Gestational diabetes fetal complications: Difference between revisions
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==Overview== | ==Overview== | ||
Poor glycemic control and increased insulin level may result in increased metabolic demands in fetus which secondarily leads to fetal and neonatal complications. [[Large for gestational age]], [[prematurity]], [[Neonatal respiratory distress syndrome|respiratoray distress syndrome]], [[hyperbilirubinemia]], [[polycythemia]] and [[congenital anomalies]] are the most common complications for GDM mother's neonates. | |||
==Fetal complications== | ==Fetal complications== | ||
*Poor glycemic control during pregnancy may lead to some fetal | *Poor glycemic control during pregnancy may lead to some fetal complications. Congenital malformations are the most common complications seen in GDM compared to healthy mothers.<ref name="pmid24331686">{{cite journal |vauthors=Mitanchez D, Burguet A, Simeoni U |title=Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health |journal=J. Pediatr. |volume=164 |issue=3 |pages=445–50 |year=2014 |pmid=24331686 |doi=10.1016/j.jpeds.2013.10.076 |url=}}</ref> | ||
*Maternal hyperglycemia will lead to hyperinsulinemia which secondarily will result in fetal macrosomia. | *Maternal hyperglycemia will lead to [[hyperinsulinemia]] which secondarily will result in fetal [[macrosomia]]. | ||
*Fetal macrosomia results in increased metabolic demands that finally will cause increased mortality, metabolic acidosis, alterations in fetal iron distribution, increased erythropoiesis and resulting polycythemia.<ref name="pmid15157588">{{cite journal |vauthors=Nold JL, Georgieff MK |title=Infants of diabetic mothers |journal=Pediatr. Clin. North Am. |volume=51 |issue=3 |pages=619–37, viii |year=2004 |pmid=15157588 |doi=10.1016/j.pcl.2004.01.003 |url=}}</ref><ref name="pmid2199280">{{cite journal |vauthors=Widness JA, Teramo KA, Clemons GK, Voutilainen P, Stenman UH, McKinlay SM, Schwartz R |title=Direct relationship of antepartum glucose control and fetal erythropoietin in human type 1 (insulin-dependent) diabetic pregnancy |journal=Diabetologia |volume=33 |issue=6 |pages=378–83 |year=1990 |pmid=2199280 |doi= |url=}}</ref> | *Fetal [[macrosomia]] results in increased metabolic demands that finally will cause increased mortality, [[metabolic acidosis]], alterations in fetal iron distribution, increased [[erythropoiesis]] and resulting [[polycythemia]].<ref name="pmid15157588">{{cite journal |vauthors=Nold JL, Georgieff MK |title=Infants of diabetic mothers |journal=Pediatr. Clin. North Am. |volume=51 |issue=3 |pages=619–37, viii |year=2004 |pmid=15157588 |doi=10.1016/j.pcl.2004.01.003 |url=}}</ref><ref name="pmid2199280">{{cite journal |vauthors=Widness JA, Teramo KA, Clemons GK, Voutilainen P, Stenman UH, McKinlay SM, Schwartz R |title=Direct relationship of antepartum glucose control and fetal erythropoietin in human type 1 (insulin-dependent) diabetic pregnancy |journal=Diabetologia |volume=33 |issue=6 |pages=378–83 |year=1990 |pmid=2199280 |doi= |url=}}</ref> | ||
*Stillbirth is another complication of GDM which is because of increased catecholamine release, hypertension and increased cardiac workload.<ref name="pmid8299468">{{cite journal |vauthors=Kitzmiller JL |title=Sweet success with diabetes. The development of insulin therapy and glycemic control for pregnancy |journal=Diabetes Care |volume=16 Suppl 3 |issue= |pages=107–21 |year=1993 |pmid=8299468 |doi= |url=}}</ref> Hypertrophic cardiomyopathy due to increased oxidative stress is another cause of stillbirth in hyperglycemic mothers.<ref name="pmid25934526">{{cite journal |vauthors=Topcuoglu S, Karatekin G, Yavuz T, Arman D, Kaya A, Gursoy T, Ovalı F |title=The relationship between the oxidative stress and the cardiac hypertrophy in infants of diabetic mothers |journal=Diabetes Res. Clin. Pract. |volume=109 |issue=1 |pages=104–9 |year=2015 |pmid=25934526 |doi=10.1016/j.diabres.2015.04.022 |url=}}</ref> | *'''[[Stillbirth]]''' is another complication of GDM which is because of increased [[catecholamine]] release, [[hypertension]] and increased cardiac workload.<ref name="pmid8299468">{{cite journal |vauthors=Kitzmiller JL |title=Sweet success with diabetes. The development of insulin therapy and glycemic control for pregnancy |journal=Diabetes Care |volume=16 Suppl 3 |issue= |pages=107–21 |year=1993 |pmid=8299468 |doi= |url=}}</ref> [[Hypertrophic cardiomyopathy]] due to increased [[oxidative stress]] is another cause of stillbirth in hyperglycemic mothers.<ref name="pmid25934526">{{cite journal |vauthors=Topcuoglu S, Karatekin G, Yavuz T, Arman D, Kaya A, Gursoy T, Ovalı F |title=The relationship between the oxidative stress and the cardiac hypertrophy in infants of diabetic mothers |journal=Diabetes Res. Clin. Pract. |volume=109 |issue=1 |pages=104–9 |year=2015 |pmid=25934526 |doi=10.1016/j.diabres.2015.04.022 |url=}}</ref> | ||
==Neonatal complications== | ==Neonatal complications== | ||
Insulin resistance, hyperinsulinemia and increased metabolic demands may result in neonatal co-morbidities including, | Insulin resistance, hyperinsulinemia and increased metabolic demands may result in neonatal co-morbidities including, large for gestational age, prematurity, respiratory distress syndrome, hyperbilirubinemia and polycythemia. Following table described them based on observed frequency.<ref name="pmid9529462" /> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Poor glycemic control and increased insulin level may result in increased metabolic demands in fetus which secondarily leads to fetal and neonatal complications. Large for gestational age, prematurity, respiratoray distress syndrome, hyperbilirubinemia, polycythemia and congenital anomalies are the most common complications for GDM mother's neonates.
Fetal complications
- Poor glycemic control during pregnancy may lead to some fetal complications. Congenital malformations are the most common complications seen in GDM compared to healthy mothers.[1]
- Maternal hyperglycemia will lead to hyperinsulinemia which secondarily will result in fetal macrosomia.
- Fetal macrosomia results in increased metabolic demands that finally will cause increased mortality, metabolic acidosis, alterations in fetal iron distribution, increased erythropoiesis and resulting polycythemia.[2][3]
- Stillbirth is another complication of GDM which is because of increased catecholamine release, hypertension and increased cardiac workload.[4] Hypertrophic cardiomyopathy due to increased oxidative stress is another cause of stillbirth in hyperglycemic mothers.[5]
Neonatal complications
Insulin resistance, hyperinsulinemia and increased metabolic demands may result in neonatal co-morbidities including, large for gestational age, prematurity, respiratory distress syndrome, hyperbilirubinemia and polycythemia. Following table described them based on observed frequency.[6]
| Neonatal complications | Frequncy♦ | |
|---|---|---|
| GDM |
|
|
♦ Based on a survey on GDM mothers[6]
† Birth weight greater than the 90th percentile
‡ 14% with gestational age <34 weeks and 22% with GA between 34 and 37 weeks
References
- ↑ Mitanchez D, Burguet A, Simeoni U (2014). "Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health". J. Pediatr. 164 (3): 445–50. doi:10.1016/j.jpeds.2013.10.076. PMID 24331686.
- ↑ Nold JL, Georgieff MK (2004). "Infants of diabetic mothers". Pediatr. Clin. North Am. 51 (3): 619–37, viii. doi:10.1016/j.pcl.2004.01.003. PMID 15157588.
- ↑ Widness JA, Teramo KA, Clemons GK, Voutilainen P, Stenman UH, McKinlay SM, Schwartz R (1990). "Direct relationship of antepartum glucose control and fetal erythropoietin in human type 1 (insulin-dependent) diabetic pregnancy". Diabetologia. 33 (6): 378–83. PMID 2199280.
- ↑ Kitzmiller JL (1993). "Sweet success with diabetes. The development of insulin therapy and glycemic control for pregnancy". Diabetes Care. 16 Suppl 3: 107–21. PMID 8299468.
- ↑ Topcuoglu S, Karatekin G, Yavuz T, Arman D, Kaya A, Gursoy T, Ovalı F (2015). "The relationship between the oxidative stress and the cardiac hypertrophy in infants of diabetic mothers". Diabetes Res. Clin. Pract. 109 (1): 104–9. doi:10.1016/j.diabres.2015.04.022. PMID 25934526.
- ↑ 6.0 6.1 Cordero L, Treuer SH, Landon MB, Gabbe SG (1998). "Management of infants of diabetic mothers". Arch Pediatr Adolesc Med. 152 (3): 249–54. PMID 9529462.