Cause of Death in Infants of Women with Pregestational Diabetes Mellitus and the Relationship with Glycemic Control
| Autor: | Fauzia Paize, Oliver Rackham, A Michael Weindling |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Birth weight Pregnancy in Diabetics Type 2 diabetes Congenital Abnormalities Cohort Studies Young Adult Pregnancy Cause of Death Diabetes mellitus medicine Birth Weight Humans Perinatal Mortality Retrospective Studies Glycemic Cause of death Glycated Hemoglobin Asphyxia Asphyxia Neonatorum Type 1 diabetes business.industry Obstetrics Infant Newborn Type 2 Diabetes Mellitus General Medicine Stillbirth medicine.disease United Kingdom Diabetes Mellitus Type 1 Diabetes Mellitus Type 2 Female medicine.symptom business |
| Zdroj: | Postgraduate Medicine. 121:26-32 |
| ISSN: | 1941-9260 0032-5481 |
| DOI: | 10.3810/pgm.2009.07.2026 |
| Popis: | Perinatal mortality remains high among infants of mothers with type 1 and type 2 diabetes mellitus. Although high glucose levels have been implicated, the mechanism is not well understood.1) to identify the causes of stillbirth and neonatal death in infants of women with type 1 and type 2 diabetes; 2) to determine whether the causes of perinatal mortality are the same for women with type 1 and type 2 diabetes; and 3) to ascertain the relationship between perinatal mortality and maternal glycemic control.The case notes of women with type 1 and type 2 diabetes mellitus who had a stillbirth or neonatal death were identified and examined by 2 reviewers independently.Ninety-three perinatal deaths were identified (59 women with type 1 diabetes; 34 women with type 2 diabetes). There were 73 stillbirths, 12 were early neonatal deaths, and 8 were late neonatal deaths. Eighteen deaths were attributed to congenital anomalies, 64 to antepartum asphyxia, 4 to intrapartum asphyxia, 3 to postnatal hyaline membrane disease, 2 to postnatal infection, 1 was unclassifiable, and 1 case had no details available. Median postmenstrual age at death was 34 weeks for both women with type 1 and type 2 diabetes. Congenital anomalies were less common in women with type 1 diabetes than those with type 2 diabetes (rate ratio, 0.37 [95% confidence interval, 0.15-0.95]). The relationship between preconceptional and maximal maternal glycosylated hemoglobin (HbA1c) concentrations and birth weight was curvilinear: at low HbA1c levels, the fetal weight was normal; when HbA1c levels were moderately raised, there was macrosomia; very high HbA1c levels were associated with severe intrauterine growth restriction.We describe a relationship between HbA1c and fetal weight. We consider that this provides evidence that hyperglycemia not only causes fetal macrosomia but also an angiopathy affecting the utero-placental blood vessels and consequent fetal hypoxia. These observations provide further evidence that good pre- and periconceptional glycemic control is likely to be of great importance in improving the outcome of pregnancies of women with diabetes. |
| Databáze: | OpenAIRE |
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