CARDIOVASCULAR MORBIDITY OF INFANTS OF DIABETIC MOTHERS AND ITS ASSOCIATION WITH MATERNAL GLYCAEMIC CONTROL ACCORDING TO HbA1c

Abstract

BACKGROUNDMaternal diabetes mellitus is a relatively common disease that complicates pregnancy and results in an increased incidence of congenital malformations, predominantly congenital heart disease. Glycated haemoglobin (HbA1c) is accepted as an indicator of glycaemic control and correlates with increased risk of congenital anomalies. There is lack of enough studies in India addressing the relationship between the level of glycaemic control in diabetic pregnancy and the incidence of congenital cardiac anomalies.The objective of this study was to determine the cardiovascular morbidity of infants of diabetic mother and to study the association between the maternal glycaemic control according to HbA1c and the cardiac status of the baby. Another objective was to estimate the frequency of various congenital heart defects in such infants. We also looked at possible relationship between variables like birth weight of the neonates and the need for insulin to control maternal diabetes and incidence of congenital heart disease.Design-Descriptive study. Setting-Tertiary care government medical college hospital in Kerala catering to urban and rural population belonging predominantly to the lower socio-economic strata. MATERIALS AND METHODSAll the antenatal women with positive Glucose Tolerance Test (GTT) admitted over a period of 8 months were included in the study. They were interviewed using a semistructured questionnaire and HbA1c testing was done within the third postnatal day. The cardiological status of the babies was assessed clinically and by ECHO within the first week after birth. RESULTSOut of total 71 diabetic women, 68(96%) had gestational diabetes and 3(4%) had overt diabetes; 14 babies (20%) were large for gestational age and 4(5%) were small for gestational age; 47