DEFORMATIONS IN INFANTS OF DIABETIC AND CONTROL PREGNANCIES

Severe and mild deformations in newborn infants of insulin dependent d iabetic mothers (IDDMs) and control mothers were evaluated with respec t to the types of anomalies and previously hypothesized constraint fac tors, Factors evaluated were gestational length, birth weight, correct ed birth weight for gestation (weight ratio), maternal height and pari ty, and severe deformations, Newborn infants from 81 control and 133 i nsulin dependent diabetic pregnancies were recruited periconceptually as part of a larger study of diabetes in early pregnancy. Examinations were done at 48 to 72 hours of life by one examiner blinded to matern al status using a checklist of major and minor deformations and malfor mations. Mild deformations were found to be common and were present in 84% of newborn infants, Severe deformations occurred in three (1.4%) IDIMs, with two of three newborn infants having major malformations in volving the CNS and/or musculoskeletal system which affected fetal mov ement, There was no significant difference between IDMs and control ne wborn infants with respect to the number with deformations; however, f etal macrosomia was not present in study participants. Using the entir e cohort, a significantly greater number of deformations were present in newborn infants with a gestation >36 weeks (P < 0.001), birth weigh t >3,000 g (P < 0.001), and weight ratio greater than or equal to 1.2 (P = 0.05), There was no significant association with primiparous moth ers or women with a height <165 cm and the presence of deformations, F or gestational age and birth weight, mild deformations were apparent o nly after 33 weeks gestation (P much less than 0.001) and/or birth wei ghts of 2.0 kg or more (P much less than 0.001), Infants with four or more deformations were more likely to have major malformations (P < 0. 05). In summary, in this study the constraint factors determined to be important in the development of mild deformations are gestational len gth, birth weight and birth weight corrected for gestational length (w eight ratio), and severe deformations affecting the neurological and/o r musculoskeletal systems, Severe deformations occur more frequently i n association with major malformations which affect fetal movement, In IDDM pregnancies, an increase in deformations can be expected with ma jor malformations or with macrosomia should it occur. (C) 1994 Wiley-L iss, Inc.