A study of the complications in infants of diabetic mothers in a rural hospital in Western Maharashtra

Abstract

Background: Diabetes Mellitus is a group of metabolic diseases characterized by chronic hyperglycaemia associated with disturbances of carbohydrate, fat and protein metabolism due to absolute or relative deficiency in insulin secretion and or action. Historically, infants of diabetic mothers (IDMs) have been at significantly greater risk for spontaneous abortion, still birth, congenital malformations and perinatal morbidity and mortality. IDMs have quadruple the incidence of admission to a new-born intensive care unit.

Aims and objectives: To know complications in infants of diabetic mothers.

Methods: This is a descriptive cross-sectional study that was conducted at the department of paediatrics, Dr. Vitthalrao Vikhe Patil Pravara Rural hospital Loni, Maharastra, India, performed on infants born to diabetic mothers from Feb 2022 to Dec 2023.

Results: 34 infants were included in the study. 2 infants were born of twin pregnancy. So total 33 mothers formed mothers of the sample size. Low birth weight (<2.5 Kg) was observed in 20.6 % of babies and macrosomia (>4 Kgs) was seen in 6% of the babies. 44.1 % weighed between 3-4 Kgs at birth. Hypoglycaemia was the commonest complication seen in 28 (84.8%) IDMs followed by respiratory distress in 11 (33.3%) and congenital anomalies in 11 (32.4%) IDMs. Hypocalcaemia was the least common complication seen in 1 (3%) IDM. None of the IDMs sustained any birth injuries. One baby with a major congenital malformation (sirenomelia) dies within 20 minutes of birth. Hypoglycaemia was more commonly observed in IDMs with birth weight <2.5 Kgs (83.3%) and >3 Kgs (100%) whereas this complication was least common in IDMs weighing 2.5-3 Kgs at birth (P<0.049). Hypoglycaemia was most commonly observed in IDMs at less than 6 hours of postnatal age whereas it was less common at 6-24 hours (12.1%) and 24-48 hours (9.1%) of postnatal age (P < 0.000). This observation was highly statistically significant. ASD was the most common cardiac anomaly observed in IDMs (27.3%) and only 1 (3.0%) IDM had a combination of ASD, VSD, and PDA (P < 0.01).

Conclusion: The neonatal complications commonly seen in infants of diabetic mothers are macrosomia, birth asphyxia, congenital anomalies, respiratory distress, hypoglycaemia, hypocalcaemia, hyperbilirubinemia, and polycythaemia. There are no significant differences in neonatal morbidity profiles of IDMs born to pre-gestational and gestational diabetic mothers. Management goals in pregnancies complicated by diabetes mellitus should be to achieve optimal glycaemic control, as neonatal complications are more common in women with suboptimal glycaemic control.