Retrospective evaluation of clinical and laboratory pathologies in diabetic mothers baby

AİM: This study was aim of evaluating the malformations, clinical, laboratory findings in the perinatal and postnatal period of infants of Diabetic Mothers (IDM) who were hospitalized in the Neonatal Intensive Care Unit (NICU) and Neonatology Service of Karadeniz Technical University (KTU) Health Application and Research Center, and their comparison according to the types of maternal diabetes mellitus (DM). MATERIAL AND METHOD: The study was conducted on 600 IDM who were hospitalized, examined and treated between 01 January 2010 and 30 August 2019 in the KTU Health Practice and Research Center Farabi Hospital NICU and Neonatology Service. The cases were divided into three groups according to the DM types of their mothers: Type-1 DM, Type-2 DM, and babies of mothers with Gestational DM. Demographic characteristics, clinical disorders and laboratory abnormalities of all IDM were recorded. At the same time, demographic characteristics of mothers, diabetes types (Type-1, Type-2 DM, Gestational DM = GDM) and diabetes control status were recorded. All these data were given both as a total and by comparison according to the groups. RESULTS: Of 600 cases, 531 (88.5%) were infants of mothers with the GDM, 34 (5.7%) with Type-1 DM, and 35 (5.8%) with Type-2 DM. Of the cases, 266 (44.3%) were female and 334 (55.7%) were male. Of the cases with a mean gestational week of 36.8, 197 (32.8%) were defined as premature and 403 (67.2%) as mature. Of the cases with a mean birth weight of 3284 ±845 grams, 18.5% were evaluated as low birth weight, 66% as normal birth weight and 15.5% as large infants. 55 (9.2%) of the cases were small for the gestational age, 398 (66.3%) were weighted appropriate for the gestational age, and 147 (24.5%) were large for the gestational age. The incidence of prematurity in the Type-2 DM (60.0%) group was found to be statistically significantly higher than the Type-1 (41.1%) and Gestational DM (30.5%) groups (p<0.001). There was no statistically significant difference between the groups in terms of other demographic characteristics of the babies (p>0.05). The most common malformations in the cases were related to the cardiovascular system (63.2%) and frequency of CVS malformation in the Gestational (64.4%) and Type-1 DM (64.7%) groups was statistically significantly higher than Type-2 (42.9%) (p<0.05). The most common clinical disorders are respiratory distress syndrome (RDS) (18.0%) and transient tachypnea of the newborn (8.0%), respectively. RDS incidence in Type-1 (23.5%) and Type-2 DM (34.3%) groups, ıt was found to be statistically significantly higher than the Gestational DM (16.6%) group (p<0.05). There was no statistically significant difference between the groups in terms of other malformations and clinical disorders (p>0.05). The most common laboratory abnormalities were hypocalcemia (30.3%), hypomagnesemia (27.6%), hypoglycemia (25.0%) and hyperbilirubinemia (22.7%), in order of frequency, and there was no statistically significant difference between the groups in terms of the frequency of these abnormalities (p>0.05). In all cases, The mean calcium (Ca) values measured at 12-hour intervals starting from the time of birth and at least until the end of the postnatal 48 hours were found to be significantly lower than those measured at the beginning (p<0.05). The mean Ca values measured at the beginning in the Type-1 and Type-2 DM groups were found to be statistically significantly lower than in the Gestational DM group (p<0.05). The frequency of diagnosis of hypocalcemia was 17.0% at baseline (0 hour), 31.9% at 12th and 24th hours, 13.7% at 36th hours and 5.5% at 48th hours. In 83% of the cases, the diagnosis was made after the onset time (0 hour). The most common diagnosis time was 12th hour (34.0%) in the Gestational DM group, 24th hour (58.3%) in the Type-1 DM group and 0 and 24th hours (36.4%) in the Type-2 DM group. The mean magnesium (Mg) values measured at the beginning of the cases were found to be significantly lower than those measured at other hours (p<0.05). There was no statistically significant difference between the groups in terms of mean Mg values (p>0.05). The frequency of diagnosis of hypomagnesemia was 73.5% at the beginning (0 hour), 17.5% at the 12th hour, 6.0% at the 24th hour, 1.2% at the 36th hour and 1.8% at the 48th hour, and it was seen that 26.5% of the cases were diagnosed in the hours after the onset. There was no statistically significant difference between the groups in terms of the frequency of diagnosis of hypomagnesemia (p>0.05). The frequency of hypoglycemia was 25% in all cases, and there was no significant difference between the groups (p>0.05). The diagnosis of hypoglycemia was made most frequently in the first day (76.6%). There was no statistically significant difference between the groups in terms of the frequency and recovery time of hypocalcemia, hypomagnesemia and hypoglycemia in pairs or triplets (p>0.05). CONCLUSION: Appropriate prenatal, natal and postnatal conditions should be prepared and necessary precautions should be taken in order to prevent malformation, clinical and laboratory problems frequently seen in that have been known to be associated with IDM for many years and can lead to life-threatening results. These babies have serious and potentially fatal congenital malformations; clinical disorders such as RDS and transient tachypnea of the newborn that may occur in the neonatal period; In terms of laboratory abnormalities such as hypocalcemia, hypomagnesemia and hypoglycemia, they should be followed up, examined and treated as soon as they are born. However, as far as we know from the cases referred to our Unit, most of the IDM are given to their mothers at the time of birth or sent to their homes in the early hours due to the reasons such as symptom-free and normal laboratory tests at the time of birth, families wanting their babies to stay with them and early discharge. Whereas; as it can be understood from the literature data and the findings obtained in this study, a significant portion of laboratory abnormalities in IDM develop hours after birth, and sequelae and death are inevitable if they are not hospitalized and followed closely.