Infants of diabetic mothers

Nold, Joan L.; Georgieff, Michael

doi:10.1016/j.pcl.2004.01.003

Cited by 253 publications

(246 citation statements)

References 26 publications

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“…22,25,32,35,38,40 As hormonas da contrarregulação -glucagon e catecolaminas -são transitoriamente insuficientes para a mobilização do glicogénio e para ativação da gluconeogénese. 4,22,27,32,38 Em regra, o bom controlo metabólico associa-se a uma diminuição da ocorrência de hipoglicemia e seria previsível que tal acontecesse sobretudo nos recém--nascidos GIG e LIG, 22 o que não se verificou nesta série. A certificação da maternidade como Hospital Amigo dos Bebés, em 2007, incentivou a colocação dos RN em contacto pele-a-pele com a mãe logo após o momento do nascimento.…”

Section: 39unclassified

“…27,41 O risco de anomalias congénitas é elevado nas mulheres com diabetes pré-gestacional, sobretudo quando existe um insuficiente controlo glicémico, 35 e tem-se mantido está-vel apesar das estratégias para normalizar a glicemia no momento da embriogénese. 20,23,25,27,32 Nas mulheres com DG o risco poderá ser maior se na reclassificação se confirmar a diabetes tipo II. 23,31,35 Na nossa maternidade será previsível que esta prevalência seja ligeiramente superior, em virtude de se tratar de um hospital de apoio perinatal diferenciado com diagnóstico pré-natal.…”

Section: 39unclassified

“…1,3 Este aumento ocorre em paralelo com o aumento da idade, da obesidade e da diabetes tipo 2 na mulher em idade fértil. 1,5,6,8,11,12,16,20,23,[29][30][31][32] Há evidência para afirmar que um controlo adequado da glicemia minimiza a morbilidade materna e neonatal. [3][4][5]9,11,12,17,20,21,23,27,30,[33][34][35] Tem sido fulcral encontrar o método de rastreio de DG mais adequado, estabelecer os valores de referência para o diagnóstico, a idade gestacional (IG) ideal para o rastreio e definir qual a valorização dos fatores de risco.…”

Section: Introductionunclassified

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Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Mimoso

2018

Acta Pediátrica Port

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Introduction: Gestational diabetes has one of the highest rates of perinatal and obstetric complications of any disease. Early diagnosis and rigorous metabolic control are essential to reduce perinatal morbidity. Maternal hyperglycaemia causes fetal hyperglycaemia and hyperinsulinism and is responsible for most fetal complications, including prematurity, macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia. We assessed the evolution of neonatal morbidity in babies of women with gestational diabetes in the current pregnancy, seeking possible correlations between neonatal morbidity and maternal metabolic control. Methods:The study included all babies born in a level III maternity hospital whose mothers, followed at the same institution between 1994 and 2013, had single--fetus pregnancy complicated by diabetes. A perinatal database was used and morbidity and perinatal mortality were analysed over three periods, according to the diagnostic and therapeutic protocol in use.Results: There were 2440 women who met the inclusion criteria. Over the study period, gestational diabetes was diagnosed earlier, insulin therapy was used more frequently, there were fewer macrosomic newborns, and morbidity associated with gestational diabetes decreased. However, in the last three years the number of smaller for gestational age newborns, neonatal hypoglycaemia, and congenital anomalies all increased. Discussion: Our analysis enabled us to characterise the main steps in the follow-up of women with gestational diabetes. In the last three years of the study period (2011)(2012)(2013), an increase in neonatal morbidity was observed, which needs to be explained and monitored.Keywords: Diabetes, Gestational; Diabetes Mellitus, Infant, Newborn, Diseases; Neonatal; Morbidity; Pregnancy Complications Introdução: A diabetes gestacional é uma das complicações médicas mais frequentes na gravidez. O diagnóstico mais precoce e o rigor do controlo metabólico são fundamentais para diminuir a morbilidade perinatal. A hiperglicemia materna ao induzir hiperglicemia fetal e consequente hiperinsulinismo, é responsável pela maioria das complicações do feto e no recém-nascido. Pretendeu-se avaliar a evolução da morbilidade neonatal de filhos de mães com diabetes gestacional explorando as possíveis correlações entre a morbilidade neonatal e o controlo metabólico materno. Métodos: Estudo observacional analítico, retrospetivo descritivo de recém-nascidos de mães com diabetes gestacional com gravidez unifetal seguidas numa maternidade de nível III no período de 1994 e 2013, com recurso à informação clínica de ambos, recolhida de um modo longitudinal sistemático e armazenada em base de dados. Analisou-se a evolução da morbilidade e mortalidade perinatal em três períodos, agrupados de acordo com o protocolo de diagnóstico e de terapêutica utilizado. Resultados: Analisaram-se 2440 díades mãe-filho. Nestes 20 anos o diagnóstico de diabetes gestacional foi mais precoce, a administração de insulinoterapia mais frequente o que condicionou menor número d...

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Section: Introductionunclassified

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Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Mimoso

2018

Acta Pediátrica Port

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“…It may cause spontaneous abortion, preeclampsia, hypertension, polyhydramnios, hypoglycemia, and ketoacidosis in pregnant women and a variety of anomalies and complications such as macrosomia, intrauterine growth restriction, and preterm delivery in the fetus (4). Although maternal hyperglycemia is diminished by current pregnancy follow-ups, the morbidity of infants of diabetic mothers (IDM) still remains important.…”

Section: Introductionmentioning

confidence: 99%

Infant of a Diabetic Mother with Spondylocostal Dysostosis and Multiple Congenital Anomalies

Toptan¹,

Karadağ²,

Tüten³

et al. 2017

Istanbul Med J

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Fetal development is adversely affected in infants of diabetic mothers. Poorly controlled diabetes in these mothers increases the incidence of congenital anomalies. The most common congenital anomalies are congenital heart disease, caudal regression syndrome, and central nervous system anomalies. The mortality rate of infants of diabetic mothers with cardiac malformations is higher. Jarcho-Levin syndrome, also known as spondylocostal dysostosis (SCD), is a rare genetic disorder with an unknown cause that manifests with respiratory failure, multiple spines, ribs, and other abnormalities. Here is a case of SCD with multiple congenital anomalies in the infant of a diabetic mother presented.

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“…Polycythemia was diagnosed if the venous hematocrit exceeds 65%; hypocalcaemia was defined as serum calcium <7mg/dl. [9][10][11][12] Billirubin level was estimated at the clinical appearance of jaundice or on day4 if not evident clinically and hyperbillirubinemia was diagnosed based on standard guidelines. 13 Chest X ray was done in all infants with respiratory problems and/or heart murmur.…”

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confidence: 99%

Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

Meher

Parida

Pradhan

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups. Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia. Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018). Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

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Infants of diabetic mothers

Cited by 253 publications

References 26 publications

Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

Infant of a Diabetic Mother with Spondylocostal Dysostosis and Multiple Congenital Anomalies

Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

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