Cardiac Defects in Neonates Born to Mothers with Gestational Diabetes Mellitus and their Association with Maternal Treatment Regime

Objective: To determine the type of cardiac anomalies on echocardiography in neonates delivered to mothers diagnosed with gestational diabetes mellitus (GDM) and evaluate the association of neonatal cardiac defects with maternal treatment during pregnancy. Methodology: This cross-sectional study was conducted at the Department of Pediatrics, Ittefaq Trust Hospital, Lahore from August 2024 to January 2025 after ethical approval. A total of 108 neonates delivered to mothers with gestational diabetes were included using non-probability consecutive sampling technique. After taking informed consent from parents, they were screened by using echocardiography and neonatal cardiac anomalies were noted, if present. All the neonates with cardiac anomalies were followed-up in outpatient department (OPD) for spontaneous closure of defect for 3 months. The data was analyzed by the Statistical Package for the Social Sciences (SPSS) version 25. Results: The mean age of neonates at presentation was 2.00±0.72 days. Gestational diabetes was diagnosed in the second trimester in 72(66.7%) and the third trimester in 36(33.3%) mothers. Out of 108 females, 12(11.1%) were only on insulin, 76(70.4%) were prescribed metformin only, 16(14.8%) were taking combination of metformin with insulin and 4(3.7%) were on diet control. On echocardiography, patent ductus arteriosus (PDA) was detected in 56(70%) cases, ventricular septal defect (VSD) in 8(10%) neonates, septal hypertrophy with PDA in 8(10%) cases, VSD with PDA in 8(10%) cases while 28(25.9%) had normal cardiac functioning. At follow-up, spontaneous closure of defect occurred in 68(85%) neonates with congenital cardiac defects. On comparison, PDA was significantly more common in neonates of diabetic mothers on metformin (p <0.05). Conclusion: Neonates born to diabetic mothers had a high frequency of cardiac abnormalities (74%). The risk of cardiac anomalies was significantly high in neonates born to females with GDM who were treated with metformin alone.