الفهرس 
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Abstract
Diabetes in pregnancy, either GDM or pre-gestational diabetes mellitus (PGDM), is linked to several maternal and fetal/neonatal complications. Infants born to mothers with diabetes mellitus are at higher risk of hypoglycemia and should be closely monitored. Hypoglycemia in the newborn may be associated with both acute decompensation and long term neuronal loss (Lynne , 2010).
The aim of this work was to study the relation between maternal glycemic parameters in the last trimester and during labor and neonatal hypoglycemia in infants of diabetic mothers.
The present study was performed in the Obstetrics and Gynecology hospital and NICU of Ain Shams University hospital in the time period from February till July 2010.
Ninety diabetic pregnant women, attending the hospital in their third trimester or for labor, who fulfilled our inclusion criteria were enrolled in the study. Our mothers’ inclusion criteria were; proven diabetes mellitus, no other illness, regular following up of their pregnancy and diabetes, having done an ultrasound during pregnancy, and giving birth to a full term singleton infant.
All studied diabetic mothers were subjected to full history taking, reviewing their clinical and laboratory data regarding their diabetes and present pregnancy, recording results of ultrasound or 3D detecting any congenital anomalies of fetus or Doppler to record intra-uterine growth retardation. The following investigations were done:
• Fasting and 2-hour post prandial blood glucose level determination in last trimester.
• Glycated hemoglobin (HbA1C) assessment by Stanbio method for women coming in the third trimester.
• Random blood sugar assessment during labor.
• Non stress test to know the state of the fetus well being.
All newborns of diabetic mothers were subjected to:
1- Prenatal and natal history including mode and duration of labor.
2- Full clinical examination with special stress on: birth weight measurement, Apgar scoring at 1 & 5 minutes, any congenital malformation and signs of hypoglycemia.
3- Echocardiography in suspected cases.
4- Blood sugar measurement at birth, 30 min and 1hour after labor and hourly thereafter till normalization of blood sugar.
We found the following:
- Mean age of studied mothers was 25 years (SD ± 3.9).
- Mean weight gain during the present pregnancy was 21.6 Kg (SD ± 6.7).
- Mean parity was two.
- Twenty mothers (22.2%) had history of one or more previous abortions
- Positive family history of DM was present in 32.2% of mothers.
- Gestational diabetes was the most prevalent type of DM among our studied mothers affecting 73.3%, while Type 2 DM affected 22.2% and Type 1 DM affected only 4.4%.
- Mothers who were on insulin therapy represented 45.6% of all, while 54.4% of mothers were only on diet regimen.
- In the third trimester, mean maternal fasting blood glucose was 93 mg/dl (SD ± 31), mean 2-hour postprandial glucose was 123mg/dl (SD ± 41).
- Mean HBA1C was 7.1% (SD ± 0.5) in the third trimester. That means that our studied mothers were not optimally controlled according to references’ values.
- During labor, mean maternal random blood glucose was 113 mg/ dl (SD ±34).
- CS was the most common mode of delivery (>76%).
- Mean Apgar scores were 6 and 8 at 1min and 5 min respectively.
- Mean birth weight was 3930 g (SD ± 784). Most of the newborn infants (66 %) were large sized babies with birth weight of 4 Kg or more, while only (10 %) were small for gestational age with birth weight of <2.5 kg.
- A positive correlation between maternal glycated hemoglobin level in the third trimester and birth weight in the diabetic newborn infants was observed (r=0.58 & p <0.001); that indicates the influence of maternal glycemic control on increased birth weight.
- Six infants (6.7%) had congenital malformations; 3 infants had cardiac; that were detected by postnatal ECHO cardiography, one infant had CNS anomalies and two infants had skeletal anomalies.
- There were no significant differences between infants with and those without congenital anomalies as regards maternal and infant clinical and laboratory data.
- Mean blood glucose level in the newborn infants was 62.8 ±16 mg/dl. Fourteen infants (16 %) had blood glucose level below 47 mg/dl i.e. hypoglycemic.
- A negative correlation between maternal RBS during labor and neonatal blood glucose level at birth was found (r=- 0.63 & p=0.001).
We concluded that IDMs were at increased risk of macrosomia (66%), and hypoglycemia (16 %). Congenital anomalies occurred in 6.7 % of them. There is an association between maternal HBA1C level in the third trimester and birth weight. Infants’ blood glucose level at birth is negatively correlated with maternal random blood sugar during labor.
We may recommend mothers with diabetes to properly follow up their pregnancy and control blood glucose levels throughout pregnancy and during labor.
Measurement of blood glucose level at birth should be performed even in asymptomatic infants for early detection and management of hypoglycemia.