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Offspring of diabetic mothers. Problems of morbidity
Insights
Infants of diabetic mothers still face neonatal health issues. New therapies show promise but alter morbidity profiles, impacting long-term growth and development.
Area of Science:
- Perinatology
- Neonatology
- Endocrinology
Background:
- Infants of diabetic mothers (IDMs) experience significant neonatal morbidity, including metabolic and functional abnormalities and macrosomia.
- While malformation rates have decreased, remaining morbidities and their long-term effects on somatic development require further investigation.
Purpose of the Study:
- To quantify neonatal morbidity in a large cohort of infants of diabetic mothers.
- To evaluate the impact of different glycemic and insulin-based therapeutic strategies on neonatal outcomes.
- To assess the relationship between neonatal findings and somatic development in early childhood.
Main Methods:
- A study of 443 neonatal infants of diabetic mothers.
- Mothers received insulin treatment based on HbA1c and blood glucose (n=340) or additionally on amniotic fluid insulin concentration (n=103).
- A new four-stage classification of fetopathy was developed, with a pilot study assessing 160 infants at four years of age.
Main Results:
- Therapeutic strategies influenced the neonatal morbidity profile.
- Additional control with amniotic fluid insulin reduced macrosomia and striking phenotypes but increased small-for-gestational-age infants and hypoglycemia.
- Only purely macrosomatic infants exhibited a tendency towards later obesity and accelerated growth.
Conclusions:
- Neonatal morbidity in infants of diabetic mothers has evolved with therapeutic advancements.
- Targeted insulin monitoring in pregnancy may alter neonatal outcomes, necessitating careful follow-up.
- Long-term somatic development is influenced by specific neonatal phenotypes observed in IDMs.
Abstract:
In the past decade, malformation rates and life-threatening neonatal disorders of infants of diabetic mothers have been lowered to a marked degree. However, the remaining neonatal morbidity (metabolic and functional abnormalities and macrosomia) is still rather high. The meaning of these signs and symptoms for the further somatic development is unclear. A study comprising 443 neonatal infants of diabetic mothers was performed in order to quantify the morbidity. In 340 of the mothers, insulin treatment during pregnancy was based on HbA1c and blood glucose values; in the remaining 103 women, it was additionally controlled by measurement of insulin concentration in the amniotic fluid. A new classification of fetopathy at four different stages was established as a basis for further follow-up. In preparation of the latter, a pilot study including 160 infants in their fourth year of life was conducted to test the hypothesis that the further somatic growth is related to neonatal findings. The results demonstrate that the neonatal morbidity profile has changed with therapy. Metabolic control based additionally on insulin concentration in the amniotic fluid has resulted (1) in less infants with macrosomia and/or with striking phenotype but (2) also in a increase of small-for-gestational-age infants and of the frequency of hypoglycaemia. Only purely macrosomatic infants showed a tendency towards obesity and length acceleration in their fourth year of life.