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World J Diabetes. Jun 10, 2015; 6(5): 734-743
Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.734
What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes?
Delphine Mitanchez, Catherine Yzydorczyk, Umberto Simeoni
Delphine Mitanchez, Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, 75012 Paris, France
Catherine Yzydorczyk, Umberto Simeoni, Division of Pediatrics and DOHaD Laboratory, CHUV University Hospital and UNIL, 1011 Lausanne, Switzerland
Author contributions: All the authors made substantial contributions to conception and design of the review, made critical revisions and final approval of the version of the article to be published.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Delphine Mitanchez, MD, PhD, Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, 26 Avenue du Docteur Arnold Netter, 75012 Paris, France. delphine.mitanchez@trs.aphp.fr
Telephone: +33-1-44736191 Fax: +33-1-44736892
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: December 17, 2014
Revised: January 29, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: June 10, 2015
Processing time: 295 Days and 0.3 Hours
Abstract

In the epidemiologic context of maternal obesity and type 2 diabetes (T2D), the incidence of gestational diabetes has significantly increased in the last decades. Infants of diabetic mothers are prone to various neonatal adverse outcomes, including metabolic and hematologic disorders, respiratory distress, cardiac disorders and neurologic impairment due to perinatal asphyxia and birth traumas, among others. Macrosomia is the most constant consequence of diabetes and its severity is mainly influenced by maternal blood glucose level. Neonatal hypoglycemia is the main metabolic disorder that should be prevented as soon as possible after birth. The severity of macrosomia and the maternal health condition have a strong impact on the frequency and the severity of adverse neonatal outcomes. Pregestational T2D and maternal obesity significantly increase the risk of perinatal death and birth defects. The high incidence of maternal hyperglycemia in developing countries, associated with the scarcity of maternal and neonatal care, seriously increase the burden of neonatal complications in these countries.

Keywords: Birth defects; Hypoglycemia; Respiratory distress; Preterm; Perinatal mortality; Type 2 diabetes; Obesity

Core tip: Increased mortality and morbidity are historically attributed to neonates of diabetic mothers. A discerning analysis of the literature shows that these adverse outcomes are uncommon among infants born from “pure” gestational diabetes mellitus (GDM) mothers, well managed during pregnancy. Macrosomia is the predominant adverse outcome and the main factor linked to neonatal complications. Poor maternal glycemic control, especially in the context of maternal type 2 diabetes and obesity increases the risk of all adverse neonatal outcomes, most strikingly the risk of perinatal mortality and birth defects. Developing strategies for screening and managing women with GDM must be encouraged notably in middle and low income countries and, also to limit the adverse effects on global health population in the future.