PERINATAL AND NEONATAL OUTCOMES AMONG INFANTS OF DIABETIC MOTHERS – COMPARISON OF INSULIN, ORAL HYPOGLYCEMIC AGENT, AND DIET CONTROL

Abstract

Background: Gestational Diabetes Mellitus (GDM) affects approximately 6.6% of pregnancies worldwide. It is a significant cause of prenatal and newborn morbidity. In developing nations like Pakistan, the management of diabetes during pregnancy remains a challenge.

Methods: A retrospective cohort study was conducted over a period of one year, in a tertiary care hospital of Pakistan. Following the inclusion criteria, a total of 350 newborns (born at ≥ 24 weeks gestation, to mothers with GDM), were enrolled. Primary neonatal outcomes were gestational age, mode of delivery and complications. Complications included: preterm delivery, small for gestational age (SGA), large for gestational age (LGA), macrosomia, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), hypoglycemia (24 hours after birth), hypocalcemia (first 48 hours of life), polycythemia, hyperbilirubinemia, congenital anomalies, need for neonatal intensive care unit (NICU) and birth injuries. The enrolled infants were then stratified in 3 groups based on the GDM treatment their mothers had received during pregnancy: diet control, oral hypoglycemic agents (OHA), or insulin. Secondary outcomes were the difference of number of complications in infants of diabetic mothers (IDM), in the 3 different groups.

Results: During the study period, 5186 births took place, of which 427 newborns were IDMs. The mean duration of GDM treatment in mothers was 12.8 weeks ± 3.8 weeks in all three groups. Of the 350 babies, 178 (50.9%) were male and 172 (49.1%) were female, with a mean weight of 2.85kg. The incidence of prematurity (defined as gestational age <37 weeks) was 26.6% (n=93), with a mean gestational age of 36.8 weeks ±2.0 weeks. The frequencies of the morbidities under study were as follows: small for gestational age (SGA) 18.9% (n=66), large for gestational age (LGA) 4.0% (n=14), hypoglycemia in first 48 hours of life 20% (n=70), hypocalcemia the first 48 hours of life 4.0% (n=14), hyperbilirubinemia throughout the first week of life 25.7% (n=90), respiratory distress syndrome (RDS) 6.3% (n=22), transient tachypnea of newborn (TTN) 3.4% (n=12), birth asphyxia 2.9% (n=10), meconium aspiration syndrome (MAS) 0.9% (n=3), congenital anomalies 11.7% (n=41), (of which 68.3% (n=28) were cardiac anomalies), birth injury 0.3% (n=1), and babies needing NICU admission 15.7% (n=55), of which. The mortality rate was 1.4% (n=5). All babies with TTN and RDS required, and were given, oxygen (n=34).

Practical Implication: we only included diabetic mothers with GDM and not those who already had Type 1 or 2 DM before pregnancy. Furthermore, our comparison comprises morbidities in neonates of three groups of diabetic mothers based on treatment regimens; however, we did not analyze the data concerning the duration for which each treatment was given.

Conclusion: Our results indicate that IDMs with mothers on insulin have significantly higher rates of certain complications as compared to mothers on diet control or OHA. Earlier detection of GDM leading to early and better glycemic control can possibly reduce the need for insulin and simultaneously improve outcomes in neonates.