CARDIAC AND EXTRACARDIAC COMPLICATIONS IN INFANTS OF DIABETIC MOTHERSAND THEIR RELATION TO PARAMETERS OF CARBOHYDRATE-METABOLISM

Despite the current improvement of diabetes care in pregnancy, neonata l complications are still more frequent than in the general population . Even in fetuses of well controlled diabetic mothers, myocardial hype rtrophy can be demonstrated although it is not related to maternal met abolic control. The objective of this study was to determine perinatal complications and the course of myocardial hypertrophy in newborns wh o had been prenatally monitored and to relate the findings to neonatal parameters of carbohydrate metabolism. Perinatal complications and ec hocardiographic evidence of myocardial hypertrophy were determined in 104 neonates of closely followed diabetic mothers. Cord blood was obta ined for determination of insulin, C-peptide and glycosylated fetal ha emoglobin (HbF(1c)). In cases of myocardial hypertrophy, the echocardi ographic examinations were repeated until normalisation of the myocard ial wall thickness. The most striking finding was myocardial hypertrop hy in 25% of the 104 neonates, which predominantly involved the interv entricular septum. This is in contrast to the prenatal symmetrical hyp ertrophy of the ventricular walls and may be explained by perinatal ch angings of ventricular geometry. There was no sign of outflow tract ob struction, and myocardial hypertrophy resolved within 6 months. Insuli n and C-peptide were elevated in the majority of the newborns, whereas HbF(1c) was significantly decreased. Neither the maternal type of dia betes nor neonatal metabolic data were related to the somatic findings . Conclusion Myocardial hypertrophy still occurs in infants of diabeti c mothers despite their good metabolic control reflected by the decrea sed fraction of glycosylated fetal hemoglobin which points to low feta l blood sugar levels during the last intra-uterine weeks.