The Laboratory and Clinical Findings in Infants Born to Diabetic Mothers

Yıl 2008, Cilt: 13 Sayı: 3, 199 - 204, 01.06.2008

Saadet Akarsu A. Neşe Çitak Kurt Abdullah Kurt Erdal Yılmaz A. Denizmen Aygün

Öz

Objectives: The risk ratio for maternal hyperglycemia has been decreased with special care of diabetic mothers. But, the morbidity rate of infants born to diabetic mothers (DAB) is still high. The malformation ratio has been reported as 8% in infants of insulin dependent diabetic (IDDM) mothers. In this study, it was aimed to determine the clinical and laboratory findings in infants of diabetic mothers, demographic characteristics of these mothers and discuss the association of values between these groups. Materials and Methods: Total 22 infants born to mothers with diabetes mellitus were included in this study. Two (9%) of 22 mothers had been diagnosed with IDDM and twenty (92%) with gestational diabetes. Results: There was correlation between congenital malformation and duration of diabetes of mothers. No correlation were detected between HbA1c levels of mothers and respiratory distress syndrome, hypoglycemia, hypocalcaemia and polycythemia in infants. There was a positive correlation between the HbA1c levels of mothers and frequency of newborn jaundice. Hypoglycemia was detected in 34.5% of patients, hyperbilirubinemia in 50%, cardiac murmur in 32% RDS in 18%,delivery trauma in 14%, hypocalcaemia in 9%, polycythemia in 9%, thrombocytopenia in 4.5% and, hypothermia in 4.5% respectively. The malformation ratio was determined as 22% and the mortality rate 9%. Conclusion:The metabolic control of diabetic mothers should be made carefully during pregnancy. Perinatal mortality rate may be decreased with balance fetal weight gain. However, the other probable complications that not preventive.©2008, Firat University, Medical Faculty.

Anahtar Kelimeler

-

Diyabetik Anne Bebeğinde Klinik ve Laboratuar Bulguları

Öz

Amaç:Diyabetik annelerin gebelikte dikkatli izlemi ile maternal hiperglisemi azaltılmıştır. Buna rağmen diyabetik anne bebeği (DAB)'nde morbidite önemli oranda devam etmektedir. İnsüline bağımlı diyabet (IDDM) olan annelerin bebeklerinde malformasyon oranı %8 olarak saptanmıştır. Bizde, DAB'nde görülen klinik ve laboratuar bulguları ile; annelere ait demografik özellikleri ve bunların birbirleri ile ilişkilerini belirlemek istedik. Gereç ve Yöntem:Toplam 22 DAB değerlendirildi. Annelerden 2 (%9)'si IDDM ve 20 (%92)'si gestasyonel diyabet tanısı ile takip edilmekte idi. Bulgular: Annenin diyabet süresinin artması ile konjenital malformasyonlar arası ilişki saptanmadı. Annenin HbA1c seviyesi ile respiratuar distres sendromu, hipoglisemi, hipokalsemi ve polisitemi gelişimi arasında ilişki saptanmadı. Annenin HbA1c düzeyi arttıkça yenidoğan sarılığı görülme sıklığında artma saptandı (p

Anahtar Kelimeler

Diyabetik anne bebeği, komplikasyon

Kaynakça

• 1. Rajdl D, Racek J, Steinerova A, et al. Markers of oxidative stress in diabetic mothers and their infants during delivery. Physiol Res 2005; 54: 429-36.
• 2. Garcia-Patterson A, Erdozain L, Ginovart G, et al. In human gestational diabetes mellitus congenital malformations are related to pre-pregnancy body mass index and to severity of diabetes. Diabetelogia 2004; 47: 509-14.
• 3. Jolly M, Robinson S. The causes and effects of fetal macrosomia in mothers with type 1 diabetes. J Clin Pathol 2000; 53: 889.
• 4. Alur P, Kodiyanplakkal P, Del Rosario A, Khubchandani S, Alur R, Moore JJ. Epidemiology of infants of diabetic mothers in indigent Micronesian population-Guam experience. Pac Health Dialog 2002; 9: 219-21.
• 5. Wender-Ozegowska E, Wroblewska K, Zawiejska A, Pietryga M, Szczapa J, Biczysko R. Threshold values of maternal blood glucose in early diabetic pregnancy-prediction of fetal malformations. Acta Obstet Gynecol Scand 2005; 84: 17-25.
• 6. Lindsay RS, Bennett PH, Hanson RL, Knowler WC. Secular trends in birth weight, BM, and diabetes in the offspring of diabetic mothers. Diabetes Care 2000; 23: 1249-54.
• 7. Abu-Sulaiman RM, Subaih B. Congenital heart disease in infants of diabetic mothers: echocardiographic study. Pediatr Cardiol 2004; 25: 137-40.
• 8. Ferencz C. A case-control study of cardiovascular malformation in live born infants: the morphogenic relevance of epidemiological findings. In: Clark EB, Takao A (ed). Developmental cardiology: morphogenesis and function. Future, Mount Kisco, NY, pp 523- 39.
• 9. Miller E, Hare JW, Cloherty JP, et al. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med 1981; 304: 1331-4.
• 10. Giannakopoulou C, Korakaki E, Hatzidaki E, Manoura A, Aligizakis A, Velivasakis E. Peroneal nerve palsy: a complication of umbilical artery catheterization in the full-term newborn of a mother with diabetes. Pediatrics 2002; 109: e66.
• 11. Schwartz R, Teramo KA. What is the significance of macrosomia? Diabetes Care 1999; 22: 1201-5.
• 12. Sperling MA. The endocrine system. Diabetes mellitus. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics (16th ed). Philadelphia: WB Saunders Company, 2000; 1773. 13.
• 14. Rıza Madazlı, Abdullah Tüten, Zerrin Calay. Gestasyonel diyabetik gebeliklerde plasentaların değerlendirilmesi. Türkiye Klinikleri Jinekoloji-Obstetrik Dergisi 2007;17:89-93.
• 15. Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology 2001; 64:98-106.
• 16. Wong SF, Oats JJN, Chan FY, McInctyre DH. Fetal growth spurt and pregestational diabetic pregnancy. Diabetes Care 2002; 25: 1681-4.
• 17. Spilson SV, Kim HJ, Chung KC. Association between maternal diabetes mellitus and newborn oral cleft. Ann Plast Surg 2001; 47: 477-81.
• 18. Ng PC, Lee CH, Lam CW, Wong E, Chan IH, Fok TF. Plasma ghrelin and resistin concentrations are suppressed in infants of insülin-dependent diabetic mothers. J Clin Endocrinol Metab 2004; 89: 5563-8.
• 19. Cinaz P, Bideci A, Camurdan MO, Sen E, Camurdan AD. Plasma leptin levels in infants of diabetic mothers in fasting and satiety states. Turk J Pediatr 2004; 46: 142-6.
• 20. Vohr BR, McGarvey ST, Tucker R. Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age. Diabetes Care 1999; 22: 1284-91.
• 21. Alabdulgader AA. Congenital heart disease in 740 subjects; epidemiological aspects. Ann Trop Paediatr 2001; 21:111-8.
• 22. Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med 1998; 152: 249-54.
• 23. Sardesai MG, Gray AA, McGrath MM, Ford SE. Fatal hypertrophic cardiomyopathy in the fetus of a woman with diabetes. Obstet Gynecol 2001; 98: 925-7.
• 24. Salle BL, Delvin EE, Lapillonne A, Bishop NJ, Glorieux FH. Perinatal metabolism of vitamin D. Am J Clin Nutr 2000; 71: 1317-24.
• 25. Mehta KC, Kalkwarf HJ, Mimouni F, Khoury J, Tsang RC. Randomized trial of magnesium administration to prevent hypocalcemia in infants of diabetic mothers. J Perinatol 1998; 18: 352-6.
• 26. Botta RM. Congenital malformations in infants of 517 pregestational diabetic mothers. Ann Ist Super Sanita 1997; 33: 307-11.