Perinatal morbidity and mortality in offspring of diabetic mothers in Qatif, Saudi Arabia

Abstract

Diabetic mothers and their offspring were prospectively studied. Perinatal and neonatal morbidity and mortality data were analysed. Out of 11,677 deliveries in the hospital, 133 (1.14%) were delivered by diabetic mothers. They were made up of six (4.5%) stillbirths and 127 (95.5%) live births. Seventy-seven (57.9%), 55 (41.3%) and 1 (0.8%) were large, appropriate and small for gestational age, respectively. Hypoglycemia occurred in 49 (38.6%) of the 127 infants. Other associated problems were bacterial infections, congenital anomalies, birth trauma, preterm delivery, respiratory distress, polycythaemia and anaemia. Only 52 (39.1%) of the mothers received appropriate treatment for their diabetes during pregnancy. Poor maternal diabetic control resulted in high perinatal morbidity and mortality in the offspring. In order to improve the outcome in offspring of diabetic mothers in Qatif and probably Saudi Arabia as a whole, health education and improved care of the diabetic mothers during pregnancy urgently needed. This may be true of other developing countries where data on diabetes in pregnancy are scarce.

PIP: In Saudi Arabia, pediatricians compared data on infants of 52 mothers who received insulin therapy during pregnancy (group A) with data on infants of 81 mothers who either did not receive insulin therapy during pregnancy or prenatal care (group B) to evaluate the outcome in infants of diabetic mothers (IDMs) managed at Qatif Central Hospital. These 133 IDMs comprised 1.14% of the 11,677 deliveries at this hospital during 1988-92. 19.7% of all mothers had gestational diabetes mellitus. Mothers in group A were younger than those in group B (31.5 vs. 35.1 years; p 0.01). They were less likely than those in group B to suffer fetal loss (23.1% vs. 53.1%; p 0.001 and [mean fetal loss] 0.62 vs. 1.33; p 0.05). All six stillbirths (2 in group A and 4 in group B) were large for gestational age (LGA) (4.543 vs. 3.753 kg for overall birth weight; p 0.001). One stillbirth was macerated and had multiple congenital anomalies including Down's syndrome. Two liveborn IDMs also had Down's syndrome. There were no early neonatal deaths. The perinatal mortality rate (PMR) was not significantly different between the groups, but the PMR for both groups was higher than it was for the same period for the hospital overall (45.1 vs. 16.6/1000; p 0.02). 57.9% of IDMs from both groups were LGA. 38.6% of all IDMs had a blood glucose level less than 30 mg/dl. Other problems identified in IDMs included bacterial infections, birth trauma, preterm delivery, respiratory distress, polycythemia, and anemia. These findings suggest that poor maternal diabetic control contributed to the high perinatal morbidity and mortality in IDMs. Health education and improved care of diabetic pregnant women are seriously needed.