Effects of Maternal Hba1c Level on Infants of Diabetic Mother: A Prospective Observational Study in a Tertiary Care Hospital

Abstract

Background: The prevalence of diabetes in pregnancy is rising worldwide along with overweight & obesity. In-utero exposure to high blood sugar levels predisposes to numerous perinatal & neonatal complications. There is lack of available data on clinical profile and outcome of infant of diabetic mother (IDM), especially from developing nation like India. The available data in literature is from an era when HbA1c and oral hypoglycemic agents (OHA) were not recommended for diagnosis and management of diabetes complicating pregnancy. Hence, the present study was conducted with aim to look for perinatal outcome of infant of diabetic mother with reference to HbA1c level in mother.

Purpose: The purpose of the study was to look for the clinical profile & complications in babies born to diabetic mothers and to compare various complications seen in babies in relation to maternal HBA1C level.

Material & methods: It was a prospective observational study conducted from 1st January 2019 to 31st July 2020 in the department of Pediatrics & Neonatology, IMS & SUM Hospital, Bhubaneswar. All the babies delivered from diabetic mothers and all the large for gestational age (LGA) babies, where mother found to be diabetic retrospectively, were included in the study. Outborn babies delivered from diabetic mothers were excluded from the study.

Result: Out of total 2107 deliveries during the study period 72 live births were from mothers diagnosed to be diabetic. Among 72 infants of diabetic mothers (IDM) 67 babies were included in the study population (2=referral, 3=early discharge). Out of 67 mothers 51 had gestational diabetic mellitus (GDM) & rest were type 2 diabetes mellitus. The male: female ratio was 1.2:1. Around 55% babies were appropriate for gestational age (AGA) whereas macrosomia was seen in 13.4% of babies. Respiratory distress (43.3%) & perinatal depression (20.9%) were the most common complications at birth. The major early neonatal complications were hyperbilirubinemia (47.7%), hypocalcemia (23.8%), hypoglycemia (16.4%). High maternal HBA1C level (>7%) were significantly associated with neonatal complications, ie, LGA (p< 0.0001), birth trauma(p= 0.0019), hypoglycemia (p= 0.0001), hypocalcemia (p= 0.0001), prematurity (p= 0.019), birth asphyxia (p< 0.0001), congenital anomalies (p< 0.0001), respiratory distress syndrome (p= 0.0002).

Conclusion: Most of the IDM babies were appropriate for gestational age. Hyperbilirubinemia, large for gestational age, hypocalcemia and hypoglycemia were the most common complications in the infants of diabetic mother. Glycemic control better defines the neonatal complications and outcome rather than the type of diabetes in mother..