September 12, 2016
EASD: Diabetes in Mom Signals Risk for Baby
Dr. Jennifer Wu, Ob/Gyn, Lenox Hill Hospital
MUNICH -- Neonates are more likely to have complications following birth if they are born to women who have been diagnosed with gestational diabetes or who had diabetes prior to becoming pregnant, researchers reported here.
Babies from these mothers, for example, were 10 times to 36 times more likely to be at risk of neonatal hypoglycemia, reported lead author Basilio Pintuadi, MD, Niguarda Ca' Granda Hospital, Milan.
In his poster presentation at the annual meeting of the European Association for the Study of Diabetes, Pintuadi reported that those differences were significant -- in children born to women with gestational diabetes (OR=10.1, 95% CI 8.5-11.) and (OR=36.0, 95% CI 27.1-47.8) in children born to mothers whose diabetes preceded contraception.
"Both gestational diabetes and diabetes in the mother when she becomes pregnant are associated with adverse outcomes in the baby independently of the presence of other clinical conditions complicating the pregnancy," Pintuadi reported. "Greater attention should be placed to the care of pregnant women with gestational diabetes or diabetes. Others clinical conditions, primarily represented by hypertensive and thyroid disorders, could complicate pregnancy outcome."
He and colleagues also found several other abnormalities among these children selected through administrative data from the Italian Puglia region from 2002 until 2012. The researchers identified 135,163 pregnancies, and of that group, 1,357 of the pregnancies involved gestational diabetes and 234 pregnancies involved women who were diabetic before they achieved pregnancy.
When compared with neonates whose mother has normal glucose levels, babies born to women with gestational diabetes were more likely to be either small for gestational age or large for gestational age -- the odds ratio in both cases was 1.7, (95% CI for small for gestational age was 1.4-2.0 and for large gestational age it was 1.3-2.1).
Compared to controls, babies born to women with pre-existing diabetes had almost six times more likely to be small at birth (OR 5.8, 95% CI 4.4-7.7) and the relative risk of delivering a large for gestational age baby was even greater (OR 7.9, 95% CI 5.7-10.9).
Jaundice -- a 70% greater risk in children who were born to gestational diabetic mothers (OR=1.7, 95% CI 1.5-2.0); a 2.6-fold increased risk if the mother had diabetes before getting pregnant (OR=2.6 95% CI 1.8-3.6).
Fetal malformations -- a 2.2-fold increased risk in women with gestational diabetes (OR=2.2, 95% CI 1.7-2.8); a 3.5-fold risk in mothers who were diabetic prior to pregnancy (OR=3.5, 95% CI 2.2-5.7).
Hypocalcemia/hypomagnesemia of newborn -- an 80% increased risk among women diagnosed with gestational diabetes (OR=1.8, 95% CI 1.2-3.0); a 9.2-fold risk in women who were diabetic at conception (OR=9.2, 95% CI 5.5-15.5).
Cesarean delivery -- a 90% greater risk in gestational diabetics (OR=1.9 95% CI 1.7-2.2); and 8.5-fold increased risk in women who were already diabetic when they conceived (OR=8.5 95% CI 5.6-12.9) compared with pregnancies with normal glucose tolerance.
Pintuadi also found that pre-gestational diabetes but not gestational diabetes was associated with a baby's higher risk of respiratory distress and polidramnios.
"Babies of diabetics and gestational diabetes face significantly higher risks," said Jennifer Wu, MD, an obstetrician/gynecologist at Lenox Hill Hospital, New York City.
"These risks include disorders in growth, jaundice, malformations and cesarean rate," she told MedPage Today. "The risks are higher for diabetics than in gestational diabetics. Proper diagnosis and observation of these patients is essential and may help to catch an early risk factor."
In the study, Pintuadi and his team identified single pregnancies that were complicated by gestational diabetes or pre-diabetes. Risks of adverse neonatal outcomes were estimated by computer modelling after adjusting for age, hypertensive and thyroid disorders and drug use with drug use indicating higher pregnancy complexity.
September 13, 2016
Diabetes During Pregnancy Could Pose Harm to Baby
Dr. Jennifer Wu, Ob/Gyn, Lenox Hill Hospital & Dr. Navid Mootabar, Chief, Ob/Gyn, Northern Westchester Hospital & Dr. Navid Mootabar, Chief, Ob/Gyn, Northern Westchester Hospital