Gestational diabetes fetal complications
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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.