Neonatal complications in infants born to diabetic mothers.

OBJECTIVE: To determine the range of complications occurring in infants of diabetic mothers (IDMs).

DESIGN: An observational cross-sectional study.

PLACE AND DURATION OF STUDY: Federal Government Services Hospital, Islamabad and National Institute of Child Health, Karachi, from August 1999 to January 2000.

SUBJECTS AND METHODS: All IDMs born during the study period were immediately admitted to the neonatal intensive care unit after delivery. Maternal history was obtained and a detailed physical examination was performed to detect congenital abnormalities. Babies were screened for hypoglycemia, hypocalcemia, hyperbilirubinemia, birth asphyxia, respiratory distress syndrome (RDS) and birth trauma. Outcome of IDMs and relative frequencies of various complications were evaluated. Results were analyzed using statistical package for social sciences (SPSS) version 11.

RESULTS: A total number of 40 babies with IDM were included in the study. Out of diabetic mothers, only 19 (47.5%) were taking insulin albeit irregularly. No mother was taking oral hypoglycemic agents, 5 (12.5%) were following only dietary advice while 16 (40%) were not following any advise for control of diabetes. Twenty-two (55%) mothers were delivered by C-section and 18 (45%) had vaginal delivery. Seven (17.5%) mothers experienced birth injuries, all of them were delivered vaginally and majority of them were large babies. Fifteen percent IDMs suffered from birth asphyxia. Most (82.5%) were delivered vaginally. Congenital anomalies were found in 10 (25%) babies. Eighteen (45%) were macrosomic, 20 (50%) were appropriate for gestational age (AGA) and 02 (5%) were small for gestational age (SGA) or growth retarded. Hypoglycemia was noted in 35% and hypocalcemia in 15%. Hyperbilirubinemia was observed in 12 (30%) newborns. Mortality was 7.5%.

CONCLUSION: The results of this study show a high frequency complications in IDMs. The diabetic mothers should have regular antenatal follow-up and maintain good glycemic control throughout pregnancy. Cesarean section may be allowed more liberally, especially with clinical evidence of macrosomic baby, to avoid birth injury and asphyxia. All deliveries of diabetic mother should be attended by pediatrician to minimize complications.