National Research Centre of Medical Sciences of I.R. IRAN
Abstract
To describe and compare the clinical outcome of infants born to mothers
with gestational and pregestational diabetes mellitus, this study was
conducted between January 2000 to January 2002 in Tehran Vali -E- Asr
Hospital. Among 4472 deliveries, we found 107 infants born to diabetic
mothers out of whom 6 were twins. The prevalence of diabetes in total
deliveries was 2.39%. Mean age of gestational and pregestational
diabetic mothers was 30.9 ±5.86 and 31 ± 5.37 respectively.
74 infants (69%) belonged to gestational diabetic mothers. 50% of
infants were male. Mean birth weight of infants was 3067±784.917
(700 -5600g). Gestational age in 57% of infants was less than 38
weeks.APGAR score at 1 & 5 minutes was <6 in 10 and 5 cases
respectively. Hypoglycemia was detected in 31%, hypocalcemia in 13%,
hypomagnesemia in 4.5%, polycythemia in 6.8%, macrosomia in 28.6%,
small for gestational age in 2%, respiratory distress syndrome in 8.2%,
early sepsis in 9.2%, NICU admission in 23.7%, and hyperbilirubinemia
in 34%. The incidences of most of these morbidities were higher in
infants of pregestational diabetic mothers. The differences between the
incidence of hypoglycemia, hypocalcemia & 5 minute APGAR score in
infants of pregestational and gestational diabetic mothers were
significant (p<0.05). There was a significant correlation between
the incidence of hypoglycemia and birth weight of infants (p<0.05).
The existence of congenital anomalies in infants of gestational
diabetic mothers could be due to unrecognized cases of noninsulin
dependent diabetes mellitus, and with respect to mean age of mothers it
is advisable to detect diabetes before pregnancy in high risk groups
and correct the level of hemoglobin A1c before pregnancy. Cleft palate
and undescended testes among the anomalies support this hypothesis that
prostaglandin deficiency may have a role in the pathophysiology of
congenital malformations in these infants