NEONATAL MORBIDITIES IN GESTATIONAL DIABETES-MELLITUS

The currently accepted definition of gestational diabetes mellitus (GD M) is rather broad. One might expect that fetal and neonatal complicat ions that may occur in GDM pregnancy would be similar to those in preg estational diabetic pregnancy Comparative evaluation of reported data on morbidity in GDM are often hampered by confounding variables (mater nal age, parity, obesity) as well as the influence of factors such as ethnic origin, diagnostic criteria, and intervention during pregnancy Recent observations indicate that GDM may be associated with increased incidence of fetal malformation and perinatal mortality. Such poor ou tcome is likely confined to a subset of GDM patients in whom diabetes was present but unrecognized before pregnancy. The most frequent and s ignificant morbidity is fetal macrosomia, which in turn is associated with increased risk of birth injuries and asphyxia. In a nationwide st udy in Sweden (1991-1993) of a large series (n = 3,322) of treated GDM pregnancies, perinatal mortality rate was not increased; but the rate of preeclampsia was doubled, and the rate of emergency cesarean secti on was 1.6 times higher than in the background population. The rates o f fetal macrosomia (greater than or equal to 4,500 g), asphyxia, and t ransient tachypnea were two to three times higher than normal. Erb's p alsy was 0.7 and 5% in vaginally delivered infants weighing < 4,500 an d greater than or equal to 4,500 g, respectively. There is a clear nee d to define the various levels of glucose intolerance in the mother th at may have an adverse effect on the offspring. Of equal importance is to standardize and systematize the criteria used to assess the signif icance of any such impact.