Prevalence of Congenital Heart Disease in Infants of Diabetic Mothers in Children Welfare Teaching Hospital

Abstract

Background: Women with diabetes in pregnancy (type 1, type 2 and gestational) are at increased risk for adverse pregnancy outcomes which also include infant development of congenital heart disease and even fetal death. Adequate glycemic control before and during pregnancy is crucial to improve outcome.

Aim of the study: to observe the significance of the cardiac complication seen in new born of diabetic mother and its relation to glycemic control.

Patients and methods: This prospective study was conducted in the nursery care unit in children welfare teaching hospital from the period 1st of July 2014 till 30th of June 2015 where one hundred newborns of diabetic mother were collected and screened by echocardiography for congenital heart disease. Those mothers were classified according to White classification, and the babies were classified according to their maturity to (full term, pre term and post term), in reference to their mode of delivery (Spontaneous vaginal delivery or caesarian section) and to their body weight.

Results: One hundred newborns where collected, 61 male and 39 female. Male to female ratio was 1.5:1; 60% were normal with no cardiac complication, 40% had congenital heart disease, hypertrophic cardiomyopathy  23%, atrial septal defect 7 %, patent ductus arteriosus 3% and ventricular septal defect 2%, 1% Transposition of great arteries, 1% Trancus arteriosus, 1% Double outlet right ventricle, 1% Tricuspid atrasia and 1% coartication of aorta, it was found that there is a significant relationship between the type of diabetes of the mother and the development of congenital heart disease in infants (p value 0.02); the degree of glycemic control according to HBA1c of the mother  and development of congenital heart disease in infants (p value 0.005); birth weight of the infants and the congenital heart disease (p value 0.023), death was reported in only 2%.

Conclusions: Hypertrophic cardiomyopathy was the most common type of congenital heart disease in infants of diabetic mothers. Most of infants of diabetic mothers were full term, delivered by caesarian section and their birth weights were more than 4 kg; Congenital heart disease in infants were more common in mothers with uncontrolled diabetes during pregnancy. Pregestational diabetes mellitus mothers are more liable to deliver babies with congenital heart disease than those with gestational diabetes mellitus.

Keywords: Congenital heart disease, Hypertrophic cardiomyopathy, Type 1 diabetes, Type 2 diabetes, Gestational diabetes.