| المستخلص: |
Background: Diabetes in pregnancy is associated with an increased risk of complications in both mother and fetus. Our study aims to analyze the neonatal complications of pre gestational diabetes mellitus PGDM as opposed to gestational diabetes mellitus GDM. Patient and methods: This cross sectional study included 70 pregnancies with diabetes mellitus among 2873 women admitted to the department of Obstetrics and Gynecology in Al-Khadhimya Teaching Hospital between the first of January to the first of July 2010, the mothers were divided in to PGDM mothers group and GDM mothers group. Data was collected by questionnaires. Results: the percentage of neonatal complications in PGDM were ; (15.6%) congenital anomalies, (18.8%) respiratory distress syndrome, (25%) hypoglycemia, (6.3%) neonatal jaundice, (12.5%) macrosomia, (0%) polycythemia, (3.1%) hypocalcemia, (6.3%) prematurity, (9.4%) perinatal mortality rate. In infant of GDM the complications were ; (0%) congenital anomalies, (2.6%) respiratory distress syndrome, (26.3%) hypoglycemia, (15.8%) neonatal jaundice, (13.2%) macrosomia, (5.3%) polycythemia, (2.6%) hypocalcemia, (13.2%) prematurity, (5.3%) perinatal mortality rate. The percentage of maternal pregnancy induced hypertension PIH was significantly higher in PGDM (43.8%) than GDM (21.1%), the P. value was (0.04). There is a significant risk of PGDM than the GDM in regarding to the congenital anomalies and respiratory distress syndrome, P. value was 0.011, 0.025 respectively. Conclusions: The percentage of maternal and neonatal complications was higher in Pre mature delivery which occur in infant with poor maternal glycemic control and associated with high rate of urinary tract infections or have associated maternal preeclampsia leading to iatrogenic premature delivery(7). Birth injury and asphyxia due to macrosomia which cause shoulder dystocia, clavicular or humeral fracture, perinatal asphyxia, cephaloheamatoma, subdural hemorrhage and facial palsy(8). Respiratory distress syndrome increased incidence may relate to the antagonistic effect of insulin on stimulation of surfactant synthesis by cortisol(9). Congenital anomalies incidence increase 3 folds in infant of DM mother, the cardiac malformations (VSD, ASD, TGV, double outlet right ventricle), and lumbosacral agenesis are the most common(10). Metabolic disorders as hypoglycemia which defined as glucose level at which brain function begin to be impaired, generally in age of less than 48 hours plasma glucose level < 50-60 mg/dl, and in age more than 48 hours the plasma glucose level < 60-70 mg/dl is considered as hypoglycemia, (the whole blood glucose concentration is 10%-20% lower than plasma glucose) (11). Insulin dependent diabetic mothers tend to have lower plasma magnesium level throughout pregnancy, and infants have lower cord and 24 h postpartum plasma level of calcium and parathyroid hormone (12). Also hyperbilirubinemia and polycythemia are PGDM than GDM, so strict control of blood glucose level during pregnancy and education of the diabetic women is essential before and during gestation.
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