[Severe diabetic fetopathy due to undiagnosed gestational diabetes mellitus].

METHODS

A 39 year-old pregnant woman (with one healthy 11 year-old daughter) presented at the antenatal care clinic for routine non-stress test (NST) at the due date. The NST demonstrated normal fetal heart pattern. No anamnestic or clinical risk factors for diabetes during the course of pregnancy were noted in the case file. Ultrasound examinations up to 30 weeks of gestation had shown fetal growth appropriate for gestational age. Two days later, the NST was non-reacting with almost no heart rate variability, indicating an acute fetal risk. While the condition of the fetus was being further assessed by Doppler sonography, a fall in fetal heart rate prompted an emergency section for fetal bradycardia. The male newborn had marked macrosomia (birth weight 5180 g). The pH in umbilical artery blood of 6,77 indicated severe intrauterine hypoxia. Apgar score was 0/1/5. Absence of heart beat and of spontaneous breathing required resuscitation. Echocardiography revealed a hypertrophic cardiomyopathy with dysfunction of the right ventricle and hepatomegaly indicating diabetic fetal pathology. The placenta displayed typical signs of carbohydrate disorder. The maternal 75 g oral glucose tolerance test confirmed the suspicion of maternal diabetes (glucose values 96/210/215 mg/dl).

METHODS

During the next the day the infant developed multi-organ failure involving the liver and kidneys, myocardial infarction with pericardial effusion and myoclonic seizures. His condition improved slowly under measures to stabilize the circulation, substitution of clotting factors and anticonvulsive therapy. Mechanical ventilation had to be continued for 5 weeks. Examination at 4 months of age revealed marked neurological abnormalities. The mother was referred to a diabetes specialist for further management.

CONCLUSIONS

Undiagnosed and therefore untreated severe gestational diabetes may have fatal consequences for the fetus. Expert committees of obstetricians and diabetes specialists have recommended blood glucose screening between 24 - 28 weeks of gestation of every pregnant woman as part of the routine prenatal care.