Severe diabetic fetopathy despite strict metabolic control

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Neonatology

Background:

• Diabetes mellitus (DM) in pregnancy poses risks like hypertension, pre-eclampsia, macrosomia, and fetal death.
• Optimal metabolic control, from preconception through postpartum, is essential for maternal and fetal well-being.
• Type 2 DM management in pregnancy often requires transitioning from oral agents to insulin therapy.

Observation:

• A 35-year-old primipara with type 2 DM, managed with insulin from 21 weeks gestation, showed generally controlled blood glucose.
• Fetal growth was initially discreet but showed rapid abdominal enlargement around 31 weeks gestation, coinciding with lower maternal glycemic values.
• Ultrasound monitoring revealed excessive fetal growth, leading to a cesarean section at 35 weeks gestation due to macrosomia.

Findings:

• The newborn presented with severe hypoglycemia (10 mg/dl) at birth, requiring immediate glucose administration.
• The infant needed respiratory support and both enteral and parenteral glucose for the first seven days postpartum.
• Despite initial complications, both mother and child were discharged in good condition 19 days postpartum.

Implications:

• This case underscores the complexity of managing glucose tolerance disturbances during pregnancy.
• It emphasizes the critical role of fetal monitoring via ultrasound in detecting potential complications.
• Maternal blood glucose levels alone may not fully reflect the fetus's metabolic status, necessitating comprehensive monitoring.