In women with insulin-dependent diabetes mellitus, it is much more difficult to maintain and control the disease during pregnancy. In addition, the need for insulin increases. Poorly controlled diabetes in women leads to the development of polyamnion and preeclampsia, an increase in the frequency of early miscarriages, congenital malformations and late unexplained intrauterine death.
Ketoacidosis leads to high fetal mortality. With meticulous control of diabetes mellitus, the level of perinatal mortality is currently only slightly higher than in healthy women.
Pathology of the fetus in mothers with diabetes :
• Congenital malformations . On average, there is a 6% risk of developing congenital malformations, which is 3 times higher compared to a population without diabetes. The range of anomalies is similar to those in the general population, with the exception of an increase in the prevalence of heart anomalies, sacral agenesis (caudal regression syndrome), and hypoplasia of the left part of the colon, although the latter two are considered rare. Studies have shown that good control of diabetes in the first trimester of pregnancy reduces the risk of congenital malformations.
• ZVUR . A three-fold increase in fetal IUGR is noted in mothers with a long-running capillary disease. • Macrosomy . Hyperglycemia in the mother causes it in the fetus, since glucose passes through the placenta. Since insulin does not pass through the placenta, the fetus responds with an increase in insulin secretion, which contributes to the growth and increase of both the number of cells and their size. About 25% of these children have a birth weight of more than 4 kg, compared with 8% in healthy women. Macrosomia predisposes to cephalocervical imbalance, birth asphyxia, brachial dystocia and trauma of the brachial plexus. Neonatal problems include the following.
• Hypoglycemia . Transient hypoglycemia as a result of fetal hyperinsulinism is typical for the first day of life, but can be prevented by the early start of feeding. The serum glucose level should be constantly monitored during the first 24 hours, hypoglycemia must be stopped. • RDS . More typical due to delayed lung development.
• Hypertrophic cardiomyopathy . In some infants, hypertrophy of the interventricular septum is observed. It regresses within a few weeks, but can cause heart failure due to a decrease in left ventricular function.
• Polycythemia (venous hematocrit> 0.65). Promotes plethoric appearance of babies. Partial exchange transfusion treatment may be required to reduce hematocrit and normalize blood viscosity. Gestational diabetes – the development of impaired glucose tolerance only during pregnancy. Its definition and methods of establishment remain controversial. This disease is more common in overweight women and in Afro-Caribbean and Asian ethnic groups.
The prevalence of macrosomia and its complications is similar to that in mothers with insulin-dependent diabetes mellitus, but the incidence of congenital malformations is not increased. Nevertheless, due to the increase in obesity in the population, the number of mothers with non-insulin-dependent type 2 diabetes is increasing. Their fruits also have a higher risk of acquiring congenital malformations.
Maternal diabetes :
• Monitoring glucose levels before conception and during pregnancy significantly reduces morbidity and mortality in the prenatal and neonatal periods.
• The fetus may experience macrosomia due to fetal hyperglycemia leading to hyperinsulinemia, or developmental delay secondary to maternal capillary disease, and the risk of congenital malformations is also increased.
• An infant with macrosomia has a higher risk of asphyxiation and trauma during childbirth with a difficult birth process or delivery.
• A newborn is prone to hypoglycemia and polycythemia.