Offspring of diabetic mothers. Problems of morbidity.

In the past decade, malformation rates and life-threatening neonatal disorders of infants of diabetic mothers have been lowered to a marked degree. However, the remaining neonatal morbidity (metabolic and functional abnormalities and macrosomia) is still rather high. The meaning of these signs and symptoms for the further somatic development is unclear. A study comprising 443 neonatal infants of diabetic mothers was performed in order to quantify the morbidity. In 340 of the mothers, insulin treatment during pregnancy was based on HbA1c and blood glucose values; in the remaining 103 women, it was additionally controlled by measurement of insulin concentration in the amniotic fluid. A new classification of fetopathy at four different stages was established as a basis for further follow-up. In preparation of the latter, a pilot study including 160 infants in their fourth year of life was conducted to test the hypothesis that the further somatic growth is related to neonatal findings. The results demonstrate that the neonatal morbidity profile has changed with therapy. Metabolic control based additionally on insulin concentration in the amniotic fluid has resulted (1) in less infants with macrosomia and/or with striking phenotype but (2) also in a increase of small-for-gestational-age infants and of the frequency of hypoglycaemia. Only purely macrosomatic infants showed a tendency towards obesity and length acceleration in their fourth year of life.