Diabetic embriopaty. Case report.

Abstract

Background. The congenital malformations produced by maternal diabetes constitute a syndrome known as “diabetic embryopathy”. The defects are associated with pregestational diabetes, type 1 or type 2. Its pathogenesis is not fully clarified but hyperglycemia seems to be the most important intrauterine stimulus, favouring the production of free radicals and other adverse conditions for embryo/fetal implantation and development. Case description. We present the case of a multiparous pregnant woman from Tegucigalpa, M.D.C, with a history of type 2 diabetes mellitus, hypothyroidism and grade I obesity, with a gyneco-obstetrics history of: G:3, C:2, A:1, HV:1, HM:1, 6 prenatal controls, with a pregnancy of 30.6 SG X FUM. She attends her prenatal check-up, performing obstetric ultrasound that showed rachischisis with severe hydrocephalus and tendency to macrocrania, bilateral equinovarus foot and polyhydramnios (AFI 21.7cc). Patient reported approximately 10 sporadic contractions in 24 hours. Physical exam: GO: dilated cervix 2 cm, B: 50% AP: -3, integral membranes, cephalic. She is admitted with caesarean section plan plus BTO obtaining NB with multiple congenital malformations (neural tube defects, craniofacial structures, and bone). Intermediate care unit was admitted, USG transfontanelar was performed and reported severe hydrocephalus and due to the presence of myelomeningocele, Arnold Chiari type II was suspected. Myeloplasty was performed with usual technique without complications, patient remained stable until the time of hospital discharge. Conclusion/recommendation. Levels of HbA1c in the first trimester ≥7% or basal glucose >120mg/dl have been associated with the development of malformations. Strict preconceptional glycemic control is important to reduce the incidence of hyperglycemic malformations in pregnancy.