Birth Injuries and Associated Complications in Infants of GDM Mothers

Abstract

Background & Objectives: Maternal diabetes mellitus—encompassing both pregestational (Type 1 and Type 2) and gestational diabetes mellitus (GDM)—is a major risk factor for adverse perinatal outcomes. Fetal exposure to maternal hyperglycemia results in hyperinsulinemia, altered anabolic growth, and disproportionate fetal macrosomia, significantly elevating the risk of mechanical birth trauma during vaginal delivery. This study aimed to evaluate the incidence, spectrum, and associated maternal and obstetric risk factors of severe birth injuries and immediate complications in neonates born to diabetic mothers admitted to a tertiary care neonatal intensive care unit (NICU). Methods: A hospital-based prospective clinical observational cohort study was conducted in the NICU attached to JJM Medical College and associated hospitals, Davangere, over a 1.5-year period (March 2021 to October 2022). Singleton live-born neonates delivered to mothers diagnosed with GDM mothers were evaluated. Detailed clinical, radiologic, and neurological assessments were performed to identify birth injuries (brachial plexus palsy [BPP], clavicular/long bone fractures, cephalohematoma, subaponeurotic hemorrhage, intracranial hemorrhage, facial nerve injury, and mechanical birth asphyxia secondary to dystocia). Odds ratios (OR) and risk factor distributions were analyzed in relation to maternal glycemic control, birthweight, shoulder dystocia (ShD), and mode of delivery. Results: Out of the enrolled infants of diabetic mothers, birth-related mechanical injuries and severe traumatic complications occurred in 8.6% of deliveries, with a significantly higher burden observed in pregestational diabetes (18.2%) compared to GDM (6.4%). Brachial plexus palsy was the single most frequent mechanical birth injury (54.5% of all injuries), followed by clavicular fractures (22.7%), subaponeurotic/cephalohematoma (13.6%), and long bone fractures (9.1%). Shoulder dystocia was the strongest individual predictor for severe birth injury (OR = 26.4; 95% CI: 11.2–62.1). Large for gestational age (LGA / birthweight > 4000 g}) and operative vaginal delivery (vacuum/forceps) dramatically amplified the probability of injury (OR = 6.8 and 4.9, respectively). Neonates experiencing severe birth trauma had a significantly higher co-occurrence of birth asphyxia and prolonged NICU stabilization. Conclusion: Infants born to diabetic mothers face a substantial risk of severe birth injuries, predominantly driven by fetal macrosomia, shoulder dystocia, and instrumental vaginal delivery. Fetal weight estimation, stringent maternal glycemic control, and judicious selection of the mode of delivery—avoiding operative vaginal delivery in suspected macrosomia—are paramount to reducing mechanical birth trauma and its lifelong sequelae.