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Exp Clin Endocrinol Diabetes 2005; 113(3): 160-166
DOI: 10.1055/s-2005-837517
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Perinatal Morbidity in Women with Undiagnosed Gestational Diabetes in Northern Thuringia in Germany

W. Hunger-Dathe1 , K. Volk4 , A. Braun1 , A. Sämann1 , U. A. Müller1 , G. Peiker2 , M. Hüller3
  • 1Department of Internal Medicine III (Head: Prof. Dr. med. G. Stein), Friedrich-Schiller University of Jena, Jena, Germany
  • 2Department of Gynaecology (Head: Prof. Dr. med. H. J. Seewald), Friedrich-Schiller University of Jena, Jena, Germany
  • 3Institute for Clinical Chemistry and Laboratory Diagnostics (Head: Prof. Dr. med. T. Deufel), Friedrich-Schiller University of Jena, Jena, Germany
  • 4Südharz-Hospital Norhausen gGmbH, Friedrich-Schiller University of Jena, Jena, Germany
Further Information

Publication History

Received: November 20, 2003 First decision: March 3, 2004

Accepted: September 9, 2004

Publication Date:
23 March 2005 (online)

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Abstract

Introduction: Undiagnosed gestational diabetes mellitus (GDM) is associated with severe perinatal complications.

Patients and Methods:Out of 970 women, infant and maternal morbidity was assessed in 114 mother-children-pairs with an infant birth weight over the 90th percentile ([Voigt et al., 1996]). It was the aim of this retrospective study to assess the number of mothers with undiagnosed GDM, who have born a macrosomic child.

Results: The macrosomia rate in newborns was 12 % in this study excluding macrosomic infants of mothers with preexisting diabetes mellitus. Maternal data: Age 28.3 ± 5.3 years, adipositas (body-mass-index > 30 kg/m2) in 42.1 % vs. 30.4 % in the peer group (p < 0.02), increase in weight > 15 kg during pregnancy in 57.9 % of the mothers who have given birth to a macrosomic child vs. 30.9 % in the peer group (p < 0.0001), family history of diabetes mellitus (28.0 % vs. 11.3 % in the peer group, p = 0.006), preeclampsia in 8.8 % vs. 2.7 % in the peer group (p = 0.002), cervical insufficiency in 2.6 % vs. 0.4 % in the peer group (p = 0.02). After delivery HbA1c was elevated in 38.6 % of the women having born macrosomic infant (mean HbA1c: 5.0 % ± 0.5). Infant data: neonatal jaundice 16.7 % vs. 4.5 % in the peer group, p < 0.0001. There were no statistically significant differences concerning perinatal condition and malformations. Neonatal hypoglycaemia occurred in 9.6 % of the macrosomic infants. Cord blood insulin levels were significantly elevated in comparison to the peer group of mothers without metabolic disorders and having born eutroph infants (8.4 mU/l [3.0 - 100.0] vs. 5.3 mU/l [3.0 - 30.7], p = 0.01). 11.4 % of all macrosomic infants had cord blood insulin levels above the normal range.

Conclusion: More than one third of the mothers having born one or more macrosomic infants had an impairment of glucose metabolism immediately after birth. The elevated prevalence of preeclampsia in this group confirms the relationship of hypertension and impaired glucose metabolism during pregnancy. The detection of hyperinsulinaemia, postnatal hypoglycaemia, elevated prevalence of neonatal jaundice with need of further therapy and diabetic fetopathy in macrosomic infants of mothers, whose metabolism was not monitored during pregnancy, pinpoint the need for a diagnostic screening for GDM.

Key words

Undiagnosed gestational diabetes mellitus - maternal and infant morbidity - fetal macrosomia - infant hyperinsulinaemia - diabetes screening

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Dr. med. W. Hunger-Dathe

University of Jena Medical School, Department of Internal Medicine III

Erlanger Allee 101

07740 Jena

Germany

Phone: + 49(0)36419324323

Fax: + 49 (0)3 64 19 32 43 22

Email: wilgard.hunger-dathe@med.uni-jena.de