Results of perinatal care of pregnant women with diabetes in Western Bohemia

Czech version

Authors: V. Korečko ¹; J. Landsmanová ¹; A. Mocková ²; T. Kutová ¹
Authors‘ workplace: Gynekologicko-porodnická klinika LF UK a FN, Plzeň, přednosta doc. MUDr. Z. Novotný, CSc. ¹; Neonatologické oddělení FN, Plzeň, primář doc. MUDr. J. Dort, Ph. D. ²
Published in: Ceska Gynekol 2014; 79(1): 43-47

Overview

Objective:
Detection of diabetic fetopathy in fetuses and neonates with diabetes. The incidence of early neonatal complications of diabetes and comparison with available literature sources.

Design:
Original work.

Setting:
Departement of Gynaecology and Obstetrics, University Hospital of Pilsen, Department of Neonatology University Hospital Pilsen.

Methodology:
In our study, we retrospectively evaluated 292 pregnant diabetic women who gave birth in our department in 2012. Before the birth were evaluated ultrasound signs of diabetic fetopathy by obstetrician, postnataly clinical signs of diabetic fetopathy by neonatologist and then their corelation was evaluated. The incidence of early neonatal complications: hypoglycemia, respiratory distress syndrome (RDS), admission newborn to neonatal intensive care unit were evaluated as well.

Results:
The total number of children with diabetic fetopathy rated by a neonatologist was 30, which is 10% of all children born to diabetic mothers in 2012 (299 children totaly, 8 twins). 30 infants (10%) were placed to the neonatal intensive care unit, 26 infants (8.7%) were treated for hypoglycemia, and RDS developed in 20 infants (6.7%). The correspondence between the ultrasound diagnosis of diabetic fetopathy and postnatal findings was only discovered in 38% of cases.

Conclusion:
In our study we have shown good results in perinatal care of pregnant diabetic patients in our center. The reason for the lower success rate in positive predicting of diabetic fetopathy are limitations in prenatal ultrasound diagnosis and its ambiguous evaluation criteria.

Keywords:
diabetes – newborn – diabetic fetopathy – hypoglycemia – respiratory distress syndrome

Sources

1. Breckwoldt, M., a kol. Gynekologie a porodnictví. Martin: Osveta, 1997, 648 s.

2. Carlson, KS., Smith, BT., Post, M. Insulin acts on the fibroblast to inhibit glucocorticoid stimulation of lung maturation. J Appl Physiol Respir Environ Exerc Physiol, 1984, 57, p. 1577–1579.

3. Creasy, R., et al. Creasy and Resnik‘s maternal-fetal medicine. 6th ed. Philadelphia: Elsevier , 2009, 1300 p.

4. James, D., et al. High risk pregnancy. 4th ed. St. Louis: Elsevier, 2011, 1504 p.

5. Kjos, SL., Walther, F., Montoro, M. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of lung maturation tests. Am J Obstet Gynecol, 1990, 163, p. 898–903.

6. Landon, M., Catalano, P., Gabbe, S. Diabetes mellitus complicating pregnancy. In Obstetrics: normal and problem pregnancies. 6th ed. Philadelphia: Elsevier, 2012, p. 888–918.

7. Landon, MB., Gabbe, SG., Piana, R., et al. Neonatal morbidity in pregnancy complicated by diabetes mellitus predictive value of maternal glycemic profiles. Am J Obstet Gynecol, 1987, p. 1089–1095.

8. Perušičová, J., et al. Diabetes mellitus 1. typu. 2. vyd. Praha: GEUM, 2008.

9. Smith, BT. Pulmonary surfactant during fetal development and neonatal adaptation: Hormonal control. In: Robertson, B., Van Golde, LMB., Batenburg, JJ., ed. Pulmonary Surfactant. Amsterdam: Elsevier, 1985, p. 357.

10. Škrha, J., et al. Diabetologie. Praha: Galén, 2009.

11. The HAPO Study Cooperative Research Group. Hyper-glycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes, 2009, 58, p. 453.

12. Zwinger, A., a kol. Porodnictví. Praha: Galén – Karolinum, 2004. 532 s.