode, and Conventional Doppler. The parameters studied included aortic root diameter (mm), left atrial diameter (mm), Interventricular Septal (IVS) in diastole (mm), left ventricular posterior wall thickness in diastole (mm), left ventricular internal diameter in diastole (mm), left ventricular internal diameter in end systole (mm), left ventricular fractional shortening (%), and left ventricular ejection fraction (%). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version-20.0 with an Independent Student’s t-test. Results: The mean gestational age for the cases was 38.50±2.57 weeks and 39.30±1.97 weeks for controls. The mean maternal age for cases was 25±4.37 years and for controls was 27±5.03 years. The left atrial diameter in cases (12.83±2.14 mm) was significantly smaller than that of the control (14.20±0.55 mm). The left ventricular posterior wall diameter in diastole was significantly increased in cases (4.53±0.50 mm) compared to controls (3.87±0.35 mm). Significant differences were observed in the interventricular septum in diastole {cases: 4.73±0.45 mm, control: 3.97±0.32 mm} and in the left ventricular internal diameter in end systole {cases: 12.30±1.84 mm, control: 13.83±1.02 mm} between cases and controls. Aortic root diameter was increased in 13.3% of cases. The percentage of left ventricular fractional shortening (cases: 35.47±3.74 %, Control: 38.53±2.43 %), Left Ventricular Ejection fraction (cases: 67.63±4.52 %, control: 72.17±4.89 %) were significantly decreased in cases compared to control. Conclusion: The present study demonstrated the development of ventricular hypertrophy and compromised myocardial contractility in infants of diabetic mothers.

Glucose and Calcium Profile in Infants of Diabetic and Nondiabetic mothers- A Comparative Study

Background: Diabetes is one of the commonest and most important metabolic disorders that affect the health of pregnant women and infants. Diabetic mellitus is one of the most common metabolic disorders complicating pregnancy. The neonatal mortality rate is over five times that of nondiabetic mothers and is higher irrespective of birth weight and gestational age. There has been significant improvement in the outcome of diabetic pregnancies largely due to better metabolic control before and during pregnancy and vigorous neonatal care in developed countries. The management in our country still poses a major challenge.
 Methods: This case-control study was designed to find out the association between an infant's hypoglycemia and hypocalcemia with maternal diabetes. For the research, a total of 300 neonates were selected, where cases were selected from infants of diabetic mothers, and the control group was selected from infants of nondiabetic mothers. The mothers were interviewed by specific questionnaire, selected neonates were examined, and some biochemical tests were done to find out the outcome.
 Results: The study included 300 neonates of diabetic and nondiabetic mothers. The mean age of the Mothers of these neonates was 25.36 (SD±5.50) years. Among diabetic mothers 115(76%) had GDM and 36(23.8%) had PGDM. It is revealed that 83 (55%) of 150 mothers took insulin as the treatment. Hypoglycemia in neonates of diabetic and nondiabetic mothers right after birth at their first ½ hour of age 111 (37%). Hypoglycemia was found in 94 (62.3%) of infants of the diabetic mother than only 17(11.4%) in infants of the nondiabetic mother. Where the p-value is <0.001, which explains developing hypoglycemia in the infant of a diabetic mother is higher than nondiabetic mother. The number of hypocalcemic infants of the diabetic mother was 34 (22.5%), while hypocalcemic infants of the nondiabetic mother were only 8 (5.4%), which is significantly (p-value <0.001) lower.
 Conclusions: Hypoglycemia and hypocalcemia in infants were directly associated with the presence of diabetes during pregnancy. In spite of intensive management of maternal diabetes, the infants of diabetic mothers continue to be a high-risk population. Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia remains the most common biochemical abnormality, followed by hypocalcemia. Therefore, this pregnancy complication will require increased re- sources to manage appropriate glycemic control during pregnancy and reduce adverse perinatal outcomes.
 TAJ 2022; 35: No-2: 93-102

Prevalence of congenital heart defects in infants of diabetic mothers in Aseer region, Southwestern, Saudi Arabia

Background: Maternal diabetes mellitus is a risk factor for adverse maternal and fetal outcomes, including anatomical malformations such as congenital heart defects (CHD). Objectives: To determine the prevalence of CHD in babies born to mothers with pre-existing or gestational diabetes. Patients and Methods: A retrospective study of all births of type 1, type 2 diabetic mothers, gestational diabetic mothers, and non-diabetic mothers admitted to the newborn nursery and the neonatal intensive care unit between July 2011 and June 2022 was performed. Results: A total of 2079 mothers and their offspring were enrolled in the study. Of 2079 mothers 1397 (67.2%) were non-diabetic and 682 (32.8%) were diabetic. In terms of diabetic status, the incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers (p

Maternal diabetes and the role of neonatal reticulocyte hemoglobin content as a biomarker of iron status in the perinatal period.

We aimed to evaluate the effects of maternal diabetes on neonatal iron status, measuring erythrocyte indices including hemoglobin, hematocrit, reticulocytes, mean corpuscular volume (MCV), percent (%) hypochromia, ferritin, and additionally mean reticulocyte hemoglobin content (MCHr) as an early marker of iron deficiency, and examine the association between neonatal MCHr, red cell indices, and ferritin. We conducted a hospital-based prospective cohort study in a tertiary neonatal unit of a University Hospital from 2018 to 2020. We enrolled 126 maternal-infant pairs of mothers whose pregnancy was associated with diabetes and 74 maternal-infant pairs from uncomplicated pregnancies. Erythrocyte indices were analyzed within the first twelve hours after birth. Erythrocyte parameters were compared between infants of the diabetes and the non-diabetic group. We examined the correlation of the neonatal MCHr with perinatal characteristics, including gestation, birth weight, maternal body mass index, the erythrocytic indices, maternal diabetes, maternal obesity, prematurity, small-for-gestational-age status, maternal preeclampsia, and maternal anemia. Finally, we evaluated the discordance between neonatal MCHr and neonatal ferritin. Infants of the diabetes group had a significantly lower MCHr (32.6 pg vs. 34.2 pg, p=0.003) compared with infants of uncomplicated pregnancies. Neonatal MCHr was significantly correlated with maternal hypochromia (r=-0.237, p=0.004) and neonatal MCV (r=0.674, p<0.001). Neonatal MCHr was significantly associated with maternal diabetes [standardized coefficients 0.21, 95% confidence interval (CI) 0.05-0.58, p=0.003) and maternal preeclampsia (standardized coefficients 0.17, 95% CI 0.02-0.92, p=0.019), after adjusting for maternal anemia, maternal obesity, prematurity, and small-for-gestational-age status. Those results were consistent also when analyzing maternal-infant pairs with pre-existing diabetes, and maternal-infant pairs with gestational diabetes. There was significant discordance between neonatal MCHr and neonatal ferritin (p=0.001). MCHr was significantly lower in infants of mothers whose pregnancy was associated with diabetes compared with infants of non-diabetic mothers and correlated with neonatal and maternal red cell indices of iron deficiency. Since there was significant discordance between neonatal MCHr and ferritin during the first postnatal day, it is possible that MCHr could be used as a screening test for iron deficiency, especially in infants.

Epicardial fat thickness in infants of diabetic mothers.

Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p < 0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p < 0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p < 0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = -0.376; p = 0.0001). The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.

Serum ferritin and red blood cell indices in infants of diabetic mothers

Background: Fetal iron stores are affected by maternal diabetes and it is lower at birth in infants of diabetic mothers (IDMs). Risks for developing iron deficiency and neurocognitive impairment are reported in IDMs. This study was done to assess serum ferritin and red cell indices in IDMs and to compare the values with infants born to mothers without diabetes mellitus.&#x0D; Methods: This cross-sectional study was carried out at BIRDEM General Hospital from March to October, 2018. Total 102 full term neonates were included in this study. Among them 70 neonates were IDMs and 32 were infants born to mother without diabetes mellitus. Serum ferritin and red cell indices like hemoglobin (Hb), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW) were measured within 48 hours of birth. Comparison of red cell indices and serum ferritin level were done between IDMs and infants of non-diabetes mothers. Statistical analysis was performed by using Epi info, and p value of &lt;0.05 was considered statistically significant.&#x0D; Results: IDMs had significantly higher value of Hb% (19.00 vs 17.47 g/dl), PCV (57.60 vs 52.67 %) and RDW (20.09 vs17.77 %) than infant of non-diabetic mother (p &lt;0.05). But there was no significant difference regarding the values of MCV, MCH and MCHC between IDMs and infants of non-diabetic mothers (p &gt;0.05). Serum ferritin level was found significantly low in IDMs (94.51 vs 307.50 ng/ml, p &lt;0.001).&#x0D; Conclusion: Iron stores of IDMs were found significantly lower at birth despite higher hemoglobin content, as indicated by lower serum ferritin level. Further studies and long-term follow up are needed to determine whether these infants are at risk for developing iron deficiency anemia or iron-deficient neurocognitive disorder&#x0D; Birdem Med J 2020; 10(3): 182-186

Assessment of cardiac diastolic function in infants of diabetic mothers using tissue Doppler echocardiography

BackgroundLimited number of studies evaluated cardiac diastolic function in infants of diabetic mothers using tissue Doppler imaging. The aim of this study was to evaluate diastolic parameters in full-term infants of diabetic mothers compared to healthy full-term neonates using both conventional echocardiography and tissue Doppler imaging. This study is a comparative study. Fifty consecutive infants of diabetic mothers (cases) in the first 3 days of life: 25 neonates with poor maternal glycemic control (Hemoglobin A1c > 7.5 g/dl) and 25 neonates with good maternal glycemic control (Hemoglobin A1c ≤ 7.5 g/dl). Thirty healthy full-term infants of non-diabetic mothers with age and sex matching were included as controls. The studied groups were assessed by conventional pulsed wave Doppler and tissue Doppler imaging.ResultsAmong pulsed wave Doppler parameters, cases had lower values than controls as regards mitral E velocity, mitral E/A ratio, tricuspid E velocity, and tricuspid E/A ratio, while neonates with poor maternal glycemic control had lower values than those with good maternal glycemic control as regards mitral E/A ratio, tricuspid E velocity, and tricuspid E/A ratio as well as higher mitral A velocity (denoting more diastolic dysfunction). Similarly, among tissue Doppler parameters, cases had lower values than controls as regards septal E' velocity, E'/A' ratio, left ventricular E' velocity, E'/A' ratio, and right ventricular E' velocity as well as higher septal A' velocity, left ventricular A' velocity, and right ventricular A' velocity, while neonates with poor maternal glycemic control had lower values than those with good maternal glycemic control as regards septal E' velocity, E'/A' ratio, left ventricular E' velocity, E'/A' ratio, and right ventricular E' velocity, as well as higher left ventricular A' velocity (denoting more diastolic dysfunction). Tissue Doppler was able to detect higher number of neonates with left ventricular diastolic dysfunction than conventional pulsed wave Doppler.ConclusionsTissue Doppler imaging was found to be able to detect diastolic dysfunction early in infants of diabetic mothers specifically as regards the left ventricle. Tissue Doppler imaging should be considered an integral part of cardiac function assessment in infants of diabetic mothers.

Cardiovascular malformations in infants of diabetic mothers: a retrospective study

Background: Despite improvements in medical care provided during pregnancy to diabetic mothers, the cardiac complications in their infants are still more frequent than in infants of general population.Methods: A retrospective case-control study was performed between the years 2017-2018 on two groups of newborns, recording details of outcome of live born babies born to diabetic and non-diabetic mothers.Results: Data were extracted from medical records, and the descriptive and analytical statistics of this information was duly applied. in a total of 50 studied infants, 40 cases (80%) of cardiovascular anomalies have been diagnosed. Most of the cardiac anomaly was hypertrophic cardiomyopathy. The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers (P=0.002). The type of maternal diabetes (diabetes mellitus, overt or gestational diabetes) did not bring about any significant difference in the incidence of cardiac malformations in infants (P=0.406).Conclusions: The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers. Many of the infants were asymptomatic and therefore clinical examination and follow up in infants of diabetic mothers is important.

The Impact Of Maternal Diabetes On Newborns Admitted To Neonatal Care Unit Of Maternity And Children Teaching Hospital in Al-Diwaniya city

Diabetes has long been associated with increased perinatal morbidity and mortality It's one of the commonest and important metabolic disorder that affect the health of both mother and infant .Patient and methodsTotal number of patient involved were one hundred eighty four , Ninety-nine of them were infants of diabetic mother , they were admitted to the NCU of AL-Diwaniya teaching hospital from the 1st of October 2013 to the end of march 2014. Eight-five neonates were also enrolled in this study as control (infants of non-diabetic mothers)ObjectiveTo determine the morbidities and mortality among infants of diabetic mother and to compare it to that of control.ResultThere is higher morbidity and mortality amongst IDM . Hypoglycemia was the commonest morbidity recorded (31.3%) followed by hyper bilirubinemia (13.3%) and respiratory distress (12.1%). More prolonged hospitalization had been seen amongst IDM.ConclusionThere is higher frequency of morbidity and mortality amongst IDM , hence ascertain a good glycemic control to diabetic mother and providing optimal neonatal care is valuable to decrease these complications.

Incidence and Glycemic Status of Infants of Diabetic Mothers among 189 Hospitalized Low Birth Weight Babies

Background: The prevalence of gestational diabetes mellitus (GDM) is 9.7% in Bangladesh. Infants of diabetic mothers (IDM) have a significant chance to develop various complications including glucose instability.Objective: To find out the incidence of IDM among low birth weight (LBW) babies and their relation with blood glucose level during 1st 48 hours of life.Materials and method: This cross sectional study was conducted from July 2012 to June 2013 on 189 LBW babies with birth weight &lt;2500 gram up to 1000 gram admitted within 3 hours of life in the neonatal unit of Jalalabad Ragib Rabeya Medical College Hospital, Sylhet, Bangladesh. Detailed history including maternal history of GDM was taken. Blood glucose level was done during admission and at 3 to &lt;6 hours of age, 6 to &lt;24 hours of age and 24-48 hours of age.Results: Among 189 cases, male baby were 136 and female baby were 53. Preterm babies were 49.2% and term babies were 50.8%. Most of the newborn babies were delivered at hospital (78.3%) and by vaginal delivery (75.1%). Among LBW babies, 5% were infants of diabetic mothers. Hypoglycemia was present in 33.3% of infants of diabetic mothers which was significantly higher than infants of non-diabetic mothers (5.6%) within 3 hours of age.Conclusion: Infants of diabetic mothers may present as LBW and may be delivered prematurely and they have high incidence of hypoglycemia during early periods of life.Delta Med Col J. Jan 2017 5(1): 4-8

Abstract 16893: Subclinical Decrease in Myocardial Function in Asymptomatic Infants of Diabetic Mothers: A Tissue Doppler Study

Introduction: Infants of diabetic mothers (IDMs) with cardiac hypertrophy are recognized to have impaired myocardial performance, but less is known about ventricular function in those without hypertrophy. We hypothesized that, in asymptomatic newborns with normal echocardiograms, tissue Doppler imaging (TDI) indices of cardiac function would be decreased in IDMs compared to controls. Methods: This retrospective case-control study involved IDMs ≥ 36 weeks gestational age, at 0 to 7 days of life. Subjects with cardiorespiratory symptoms, ventricular hypertrophy or dysfunction, or any echocardiographic abnormality (other than a patent ductus arteriosus before 4 days of life, or a patent foramen ovale) were excluded. Each subject was matched with 3 controls (healthy infants of non-diabetic mothers) by age (0-24, 25-48, 49-72, or &gt; 72 hours of life), birth weight (± 0.5 kg), body surface area (± 0.03 m 2 ), and by the ultrasound system utilized. TDI systolic (S’), early diastolic (E’), and late diastolic (A’) velocities were measured at the mitral valve (MV) annulus, basal ventricular septum, and tricuspid valve (TV) annulus, and were averaged from 3 consecutive cardiac cycles. Early Doppler inflow velocity to E’ ratios (E/E’) were calculated. Results: Seventy cases (39 male) were identified: first 24 hours (h) of life (n=18), 25-48 h (n=22), 49-72 h (n=14), and &gt; 72 h (n=16). Maternal diabetes was gestational in 60 cases, and pre-existing in 10. Median gestational age was 38 6/7 weeks (range 36-41 2/7), median birth weight 3.65 kg (2.56-5.38), and median BSA 0.22 m 2 (0.17-0.27). Ultrasound system vendors included Siemens ® (n=46), Philips ® (n=23), and General Electric ® (n=1). Cases were matched with 210 controls. IDMs had significantly lower S’ ( p ≤ 0.05) and E’ ( p ≤ 0.01) velocities, and significantly higher E/E’ ratios ( p ≤ 0.01) at the MV, basal septum, and TV compared to controls (Wilcoxon rank-sum test). There were no significant differences in A’ values between groups. Intraclass correlation demonstrated 84-99% interobserver and 98-99% intraobserver reliability. Conclusions: In asymptomatic newborn IDMs without cardiac hypertrophy, TDI suggests a subclinical decrease in systolic and diastolic myocardial function compared to controls.

Comparison of neonatal outcomes in macrosomic infants of diabetic and non-diabetic mothers.

To compare the neonatal outcomes in macrosomic term infants of diabetic mothers and non-diabetic mothers. This is a retrospective survey of all live-born term singletons with a birth weight ≥4000 g, admitted at Tianjin Medical University General Hospital between 2010 and 2013. Data collected for the mothers included age, parity, gestational age, method of glycemic control and mode of delivery. Data for the infants included sex, birth weight, birth length, duration of hospital stay and laboratory tests. Outcomes were compared between infants of diabetic mothers (IDMs) and infants of non-diabetic mothers (Non-IDMs). All data were analyzed using Statistical Package for Social Sciences (SPSS) 17.0. One hundred and eleven infant-mother pairs met the inclusion criteria. Fifty-seven were IDMs while 54 were non-IDMs. Seven (12.28%) of the IDMs were delivered vaginally while 50 (87.72%) were delivered via Caesarian section (CS). Seventeen (31.48%) of the non-IDMs were delivered vaginally while 37 (68.51%) were delivered by CS. Respiratory distress was the most common morbidity affecting 52.6% of the IDMs and 40.7% of the non-IDMs. Hyperbilirubinemia was observed in 49.1% of the IDMs and 14.8% of the non-IDMs. Hypoglycemia affected 38.6% of the IDMs and 7.4% of the non-IDMs. Cardiac enzymes were higher in IDMs than in non-IDMs. On average, IDMs had a longer duration of hospital stay. Macrosomic IDMs in comparison to macrosomic non-IDMs are at an increased risk for adverse neonatal outcomes.

Short Term Outcome Of Macrosomic Neonates Of Diabetic &amp; Non-Diabetic Mothers

Background: Big birth weight is one of the important factors affecting the perinatal morbidity &amp; mortality. It may result in an irreversible squeal because of birth trauma &amp; fetal asphyxia.Patients &amp; Methods: This is a prospective study of 50 singleton macrosomic newborns weighting 4000 g &amp; more aged 1-3 days admitted in the neonatal care unit of Children Welfare Teaching Hospital &amp; Baghdad Teaching Hospital during a 6 months period from 1st of March to 1st of September 2010. The maternal &amp; neonatal records were reviewed &amp; infant morbidities including hypoglycemia, respiratory distress, feeding intolerance, birth injury &amp; associated anomalies were discussed. All the infants were followed until they were discharged from the hospital.Objectives: to compare the short term outcomes of macrosomic infants born to diabetic and non-diabetic mothers.&#x0D; Results: Infants of diabetic mothers (52%) were more likely to develop neonatal morbidity compared to infants of non diabetic mothers (48%), these include hypoglycemia (76.9% vs. 8.3%), Respiratory distress (61.5% vs. 37.5%), and birth injury (7.7% vs. 4.2%) &amp; nearly equal incidence of feeding intolerance (11.5% vs. 12.5%). Associated anomalies especially congenital heart disease (10%) found in infant of diabetic mothers only.&#x0D; Conclusions: Most of birth weight variation remains unexplained &amp; most non-IDM macrosomic infants do not have identifiable risk factors. Macrosomia is generally associated with neonatal morbidity &amp; neonatal injury. The potential dangers of birth injury in vaginal delivery have increased the rates of cesarean section to (68%). Infants of diabetic mothers have a higher rate of neonatal morbidity overall including hypoglycemia, respiratory distress, birth injury &amp; congenital heart disease.

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Echocardiographic study of infants of diabetic mothers versus macrosomic infants of non-diabetic mothers - an Egyptian experience

Impact of Maternal Diabetes Mellitus on Mortality and Morbidity of Preterm Infants (24–33 Weeks' Gestation)

Data from several epidemiologic studies have demonstrated that diabetes mellitus (DM) is a risk factor for respiratory distress syndrome (RDS). Two previous studies have shown that with modern management and adequate glycemic control, the risk of RDS in near-term and term newborns of mothers with DM is not increased beyond that observed in a nondiabetic control population. Both these studies were limited by small numbers of preterm infants, and it remains unclear whether preterm infants of diabetic mothers are at increased risk for RDS. This study tested the hypothesis that maternal DM among a population of very low birth weight (VLBW) infants is associated with increased risk for mortality, RDS, and major complications of prematurity. Prospective data collected between 1995 and 2007 by the Israel Neonatal Network on VLBW Infants were analyzed with multivariable logistic regression analysis to assess the independent effect of maternal DM status (pregestational and gestational) on infant mortality, RDS, and other complications of prematurity. Because rates of major neonatal complications were very similar among infants of mothers with pregestational (n = 120) and gestational (n = 825) diabetes, their data were pooled. There was a greater likelihood that mothers with DM had received a complete course of prenatal steroids than nondiabetic mothers. Both the gestational age and birth weight were slightly increased in infants of diabetic mothers compared with infants of nondiabetic mothers. A nearly identical distribution of birth weight percentiles and mean birth weight z scores were found in both groups. Apgar scores were significantly higher among infants of diabetic mothers. With multivariate analysis, no significant differences between the 2 groups occurred in delivery room mortality, RDS, and other major complications of prematurity. Rates of total mortality and bronchopulmonary dysplasia were significantly higher among infants of nondiabetic mothers. No significant increases occurred in infants of diabetic mothers in the adjusted odds ratios for mortality, RDS, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and patent ductus arteriosus. These findings indicate that with modern management and adequate prenatal care, VLBW infants of diabetic mothers are at no higher risk of developing RDS or other major complications of prematurity than infants of nondiabetic mothers.

Cardiac troponin I levels and its relation to echocardiographic findings in infants of diabetic mothers

BackgroundCardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms responsible for it are unknown. The aim of this study was to compare between infants of diabetic mothers (IDM) and infants of non- diabetic mothers (INDM) as regards cardiac troponin I (cTnI) levels (as a marker of cardiac dysfunction) and to examine the relationship between this marker and neonatal echocardiographic changes (cardiac structure and function).MethodsA prospective, comparative study included eighty full term neonates during the first three days of life, during the period from April 2008 to June 2011. They were divided into 2 groups, group I: included 40 infants of diabetic mothers (IDMs)and group II: included 40 infants of non diabetic healthy mothers as a control group.Results37.5% of the IDMs were large for gestational age and demonstrated a significantly lower blood glucose level than the control group (34.6 ± 11.3mg/dl Vs 77.2 ± 19.8 mg/dl respectively) , respiratory distress and cyanosis were the presenting signs in 67.5% of IDMs. Cardiac TnI on the second day of life increased significantly in infants of diabetic mothers in comparison to INDM (p < 0.006) . IDMs had a significant increase in left atrial thickness ( 11.5 ± 1.8mm in IDM Vs 10.5 ± 0.9mm in INDM P < 0.002*) and a significant increase in septal thickness (5.0 ± 1.2mm in IDM Vs 4.0 ± 0.5mm in INDM P < 0.001*). CTnI correlated positively with interventricular septum thickness (P-value = 0.002*). Cardiac TnI was significantly increased in IDMs with respiratory distress (P –value < 0.05).ConclusionsThis study demonstrated a highly significant positive correlation between cTnI level on the second day of life and the left ventricular end diastolic diameter (LVED) and interventricular septum diameter (IVSD). Cardiac troponin I (cTnI) is a useful biochemical marker for monitoring myocardial injury in infants of diabetic mothers. An elevated cTnI concentration in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction.

Decreased urine albumin:creatinine ratios in infants of diabetic mothers: does exposure to diabetic pregnancies alter fetal renal development?

Offspring of diabetic mothers experience an increased risk for type 2 diabetes but it is not known whether diabetic pregnancies also confer a higher inter-generational risk for diabetic complications. Because microalbuminuria is a sensitive indicator of glomerular damage, we compared the urine albumin:creatinine ratios (ACRs) between 65 infants of diabetic mothers (InfDM+) and 59 infants of non-diabetic mothers (InfDM-), and repeated the comparisons in 21 InfDM+ and 19 InfDM- when children were 5-19 months old. ACRs were higher among neonates compared with normal reference values for adults, but declined with increasing age. The only independent predictor of higher ACRs in a logistic regression model (⩾13 mg/mmol v. <13 mg/mmol) was the presence of delivery complications (odds ratio 2.95; P = 0.015). Neither high nor low birth weight was associated with higher neonatal ACRs. The most unique finding of the study was that InfDM+ had significantly lower ACRs than InfDM- [mean = 12.9 (median = 6.0) v. mean = 16.6 (median = 11.5), respectively at P = 0.05] even after adjusting for other variables using logistic regression (odds ratio 0.25; P = 0.001). In contrast, by 5-19 months, there was a trend toward higher ACRs among InfDM+ compared with InfDM- [mean = 6.3 mg/mmol (median = 1.9) v. mean = 3.0 mg/mmol (median = 2.5), respectively at P = 0.25]. Lower ACRs in InfDM+ may be due to developmental changes in fetal kidneys induced by hyperinsulinemia. Although the implications of this observation are unclear, it is possible that exposure to a diabetic intrauterine environment might influence the later risk for renal disease.

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus. This was a retrospective study of LGA infants of ≥36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006-2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student's t test were used for comparing variables. Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045). The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria

BackgroundInfants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital.MethodsThis was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0.ResultsSixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMsConclusionsThe incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs.Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality