problems associated with pregnancies complicated with diabetes

Perinatal morbidity and birth injuries will be high if the mother is diabetic during the pregnancy. Apart from these two conditions, other perinatal conditions associated with gestational diabetes are;
1. Perinatal mortality
2. Polycythemia
3. Hypoglycemia
4. Neonatal hypocalcemia
5. Postnatal hyperbilirubinemia
6. Respiratory problems
7. Hypertrophic cardiomyopathy

Perinatal mortality

Perinatal mortality is higher among the fetuses of diabetic mothers than that of nondiabetic mothers. The current perinatal mortality rates among diabetic women remain approximately twice those observed in the nondiabetic population.
Congenital malformations, respiratory distress syndrome (RDS) and extreme prematurity are the leading causes of most perinatal deaths in the context of diabetes during pregnancy. Because of intensive obstetrics and infant care, the perinatal mortality rate is going down. But this provides a major contribution to infant mortality in developing countries.
Birth injury

The factors which increase the birth injuries are macrosomia, prematurity, etc. These conditions are more prevalent among fetuses/infants of diabetic mothers. Common birth injuries associated with diabetes are brachial plexus trauma, facial nerve injury, cephalohematoma and shoulder dystocia.
Polycythemia

A central venous hemoglobin concentration greater than 20 g/dl or a hematocrit value greater than 65% (polycythemia) is not uncommon in infants of diabetic mothers (IDMs) and is related to glycemic control. Treatment with partial exchange transfusion to reduce the hematocrit may be required.


Hypoglycemia

Transient hypoglycemia is common during the first day of life from fetal hyperinsulism, but often be prevented by early feeding .The infant’s blood glucose should be closely monitored during first 24 hours and hypoglycemia treated. Unrecognized postnatal hypoglycemia may lead to neonatal seizures, coma, and brain damage.

Neonatal hypocalcemia

Up to 50% of IDMs have low levels of serum calcium (<7 mg/100 mL). With improved management of diabetes in pregnancy, this rate has been reduced. These changes in calcium appear to be attributable to a functional hypoparathyroidism, although the exact pathophysiology is not well understood.

Postnatal hyperbilirubinemia

Hyperbilirubinemia occurs in approximately 25% of IDMs, a rate approximately double that in a normal population. The causes of hyperbilirubinemia in IDMs are multiple, but prematurity and polycythemia are the primary contributing factors. Increased destruction of red blood cells contributes to the risk of jaundice and kernicterus.
The treatment of this complication is usually phototherapy, but exchange transfusions may be necessary if bilirubin levels are markedly elevated.

Respiratory problems
Neonatal respiratory distress syndrome (RDS) is one of the dreaded complications of gestational diabetes. This is due to the delayed lung maturation.