Non-diabetic Mothers Research Articles

Umbilical cord serum lipid profile of healthy neonates- A single center study from rural Tamil Nadu, India

Introduction and Aim: Umbilical cord lipid profile of neonates might help facilitate the assessment of risk of developing atherosclerotic disorders later in life. This study prospectively measures the cord blood lipid profile of healthy newborn at birth in medical college hospital in rural Tamil Nadu. Material sand Methods: Consecutive full-term newborns (n=105) were enrolled for this study. Umbilical cord blood sample was collected from placental end of the cord immediately after delivery of placenta of each baby and sent to the lab for lipid profile estimation. Results: In the newborns born to non-diabetic mothers, the mean cord blood total serum cholesterol (TC) was 73.31mg %, triglyceride (TGL) was 51.50mg %, high-density lipoproteins (HDL) 24.62 mg % and low-density lipoproteins (LDL) 51.73 mg %. Amongst newborns born to diabetic mothers, the mean TC was 113 mg % (P = 0.001), TGL 98.08mg% (P = 0.045) HDL 28.75 mg% (P = 0.130) LDL 73.48mg% (P = 0.007). Umbilical cord blood lipid profile did not show any significant sex-dependent difference. There was no statistical difference in lipid values between appropriate for gestational age (AGA)and small for gestational age (SGA). Birth weight had a negative correlation to cord blood serum TC and TGL values and showed no correlation to HDL and LDL values. Other parameters including head circumference, length of newborn at birth also showed no correlation to lipid profile. Total cholesterol, TGL and LDL were significantly elevated in newborns born to diabetic mothers. There was no statistical difference in cord blood lipid profile of babies born to mothers who were hypertensive. Conclusion: Infants born to diabetic mothers tend to have significantly elevated lipid values at birth and must be followed regularly later in life to diagnose and treat dyslipidemia and diabetes, to prevent onset of premature atherosclerotic coronary artery disease in this population.

Phytochemical and antidiabetic analysis of Curatella americana L. aqueous extract on the rat pregnancy

Ethnopharmacological relevanceCuratella americana L. is employed in popular medicine for treating diabetes. However, the understanding around its outcomes during pregnancy is unclear. Aim of the studyTo evaluate the phytochemical and hypoglycemic analysis of the C. americana extract and its maternal-fetal effect on diabetic rats. Materials and methodDiabetes was chemically induced 24 h after birth in Wistar female newborn rats. At adulthood, after diabetes status confirmation, the rats were mated and randomized into four experimental groups: Nondiabetic (Control): given water; Treated: given C. americana extract; Diabetic, and Treated Diabetic rats. The aqueous extract of C. americana leaves (300 mg/kg) was administered daily through oral route during pregnancy. Maternal toxicity and biochemical profile, reproductive outcomes, fetal development, and phenolic composition and biogenic amines in aqueous extract were analyzed. Results and conclusionPhytochemical analysis revealed that the main phenolic components are 3-hydroxytyrosol, kaempferol, and quercetin, while tryptophan and putrescine derivatives were identified as the dominant amines. C. americana extract treatment improved the lipid profile, although no effect on hyperglycemic control in diabetic rats was observed. Maternal diabetes or C. americana extract caused embryo losses confirmed by the lower number of pre-embryos in early pregnancy and higher percentage of abnormal morphologically pre-embryos. C. americana extract previously caused premature pre-embryo fixation before implantation window in nondiabetic and diabetic mothers and intrauterine growth restriction in the fetuses of treated nondiabetic dams, complicating the embryo fetal development. These findings reinforce the caution of indiscriminate use of medicinal plants, especially during pregnancy.

Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial

ObjectiveTo evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers.MethodsThis prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO3−), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), lactate, hemoglobin, hematocrit and glucose were compared among groups.ResultsIn neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO3− and BE and increased lactate (ICC versus LCC, HCO3−: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus − 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO2, pO2, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO3−: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus − 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM.ConclusionsLater cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM.Trial registrationClinicalTrials.gov: NCT04369313; date of registration: 30/04/2020 (retrospectively registered).

Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery: a national prevalence study of 11 provinces in Iran

SummaryBackgroundGestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy that significantly affects perinatal outcomes.ObjectiveThe aim of this study was to determine the prevalence of GDM and its relation with the incidence of stillbirth, preterm birth, macrosomia, abortion and cesarean section (C-section) delivery in pregnant women.MethodsThis cross-sectional study was conducted on 3675 pregnant women in 11 provinces across Iran. Cluster sampling was used to select samples from mothers covered by health plans in 11 provinces of Iran. Prevalence of adverse pregnancy outcomes, including preterm delivery, type of delivery, macrosomic preterm birth, miscarriage, stillbirth, infant death, and birth weight were measured, using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software.ResultsAbout four percent of Iranian pregnant women had GDM during pregnancy. Prevalence of C-section was significantly higher in diabetic women than in the non-diabetic ones (53.19 vs 46.81, respectively, P < 0.001). Abortion in diabetic mothers was more than twice that of the non-diabetic mothers (P < 0.001). In the adjusted logistic regression model, the odds of stillbirth in mothers with GDM were 1.8 (95% CI: 1.11, 2.91, P = 0.018) times higher than that of the non-diabetics. The odds of macrosomia in diabetic women was about 7 times higher than the non-diabetic women (95% CI: 2.81, 17.14, P < 0.001). The odds of GDM had an increasing trend according to the BMI (p < 0.001). The risk of GDM were significantly lower, according to the daily physical activity (PA) (p < 0.001).ConclusionThe GDM prevalence has a decreasing trend in Iran. It increases the adverse pregnancy outcomes such as stillbirth, neonatal deaths, macrosomia, preterm birth, abortion and C-section delivery. As, some of these consequences like macrosomia are not treatable, thus early prevention is very crucial.

Maternal diabetes and fetal cardiac output.

The intrauterine environment is a key determinant for long-term health outcomes. Adverse fetal environments, such as maternal diabetes, obesity and placental insufficiency are strongly associated with long-term health risks in children. Little is known about differences in fetal cardiac output hemodynamics of diabetic mothers (DM) vs. non-diabetic mothers (NDM). Our study aims to investigate the left-sided, right-sided, and combined cardiac output (CCO) in fetuses of DM vs. NDM. Retrospective data were collected in fetuses of DM (N = 532) and NDM (103) at mean gestational age 24 weeks. Examination included 2D echo and pulse wave Doppler. Wilcoxon rank sum tests and Chi-square tests were used to test for distribution difference of maternal and fetal continuous and categorical measures respectively between DM and NDM. Intraclass correlation coefficients were calculated to assess intra-observer reliability of fetal cardiac measurements. DM mothers had higher mean weight (89.7±22.2 kg) than NDM (76.8±19.8 kg), p < 0.0001 and higher mean BMI (33.4±7.5) than NDM (28.3±5.8), p < 0.0001. C-section delivery occurred in 66% of DM vs. 35% of NDM fetuses. Fetuses of DM mothers had significantly larger semilunar valve diameter, higher left ventricular (LV) output, higher combined cardiac output and lower right ventricle /left ventricle ratio compared to NDM. The greater CCO (adjusted for fetal weight), left sided cardiac output in the fetuses of DM, compared to NDM, represent differences in cardiac adaptation to the diabetic environment.

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.

The Relationship of Fetal Adrenal Gland Size with Fetal Liver Length and Fetal Abdominal Wall Fat Thickness in Mothers with and Without Gestational Diabetes

Background: Given the possible association between maternal diabetes status and metabolic disorders in the fetus, such as hepatic dysfunction or subcutaneous fat mass, it is expected that there is a close relationship between fetal adrenal gland volume and these two indicators. Aim: We decided to examine the relationship of fetal adrenal gland size with fetal liver length and fetal abdominal wall fat thickness in mothers with gestational diabetes and to compare it with non-diabetic mothers. Methods: This cross-sectional study was performed on 40 pregnant women in the third trimester of pregnancy suffering gestational diabetes under insulin therapy as the cases and 40 age and gestational age-matched pregnant women without diabetes as the controls. An ultrasound was performed for all participants in the third trimester of pregnancy to assess adrenal gland size, liver dimensions and fetal abdominal wall fat thickness. Results: The fetuses in diabetic group was found to have adrenal glands with significantly higher mean width, but with lower height leading similarity in mean adrenal volume as compared to non-diabetic group. The mean fetal abdominal wall fat thickness was significantly higher in diabetic than in non-diabetic groups. In diabetic groups, we found a direct association between height of adrenal gland and fetal abdominal wall fat thickness (p = 0.001). The length of adrenal gland was also positively associated with abdominal wall fat thickness (p = 0.001). However, in non-diabetic group, we found no association between adrenal height and fetal abdominal wall fat thickness. Measuring liver length in the two groups showed significantly higher mean value in diabetic than in non-diabetic groups. No association was revealed between adrenal volume and liver length in diabetic group. In non-diabetic group, there was a significant direct association between adrenal volume and liver length (p = 0.008). Conclusion: Gestational diabetes is directly associated with increasing fetal abdominal wall fat thickness and liver length in fetus. The dimensions of adrenal gland in fetus are also associated with fetus abdominal wall fat thickness and liver length probably independent to maternal diabetic status.

Association Between Umbilical Cord Levels of Glypican-1, Glypican-3, Syndecan-1, WISP1, Leptin and Birth Weight of Small, Appropriate, and Large for Gestational Age Infants

Background:Many factors are affecting intrauterine growth. The role of Wingless-type (Wnt) inducible signaling pathway protein-1 (WISP1), a novel adipokine and placental proteoglycans in intrauterine growth, is not known. We aimed to measure umbilical cord blood levels of glucose, insulin, leptin, WISP1, and placental proteoglycans [glypican-1 (GPC1), glypican-3 (GPC3), and syndecan-1 (SDC1)] which are thought to have an important role in fetal growth and investigate their relation with birth weight.Methods:Full-term neonates were included in this prospective, cross-sectional study and classified as appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA) according to their birth weight. Umbilical cord blood levels of glucose, insulin, leptin, WISP1, GPC1, GPC3, and SDC1 were measured.Results:Leptin levels were higher in LGA newborns compared to AGA and SGA newborns, while WISP1, GPC1, GPC3, and SDC1 levels were not different between the three groups. Leptin and GPC1 levels were higher in infants of mothers with gestational diabetes mellitus compared to infants of non-diabetic mothers, while WISP1, GPC3, and SDC1 were not different between the groups. Leptin was positively correlated with insulin, birth weight, and maternal weight. While there was a strong correlation between the WISP1, GPC1, GPC3, and SDC1 levels; there was no correlation between the birth weight, maternal weight, glucose, insulin, and WISP1, GPC1, GPC3, and SDC1 levels.Conclusion:Umbilical cord blood levels of GPC1, GPC3, SDC1, and WISP1 were not different between SGA, AGA, and LGA infants. The significance of serum levels of these adipokines and proteoglycans remains to be elucidated.

Effect of diabetes mellitus on pregnancy and birth outcomes in Wolaita Zone, Southern Ethiopia: A retrospective cohort study

Background and aimsPresence of diabetes mellitus (DM) during pregnancy is important cause of maternal and fetal complications. Studies that address the effect of DM on pregnancy and birth outcome are scarce in Ethiopia. The aim of this study was to determine the effect of DM on maternal and birth outcomes in Wolaita Zone, Southern Ethiopia. MethodsA retrospective cohort study was done to compare maternal and birth outcomes of mothers with DM and non-DM who received maternity service in three hospitals and four health centers in Southern Ethiopia. A total of 136 exposed (with DM) and 272 unexposed (non-DM) mothers were included in the study. Data were extracted from medical records of mothers by experienced and trained data collectors. Means were compared for continuous variables. Logistic regression analysis model was used to check the effect of DM on pregnancy and birth outcome. Risk Ratio was calculated and p value less than 0.05 was considered statistically significant. ResultsPregnancy of diabetic mothers was significantly complicated by pre-eclampsia when compared with non-diabetic mothers, (RR = 1.8: 95% CI; 1.2–2.7). The risk of macrosomia was higher for neonates of diabetic mothers than non-diabetic mothers, (RR = 1.9: 95% CI; 1.3–2.7). From multivariate analysis, mothers with DM were 2.9 times more likely to be delivered by caesarean section than non-diabetic mothers (RR = 2.9: 95%CI; 1.3–6.2) and the risk of pre-term delivery was 2.5 times higher among mothers with DM, (RR = 2.5: 95% CI; 1.1–6.2). ConclusionsDiabetes mellitus among pregnant mothers is associated with increased risk of pre-term delivery, macrosomia and maternal complications of pre-eclampsia and caesarian delivery. Early detection and management of DM should be one of the key activities to improve maternal and child mortality and morbidity.

A Prospective Case-Control Study to Compare the Clinical Outcomes and Metabolic Profile in Neonates Born to Diabetic Mothers in a Tertiary Care Armed Forces Hospital, India

Introduction: The prevalence of gestational diabetes mellitus (GDM) is on the rise especially in women of Asian ethnicity. GDM carries with it a multitude of foeto-maternal complications, the management of which is still a challenge, especially in developing countries. Methods: This was a hospital based prospective case control study conducted on 100 neonates to compare clinical outcomes and metabolic profiles in neonates of diabetic mothers and neonates of non-diabetic mothers over a period of two years. Results: The mothers in GDM group had 66% emergency lower segment caesarean section (LSCS) compared to 32% in non- GDM group (p = 0.001). The infants of diabetic mothers (IDM) had statistically significant higher percentage of preterm births, NICU admission, hyperbilirubinemia, hypoglycaemia and polycythemia. The anthropometric and cord blood parameters (Haemoglobin, haematocrit, platelet, calcium and bilirubin) were comparable in both the groups. Conclusions: GDM poses significant risks to both mother and neonate, however optimal glycemic control and meticulous monitoring and treatment protocols can reduce the incidence of certain known complications.

Persistent subclinical myocardial dysfunction among infants of diabetic mothers

IntroductionOffspring of diabetic mothers have five times higher risk of cardiovascular abnormalities than in normal pregnancies. These cardiac anomalies involve fetal cardiac morphological and functional changes. Here, we investigate subclinical cardiovascular abnormalities, including structural and functional changes among infants of diabetic mothers. Material and methodsA prospective cohort study was carried out from March 2017 to September 2020 at a South Indian tertiary care center. One hundred ninety-eight newborns delivered from non-diabetic mothers, well-controlled diabetic mothers (WCDM), and poorly controlled diabetic mothers (PCDM) were studied. Neonates and infantile echocardiographic imaging were performed at the first week of life, at 6-weeks, and 6-months of life. Cardiac structure and function were assessed using 2D, M-mode, Conventional Doppler, and Tissue Doppler imaging. ResultsOut of the total (198) infants, 66 (33.3%) were from the non-diabetic (control) mothers, 60 (30.3%) from the WCDM, and 72 (36.4%) were from the PCDM groups. In both WCDM and PCDM groups, the mean gestational ages at birth were shorter than the control group (37.19 ± 0.82, 36.02 ± 2.15, and 37.91 ± 1.33 weeks respectively). There was a high incidence of neonatal hypoglycemia (p-value <0.001), NICU stay >7 days (p-value <0.018), and persistent fetal transitional cardiac shunt (p-value <0.03) among poorly controlled DM group in comparison to others. Tissue deformation imaging showed a significant reduction in left ventricular global strain and strain rate in the neonatal heart from poorly controlled diabetic mothers. Myocardial wall thickness among neonates of diabetic mothers was higher compared to controls. LV TEI was higher in PCDM groups in comparison with WCDM and control groups; (0.59 ± 0.11, 0.46 ± 0.35, and 0.37 ± 0.12 respectively, p-value =0.01). Similarly, RV TEI was high in the PCDM (0.56 ± 0.09) group compared to the WCDM group (0.33 ± 0.12) and control group (0.28 ± 0.10). ConclusionsInfants of diabetic mothers are at higher risk of developing cardiac abnormalities, including structural and functional defects. The highest increase in interventricular septal thickening found in poorly controlled diabetic mothers' neonates will disrupt both ventricles' functions, followed by WCDM and the control group.

Macrosomia and its predictors in pregnant women with diabetes in Ethiopia.

To estimate the prevalence of macrosomia and contributing factors among pregnant women with diabetes in Ethiopia. The Cochrane, PubMed, Google Scholar, SCOPUS, Web of Science electronic databases and grey literature found in online university repositories were searched for primary studies reporting the prevalence of macrosomia (birth weight ≥4kg, irrespective of gestational age) and/or at least one determinant factor using WHO diabetes diagnosis criteria were involved. Variations across the studies were checked using the I2 statistic; funnel plot and Egger's test were used to assess publication bias. A weighted inverse random effect model was used to estimate the overall prevalence of macrosomia. The overall prevalence of macrosomic newborns among pregnant women with diabetes [15.1% (95% CI: 9.0%, 21.2%)] was higher than the prevalence among non-diabetic mothers (3.9%). Maternal blood glucose level >100mg/dl [AOR = 10.5: 95% CI: 5.9, 15.1] and >120mg/dl [AOR = 8.8: 95% CI: 4.5, 13.0], lack of Antenatal Care (ANC) visit [AOR = 10.8: 95% CI: 6.0, 15.0], previous adverse birth outcomes and advanced maternal age [AOR = 3.5: 95% CI: 1.0, 5.9] were significantly associated with the prevalence of macrosomia at 95% CI. The pooled prevalence of macrosomia among pregnant women with diabetes was higher than the prevalence among non-diabetic pregnant women (3.9%). Advanced maternal age, previous adverse birth outcomes, lack of ANC and uncontrolled maternal plasma glucose level were independent predictors of macrosomia.

Thermoultrasonication, ultraviolet-C irradiation, and high-pressure processing: Novel techniques to preserve insulin in donor human milk

Donor human milk (DHM) is recommended as the first alternative for preterm infants if their mother's own milk is not available or if the quantity is not sufficient. The most commonly used technique to eliminate microbial contaminants in DHM is holder pasteurization (HoP). However, the heating process during HoP partially destroys milk bioactive factors such as insulin. Therefore, innovative techniques have been developed as alternatives to HoP. The objective of this study was to determine the effect of HoP, high-temperature-short-time (HTST), thermoultrasonication (TUS), ultraviolet-C irradiation (UV-C), and high-pressure processing (HPP) on the insulin concentration in DHM. Milk samples from 28 non-diabetic mothers were collected. The milk samples were aliquoted and either left untreated or treated with HoP (62.5°C; 30min), HTST (72°C; 15s), TUS (60W; 6min), UV-C (4863J/L), or HPP (500MPa; 5min). The mean insulin concentration in untreated milk was 79±41pmol/L. The mean insulin retention rate was 67% for HoP, 78% for HTST, 97% for TUS, 94% for UV-C, and 106%for HPP. The mean insulin concentration in milk treated with HoP was significantly lower compared to untreated milk (p=0.01). TUS, UV-C, and HPP preserve insulin in DHM. The insulin concentration in DHM is affected to a larger extent by HoP than by HTST. These results indicate that TUS, UV-C, and HPP may serve as alternatives to HoP.

Insulin Concentration in Human Milk in the First Ten Days Postpartum: Course and Associated Factors.

Human milk (HM) is better tolerated than formula in preterm infants. Insulin, which is naturally present in HM but not in formula, has been suggested as a key factor for feeding tolerance, as it appears to stimulate intestinal maturation. Its precise concentrations during the early postnatal period, however, remains unknown. The objective of this study was to assess the natural timecourse of the HM insulin concentration during the first ten days postpartum. The effect of preterm delivery, maternal obesity, and diurnal rhythm were also assessed. HM was collected from 31 non-diabetic mothers (21 preterm [gestational age (GA) < 37 weeks]; 10 at-term [GA ≥ 37 weeks]) on ≥ 4 time-points per day during the first five days, and once on the tenth day postpartum. The HM insulin concentration declined rapidly within the first three days postpartum (day 1: 516 [312-1058] pmol/L; day 3: 157 [87-299] pmol/L), after which the concentration remained relatively stable. The insulin concentrations were higher in HM from obese mothers than from non-obese mothers (P < 0.001). Preterm delivery did not significantly affect HM insulin concentrations when adjusted for maternal pre-pregnancy body mass index category (P = 0.270). Diurnal rhythm was characterized by an insulin concentration decline throughout the night (P = 0.001), followed by an increase in the morning (P = 0.001). The HM insulin concentration declines rapidly in the first three days postpartum, follows a diurnal rhythm, and is higher in obese mothers compared to non-obese mothers. HM insulin concentrations are not affected by preterm delivery.

The Incidence of Congenital Heart Defects in Offspring Among Women With Diabetes in Saudi Arabia.

Background: The risk of congenital anomalies is increased in infants of diabetic mothers (IDM). The most frequent cardiac anomalies in IDMs include ventricular septal defect, transposition of great arteries, and aortic stenosis.Objective: Estimating the incidence of infants with congenital heart defects (CHD) whose mothers have diabetes in Saudi Arabia at a tertiary hospital in the National Guard Health Affairs (NGHA) system.Materials and methods: This study was a retrospective cohort. The population was all births of type 1 and type 2 diabetic mothers and non-diabetic mothers (also mothers with gestational diabetes) in NGHA by following the exclusion criteria, which were mothers over 40 and below 20 years of age, and other risk factors such as drug-induced congenital disease. The data was from deliveries from January 1st 2018 to January 1st 2019. Data were collected by chart review using the Best-Care system at NGHA hospital. Statistical Package for the Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA) was used for the statistical analysis.Results: A total of 1838 diabetic mothers and non-exposure, non-diabetic mothers, with the outcome of whether the infant had CHD, were included in this study. Most of the mothers (544, 30.11%) were aged 30-34 years old. About two-thirds of mothers, 1161 (63.24%), weren't diabetic, 500 (27.23%) had gestational diabetes, 132 (7.19%) were type 2 diabetes (T2DM), and 43 (2.34%) were type 1 diabetes (T1DM). Two hundred eighteen (11.82%) offspring had CHD, and the remaining 1625 (88.17%) did not. The most frequent echocardiographic abnormalities in infants of diabetic mothers were patent ductus arteriosus (PDA) (31.75%), patent foramen ovale (PFO) (31.75%), and atrial septal defect (ASD) (23.64%).Conclusion: The incidence of CHD among infants of included mothers in this cohort study was 11.82%. The most frequent echocardiographic abnormalities in the infants of diabetics were PDA and PFO. The incidence of CHD was higher among mothers who had T1DM followed by T2DM, and whose ages were between 30-34.

The Delayed Immune Response of Infants of Diabetic Mothers to Hepatitis B Vaccine: A Prospective Case-Control Study

Background: Infants of diabetic mothers (IDMs) have a significantly greater risk for perinatal morbidity, mortality, and altered immune response. Aim of work: To assess the immune response of IDMs for hepatitis B virus (HBV) vaccine and to compare them with infants of non-diabetic mothers as a control group. Patients and Methods: 150 neonates met the inclusion criteria; 100 IDMs and 50 infants’ non-diabetic mothers as controls. All neonates who met the inclusion criteria received HBV vaccine during the first 24 hours of age and at 1 and 6 months of age according to the WHO guidelines. Furthermore, hepatitis B surface antigen (HBsAg), hepatitis B virus surface antibodies (anti-HBs), and hepatitis B virus core antibodies (anti-Hbc) were measured at 9, 12, and 24 months of age. Results: IDMs had significantly higher birth weight when compared to infants of the non-diabetic mothers (3.6 ± 0.4 kg and 3.03 ± 0.5 kg, P-value 0.01). There was a significant difference between the response to anti-HBs between case group and control group at 9 months 7±12 mIU/dL versus 20±23 mIU/dL (P-value < 0.0001). However, anti-HBs antibodies levels follow-up at 12 and 24 months showed no significant differences between the case and control groups. Conclusion:At 9 months of age, post HBV vaccination, there was a delayed immune response for HBV vaccine was present in IDM compared to infants of non-diabetic mothers. However, IDM became immune at follow-up at 12 and 24 months of age.

Congenital Heart Disease in Non-Diabetic Large-for-Gestational-Age (LGA) Neonates.

Congenital heart diseases are the most prevalent congenital abnormalities in the neonates, caused by environmental and genetic factors and contributing to the leading cause of death. This study aims to evaluate the relationship between neonates with large for gestational age and increased risk of congenital heart diseases among non-diabetic mothers. In this study, 179 neonates with large gestational age in Khorramabad were enrolled where heart abnormalities were evaluated using echocardiography. 87 neonates had more than 4000 g of birth weight with no heart abnormalities and 92 (51%) macrosomic neonates had congenital heart diseases. Statistical analysis revealed a significant relationship between birth weight and increased risk of acquiring congenital heart disease between the two groups. There was no significant relationship between birth weight, maternal age, gender, labor type and blood group between the two groups. The highest incidence of congenital heart anomalies was related to 38% of arterial septal defect (ASD) and 15.2% of ASD and VSD, respectively. The most prevalent abnormality was arterial septal ASD. None of these abnormalities were associated with maternal age, birth weight and neonate gender. Future studies for congenital heart disease and neonatal birth weight are, therefore, recommended.

Maternal Diabetes: A Potential Risk Factor of Congenital Hearing Loss

Objective. The purpose of this study is to identify the incidence rate of 'refer' result in neonates born to diabetic mothers and to determine the association of maternal diabetes and the initial 'refer' result.&#x0D; Methods. This was a retrospective cross-sectional study which included neonates who had hearing screening test using transient-evoked otoacoustic emissions test (TEOAE) on both ears at the Philippine General Hospital Ear unit during three weeks. We obtained the demographic characteristics, presence/absence of maternal diabetes, and OAE results.&#x0D; Results. Among the 150 neonates, ten were born to diabetic mothers, with an age range of 2-8 days old. Forty percent of neonates of diabetic mothers had an initial 'refer' result compared with 7.9% of nondiabetic mothers' neonates. After logistic regression analysis, there is a significant association between maternal diabetes and initial 'refer' result in OAE with a p-value &lt;0.05. If the mother is diagnosed with diabetes (gestational/pre-gestational), the odds of having an initial 'refer' result in the hearing screening is 2x higher. The odds can range from 2-43 times.&#x0D; Conclusion. The incidence rate of an initial 'refer' result in neonates of diabetic mothers is 40%. There is a significant association between maternal diabetes and the initial 'refer' result in the OAE test.

Diminished substrate-mediated cardiac mitochondrial respiration and elevated autophagy in adult male offspring of gestational diabetic rats.

Heart diseases are common in the offspring of diabetic mother (ODM). Defects in mitochondrial metabolism and autophagy may, in part, be responsible for the adverse structural and functional alterations in the heart. The principal objective of this study was to investigate cardiac mitochondrial respiration and autophagy in male and female offspring of diabetic pregnancy at two different developmental stages of life, weaning and adult. Male and female offspring of rats with streptozotocin-induced gestational diabetes were used for the study and compared with offspring of control (non-diabetic) mother (OCM) rats. High-resolution respirometry was used to measure substrate-mediated respiration in mitochondria isolated from ventricular tissues of ODM and OCM. Expression of proteins associated with autophagy and oxidative stress was examined by western blot analysis. Mitochondrial complex I and complex II respiration was significantly reduced in adult male ODM while it was unaltered or less affected in weaning male, adult and weaning female ODM. Elevated autophagy was observed in adult male but not in adult female ODM. Expression of oxidative stress markers was observed to be similar in all the groups. Altered cardiac mitochondrial respiration and autophagy were observed in adult male ODM compared to OCM, while the male and female offspring at weaning stage were less affected. The results of the study show that maternal hyperglycemia affects mitochondrial respiration and autophagy in the ODM heart, which may potentially be responsible for the cardiovascular complications observed in adult life.

Macrosomic Infants of Diabetic and Non-diabetic Pregnant Women

Background: Macrosomia is defined as a birth weight above the 90th percentile for gestational age. Macrosomic infants associated with neonatal morbidities and admissions to the neonatal intensive care unit,also is associated with maternal complications such as cesarean delivery, postpartum hemorrhage and trauma. Objective: The aim of the study was to assess the neonatal outcomes of macrosomic babies for both pregnant women with gestational diabetes mellitus and without the disease. Methods: This retrospective cohort study was conduc- ted at the Duhok Obstetrics and Gynecology Teaching Hospital, Hive Pediatrics Teaching Hospital, and Kurdistan Private Hospital in Iraqi Kurdistan between March 2017 and March 2021. The study included hundred pregnant women, they were divided into two groups; first group (Diabetic mothers) included pregnant women who had gestational diabetes mellitus, second group (Non- Diabetic mothers) included pregnant women who had not the disease. Both groups were included their macrocosmic babies. Both groups were compared regarding a baseline characteristics and neonatal outcomes. The data were statistically analyzed using a software package, current versions IBM (SPSS) Statistic. Results: During the study period, from March 2017 to March 2021,fourty pregnant women who had gestational diabetes mellitus were compared with the sixty pregnant women who had not the disease. pregnant women who had gestational diabetes mellitus had lower parity than non-diabetic mothers, more likely to smoke, more often obese, and more had a history of previous cesarean delivery. Elective cesarean section was more in diabetic group than non-diabetic group. The majority of newborns for both group were male babies. All macrocosmic babies were examine by neonatologist. Neonatal intensive care unit (NICU) admission was more for diabetic group than non-diabetic group. Conclusions: Both macrosomic infants of diabetic and non-diabetic mothers are at risk for neonatal complications especially infants of diabetic mothers and male babies in the short term period.