[Child of insulin-dependent diabetic mother: neonatal impact]

Abstract

Pregnancy and diabetes mellitus have been associated to a high incidence of neonatal morbidity and mortality. The purpose of the present study was to determinate the incidence of macrosomia, congenital malformations and their effect in the neonatal period. We review 42 live infants of insulin dependent diabetic mothers (IDDM) in a third level center. The variables analyzed were: severity of maternal diabetes, sex, weight, gestational age, trophism, Apgar score at one minute, mode of delivery, presence of congenital malformations, morbidity and mortality. The population was divided in three groups: 1. Neonates with appropriate for gestational age (AGA), 2. Large for gestational age (LGA), and 3. Small for gestational age (SGA). According to trophism, 27 (64%) were AGA, eleven (26%) were LGA and four (9%) were SGA. About morbidity, hypoglycemia was more frequent in the LGA. The group of SGA had lower Apgar score at one minute compared with the AGA. There were congenital malformations in seven neonates and being more frequent in the SGA group. The proportion of major malformation was of 4.7%. Fetal hyperinsulinemia is responsible for the morbidity of IDDM, being necessary adequate metabolic control of the mothers before pregnancy and the management of diabetes and pregnancy should be done in a center with experience.