Term Infants Of Diabetic Mothers Research Articles

Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry.

A recent discussion surrounding the extension of antenatal corticosteroid (ACS) use beyond 34weeks of gestation did not include the subgroup of infants of diabetic mothers (IDM). We aimed to examine the association between ACS exposure and outcomes in neonates born at term and at near-term gestation in a large cohort of IDMs. We selected 13976 eligible near-term and term infants who were included in the PEARL-Peristat Perinatal Registry Study (PPS). We assessed the association of ACS exposure with neonatal outcomes in a multivariate regression model that controlled for diabetes mellitus (DM) and other perinatal variables. The incidence of DM was 28% (3,895 of 13,976) in the cohort. Caesarean section was performed in one-third of the study population. The incidence of ACS exposure was low (1.8%) and typically occurred>2weeks before delivery. The incidence rates of respiratory distress syndrome (RDS)/ transient tachypnoea of newborns (TTN), all-cause neonatal intensive care unit (NICU) admissions, NICU admissions for hypoglycaemia, and low 5-min Apgar scores were 3.5, 8.8, 1.3, and 0.1%, respectively. In a multivariate regression model, ACS was associated with a slight increase in NICU admissions (OR: 1.44; 95% CI: 1.04-2.03; p=0.028), but not with RDS/TTN. Although the low exposure rate was a limitation, ACS administration did not reduce respiratory morbidity in near-term or term IDMs. It was independently associated with an increase in NICU admissions. Randomized controlled trials are required to assess the efficacy and safety of ACS administration in diabetic mothers at late gestation.

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.

Potential prevention of small for gestational age in Australia: a population-based linkage study.

BackgroundSmall for gestational age (SGA) infants are at increased risk of morbidity and mortality. We sought to identify risk factors associated with SGA and examined the potential for reducing the proportion of infants with SGA at a population level.MethodsBirth and hospital records were linked for births occurring in 2007–2010 in New South Wales, Australia. The analysis was stratified into three groups: preterm births, term births to non-diabetic mothers and term births to diabetic mothers. Logistic regression was used to examine the association between SGA and a range of socio-demographic and behavioural factors and health conditions, with generalised estimating equations to account for correlation among births to the same mother. Model-based population attributable fractions (PAFs) were calculated for risk factors that were considered causative and potentially modifiable.ResultsOf 28,126 SGA infants, the largest group was term infants of non-diabetic mothers (88.5%), followed by term infants of diabetic mothers (6.3%) and preterm infants (5.3%). The highest PAFs were for smoking: 12.4% for preterm SGA and 10.3% for term SGA infants of non-diabetic mothers. Other risk factors for SGA that were considered modifiable included: illicit drug dependency or abuse in pregnancy in all three groups, and pregnancy hypertension and late commencement of antenatal care in term infants of non-diabetic mothers, but PAFs were less than 3%.ConclusionsThere are opportunities for modest reduction of the prevalence of SGA through reduction in smoking in pregnancy, and possibly earlier commencement of antenatal care and improved management of high-risk pregnancies.

344: Prediction of fetal macrosomia in term infants of diabetic mothers based on early third trimester ultrasound

344: Prediction of fetal macrosomia in term infants of diabetic mothers based on early third trimester ultrasound

Hypoglycemia Rates in the First Days of Life among Term Infants Born to Diabetic Mothers

Objectives: To discover the risk factors for developing hypoglycemia in newborns born to diabetic mothers and to characterize the rates of glucose concentrations in the first two days of life. Methods: Retrospective recordings of medical charts of 576 healthy term infants of diabetic mothers during an 18-month period. We determined the following pre-feeding glucose concentrations: ‘normoglycemia’ (≥47 mg/dl = 2.6 mmol/l), ‘mild hypoglycemia’ (40–46 mg/dl = 2.2– 2.5 mmol/l), ‘moderate hypoglycemia’ (30–39 mg/dl = 1.7–2.1 mmol/l) and ‘severe hypoglycemia’ (<30 mg/dl = 1.7 mmol/l). Results: Glucose concentrations below ‘normoglycemia’ and ‘severe hypoglycemia’ were observed in 280 (48.6%) and 23 (4%) of the infants, respectively. The main risk factors for developing glucose concentrations below ‘normoglycemia’ in the first day of life were large size for gestational age and maternal insulin-dependent diabetes mellitus. ‘Severe hypoglycemia’ was more common among infants born to mothers who needed insulin (either type A2 or insulin-dependent diabetes mellitus). Infants born to mothers with insulin-dependent diabetes mellitus were less mature, heavier, large for their gestational age and exhibited more ‘severe and moderate hypoglycemia’ in the first day of life as compared to infants born to diabetes type A1 and A2 mothers. In addition, infants who were large for gestational age tended to have more ‘moderate hypoglycemia’ when born to diabetes type A1 mothers compared to small and appropriate-for-gestational-age infants. Thirty infants (5%) still had hypoglycemia on the second day of life. This subgroup of infants did not differ with regard to maternal-type diabetes. Conclusions: Infants born to diabetic mothers tend to have a high rate of hypoglycemia on the first day of life when a relatively high cut-off point (≥47 mg/dl = 2.6 mmol/l) is used. Infants born large for gestational age as well as those born to mothers with juvenile diabetes mellitus are at higher risk and should be closely monitored.

Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control

Objective: To determine whether omitting fetal lung maturity (FLM) testing prior to delivery in term pregnancies complicated by gestational (GDM) and pregestational diabetes mellitus would increase the risk of neonatal respiratory distress syndrome (RDS). Methods: In a 2-year study (1990-91), 1457 pregnant women with accurately dated pregnancies were enrolled after 37 completed weeks and prospectively followed through delivery without FLM testing (study group). The prevalence of RDS and other neonatal outcomes was compared with a historical control group (n = 713, 1988-89) who had undergone determination of lecithin/sphingomyelin ratio prior to delivery at term. Logistic regression analysis was performed to determine independent predictors of RDS. Results: The study group compared to the control group had less severe diabetes: diet-controlled GDM, 35% vs. 18%, respectively; insulin-requiring GDM, 42% vs. 42%, respectively; undiagnosed type-2 diabetes, 14% vs. 31%, respectively; and pre-existing diabetes, 9.6% vs. 8.8%, respectively, p < 0.001. RDS rates in the study group (0.8%) and control group (1.0%) were not significantly different, nor were rates of resuscitation at delivery, neonatal intensive care admission or hospitalization days. Logistic regression analysis found only Cesarean delivery to be independently predictive (adjusted OR 2.21, 95% CI 2.04-2.27) of RDS. Non-predictive variables included FLM testing, diabetic classification, insulin use, poor third-trimester glycemic control, chronic hypertension, pre-eclampsia, labor, neonatal gender, gestational age or large-for-gestational-age fetuses. Conclusions: Routine FLM testing did not change the RDS prevalence in reliably dated, term infants of diabetic mothers and should be abandoned. Delivery by Cesarean section was associated with increased RDS.

Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control

Objective: To determine whether omitting fetal lung maturity (FLM) testing prior to delivery in term pregnancies complicated by gestational (GDM) and pregestational diabetes mellitus would increasethe risk of neonatal respiratory distress syndrome (RDS).Methods: In a 2-year study (1990-91), 1457 pregnant women with accurately dated pregnancies were enrolled after 37 completed weeks andprospectively followed through delivery without FLM testing (study group). The prevalence of RDS and other neonatal outcomes was compared with a historical control group (n = 713, 1988-89) who hadundergone determination of lecithin/sphingomyelin ratio prior to delivery at term. Logistic regression analysis was performed to determine independent predictors of RDS.Results: The study groupcompared to the control group had less severe diabetes: diet-controlled GDM, 35% vs. 18%, respectively; insulin-requiring GDM, 42% vs. 42%, respectively; undiagnosed type-2 diabetes, 14% vs. 31%, respectively;and pre-existing diabetes, 9.6% vs. 8.8%, respectively, p < 0.001. RDS rates in the study group (0.8%) and control group (1.0%) were not significantly different, nor were rates of resuscitationat delivery, neonatal intensive care admission or hospitalization days. Logistic regression analysis found only Cesarean delivery to be independently predictive (adjusted OR 2.21, 95% CI 2.04-2.27) of RDS.Non-predictive variables included FLM testing, diabetic classification, insulin use, poor third-trimester glycemic control, chronic hypertension, pre-eclampsia, labor, neonatal gender, gestational age orlarge-for-gestational-age fetuses.Conclusions: Routine FLM testing did not change the RDS prevalence in reliably dated, term infants of diabetic mothers and should be abandoned. Delivery byCesarean section was associated with increased RDS.

Outcome of Diabetic Pregnancy With Spontaneous Labour After 38 Weeks

Previously, the risk of intrauterine death in term infants of diabetic mothers led to elective delivery at 38 weeks, after confirmation that the lungs were mature. This study looked at perinatal outcomes in 148 women with well-controlled insulin-dependent diabetes who were allowed to enter labor spontaneously. All of them had reached 38 weeks with a live fetus, no obstetrical complications, and fasting blood glucose levels of 3 to 5 mM/liter (with 2-hour postprandial levels <7 mM/liter) through most of the pregnancy. One-third of the group were primigravidas. Half of the women delivered between 38 and 39 weeks’ gestation, and the rest delivered at 40 to 42 weeks’ gestation. Instrumental delivery was performed in 9 percent of cases, and cesarean delivery was performed in 7 percent. The two perinatal deaths yielded a perinatal mortality rate of 13.5 per 1000. Twenty-one infants, 14 percent of those born, required admission to a special care unit. The major differences from the general hospital population were a higher rate of operative delivery in labor (7 vs. 3.4 percent) and a higher proportion of newborn infants weighing 4 kg or more (33 vs. 18 percent). Nevertheless, there was only one case of shoulder dystocia in the diabetic group. In a larger group of 373 insulin-dependent diabetic women, from whom the study population was selected, the perinatal mortality was 3-fold greater than in the general hospital population (32 vs. 10.6 per 1000). In the well-controlled diabetic patients, the last glycosylated hemoglobin level before delivery did not predict either high birth weight or the need for cesarean delivery. Vaginal delivery is the norm in well-controlled women with insulin-dependent diabetes who are allowed to enter labor spontaneously after 38 weeks’ gestation. Perinatal morbidity and mortality are not excessive, and the risk of shoulder dystocia is not increased. Ir J Med Sci 1999;168:160–163

Predictive factors and incidence of complications in apparently healthy full term infants of diabetic mothers

To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early. A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours. One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively. Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

Beta glucuronidase and hyperbilirubinaemia in breast fed infants of diabetic mothers.

A prospective study was performed comparing bilirubin concentrations in 10 breast fed term infants of diabetic mothers (IDM) to those of 10 breast fed normal term infants. The beta-glucuronidase concentrations in serum and breast milk were assayed in the respective mothers. Significantly higher bilirubin concentrations were noted in the IDM group. Serum and breast milk beta-glucuronidase concentrations were significantly higher in diabetic mothers as compared with those of non-diabetic mothers. We suggest that the high concentration of beta-glucuronidase in breast milk of diabetic mothers is an additional important cause leading to hyperbilirubinaemia in their breast fed infants.

Circulating Levels of Biologically Active and Immunoreactive Intact Parathyroid Hormone in Human Newborns

We evaluated circulating levels of biologically active and immunoreactive intact parathyroid hormone [iPTH-(1-84)] in 47 newborns at birth and eight hypocalcemic preterm infants during the first 10 d of life. Use of two sensitive detection systems, the cytochemical bioassay and an immunoradiometric assay specific for intact parathyroid hormone, enabled us to compare plasma concentrations of PTH-like bioactivity (bioPTH) and iPTH-(1-84). Mean umbilical venous plasma bioPTH was elevated in nondiabetic term and preterm newborns [22.5 +/- 3.1 (+/- SEM) and 15.8 +/- 2.5 ng-equiv/L, respectively] compared with normal adult subjects (9.8 +/- 2.6 ng-equiv/L; p less than 0.01). Umbilical bioPTH was suppressed in five term infants of diabetic mothers (2.6 +/- 0.4 ng-equiv/L). In contrast, iPTH-(1-84) was low in term and preterm nondiabetic infants' and term infants of diabetic mothers' umbilical samples (5.4 +/- 1.5, 4.3 +/- 1.5, and 2.4 +/- 1.0 ng/L, respectively). Umbilical venous bioPTH was highly correlated with the magnitude of the transplacental calcium gradient (r = 0.90; p less than 0.05). In eight preterm infants studied longitudinally, by 24-36 h of life, declining plasma total and ionized calcium (1.71 +/- 0.04 and 0.78 +/- 0.03 mmol/L, respectively) were accompanied by a significant rise in both bioPTH (41.2 +/- 6.3 ng-equiv/L) and iPTH-(1-84) (56.3 +/- 11.6 ng/L). These data indicate that the 3rd trimester fetoplacental circulation contains levels of bioPTH several-fold higher than those of immunoreactive intact hormone. We also conclude that even hypocalcemic preterm newborn infants can significantly elevate circulating levels of PTH.

Absence of evidence of pulmonary maturity at amniocentesis in term infants of diabetic mothers

A total of 153 patients' charts were reviewed over a 6-year period to assess the results of the practice of amniocentesis for diabetic mothers at term (≥37 weeks' gestation) before elective induction/delivery. The numbers of cases with absent phosphatidylglycerol were determined at each specific gestational age at or near term. Phosphatidylglycerol was present in 130, and phosphatidylglycerol was absent in 23 at first amniocentesis sampling. A significant proportion (~21%) of those with gestational diabetes were phosphatidylglycerol-negative as late as 38 weeks' gestation. A similar proportion of overt diabetic patients were phosphatidylglycerol-negative as late as 39 weeks' gestation. These figures give the clinician some estimate of the likelihood of the absence of phosphatidylglycerol at or near term if amniocentesis is used before elective delivery in these patients.

Abnormal iron distribution in infants of diabetic mothers: Spectrum and maternal antecedents

Because chronic hypoxemia causes a redistribution of iron from serum and storage pools into an expanding erythrocyte mass, and because infants of diabetic mothers are often hypoxemic in utero and have a high prevalence of polycythemia at birth, we studied iron distribution in 43 term infants of diabetic mothers. Twenty-four infants were at an appropriate size for gestational age; 19 were large for gestational age. At birth, 28 infants (65%) had abnormal serum iron profiles; eight had decreased ferritin concentrations only (stage 1), nine had decreased ferritin and increased total iron-binding capacity values (stage 2), and 11 had these serum findings plus elevated free erythrocyte protoporphyrin concentrations (stage 3). The hypoglycemic infants who were large for gestational age (n = 14) had a higher prevalence of abnormal iron profiles than euglycemic infants who were appropriate in size for gestational age (n = 20; 93% vs 50%; p = 0.009). Progressively abnormal iron profiles were associated with higher glycosylated fetal hemoglobin values, greater degrees of macrosomia, increased hemoglobin and erythropoietin concentrations, and increased erythrocyte/storage iron ratios. Erythropoietin concentrations were inversely linearly correlated with serum iron values (n = 32, r = -0.54; p = 0.003). The combined erythrocyte and storage iron pools were significantly lower in infants with abnormal iron values whose mothers were diabetic, particularly in infants of women with confirmed diabetic vasculopathy. We speculate that these findings are likely due to (1) increased fetal iron utilization during compensatory hemoglobin synthesis in response to chronic hypoxemia and (2) reduced iron transfer during late gestation complicated by diabetes.

Insulin-Like Growth Factors in Fetal Macrosomia with and without Maternal Diabetes

Insulin-like growth factors (IGFs/somatomedins) have been implicated as regulators of fetal growth. This study investigates whether IGFs are related to macrosomia in infants of normal or insulin-dependent diabetic mothers. Cord concentrations of IGF-I (radioimmunoassay), total IGF (radioreceptor assay) and IGF binding protein (radiobinding assay) were measured in 15 term infants of diabetic mothers (IDM) and 29 term infants of nondiabetic mothers. In infants of control mothers cord IGF and total IGF levels were significantly higher in large-for-gestational-age than appropriate-for-gestational-age infants; but this relationship was lost in IDM, in whom IGF-I concentrations were similar to control infants. IGF binding protein levels were not significantly different in any of these groups. The absence of elevated IGF levels in macrosomic IDM indicates that the pathologic process does not involve a simple increase in these growth factors.

Thyroid hormone levels in diabetic mothers and their neonates.

Infants born to diabetic mothers have decreased activity of many metabolic pathways which might be regulated by thyroid hormone. Serum TSH, T4, T3, and reverse T3 levels were measured in 22 term infants of diabetic mothers and in 9 normal term babies at 2, 12, 24, and 72 hours of age, as well as in maternal and cord sera. T4 binding index and free T4 levels were measured in 11 diabetic mothers and their babies and 5 normal mothers and babies. Mean TSH levels did not differ between diabetic and normal mothers or their infants. Mean T4 of the diabetic mothers (9.6 micrograms/dl) was significantly (p less than 0.005) less than the mean T4 of the normal mothers (12.8 micrograms/dl). Mean T4 of neonatal specimens was lower in infants of diabetic mothers for each determination, but this difference achieved statistical significance at the 12-hour sample only (p less than 0.001). Mean serum T4 binding index was similar in the neonatal specimens at each time period studied. Mean T3 of diabetic mothers (149 ng/dl) was significantly (p less than 0.001) less than that of normal mothers (217 ng/dl). At each time interval, mean T3 concentration in infants of diabetic mothers was significantly lower than that of normal infants. Levels of reverse T3 were not significantly different between normal and diabetic mothers or their neonates. These data suggest that there is an effect of maternal diabetes on T3 secretion or conversion of T4 to the more active hormone, T3, in the fetus and early newborn.(ABSTRACT TRUNCATED AT 250 WORDS)

1188 THYROID FUNCTION IN NEONATES OF DIABETIC MOTHERS

Infants born to diabetic mothers have decreased activity of many metabolic pathways which might be regulated by thyroid hormone. This study was designed to define thyroid function in neo-nates born to diabetic mothers. Serum TSH, T4, and T3 levels were measured in 19 term infants of diabetic mothers and in 7 normal term babies at 2,12,24, and 72 hrs. of age, as well as in maternal and cord sera. Mean TSH levels did not differ between diabetic and normal mothers or infants. Results are expressed as mean ± SEM. Maternal T4 and T3 levels are decreased at delivery in diabetics as compared to normals. Neonates of diabetics have significantly decreased serum levels of T3, suggesting decreased gland secretion or peripheral synthesis. These data lead to the speculation that decreased thyroid hormone levels may explain some metabolic alterations seen in neonates born to diabetic mothers.