Neonates neurological consequences and the immediate risk of

Neonates who are born to mothers with GDM hold a higher risk of developing symptomatic hypoglycaemia in the immediate hours after birth. This is caused by relative foetal hyperinsulinism, manifested as a feedback mechanism for the balance of the high glucose levels induced by the maternal diabetes. Due to long and short term consequences in hypoglycaemic neonates, it is mandatory to do screening in neonatal hypoglycaemia in all newborns from diabetes mothers. Compared to controls from non-diabetic mothers, the prevalence of hypoglycaemic episodes in infants from diabetic mothers is as high as 40%, and with the risk of long-term neurological consequences and the immediate risk of convulsions, coma and even death. These effects can persist up to one week after birth, with increased frequency in the first 4 days of post-natal period. This happens until the endogenous insulin level becomes balanced within neonate. Because of that, neonatal screening should be done at immediately after birth and then at 30 min, 1h, 2hrs, 4hrs, 8hrs and 12hrs and at any moment when hypoglycaemic symptoms occur.24 But, the research on 900 antenatal women of gestational age 24 weeks and above which was conducted at Gandhi hospital, Secunderabad in India, regarding neonatal complications of gestational diabetes mellitus, depicts neonatal hypoglycaemia is common complication with GDM and it occurred 50% with infants and 5-15% with optimally controlled GDM women.25 A study was done at department of obstetric and gynaecology, The first affiliated hospital of Chongqing medical university, China in 2015 showed that macrosomia  affected 12% of newborns of normal women & 15-45% of newborns of women with GDM.26The study on occurrence of foetal macrosomia rate which was done by department of public health, Ahvaz Jundishapur university of medical sciences, Ahvaz, Iran showed that the incidence of macrosomia was 9% during 5 years. Rate of maternal diabetes was 39.5% and 6.1%, respectively among macrosomia and control group. Therefore it reveals, GDM carry a high percentage of occurrence of macrosomia.27 An article published by the European journal of obstetrics & gynaecology and reproductive biology in 1994, was prevalence of minor congenital anomalies in newborns of diabetic mothers. According to that, the prevalence of infants with minor congenital anomalies ranged between 19.4 %- 20.5% in three selected groups (GDM mothers, Pre-gestational diabetic mothers, offspring born to normal mother) and they found that, there was no correlation between the prevalence and type of congenital anomalies & diabetic state of mother.28 A research  about congenital anomalies was published in 2009,that was foetal cardiac effects of maternal hypoglycaemia during pregnancy suggested that maternal diabetes mellitus (pre-gestational type 1 & type 2 diabetes) was associated with increased teratogenesis. Cardiac defects such as transposition of the great arteries, mitral atresia and pulmonary atresia, double outlet of the right ventricle, Tetralogy of Fallot, and foetal cardiomyopathy and also neural tube defects in newborns of pre-gestational diabetic women were the most common congenital abnormalities.29 A research was done in Spain for the years 1976 to 1985 and discovered that there was a correlation between GDM and the risk for the specific birth defects. Risk for the defects of the systems like central nervous system (CNS), skeletal and cardiovascular systems had being visibly increased according to the research. And also Non-insulin-treated diabetic mothers’ infants were 2.9 times more prone to have major congenital birth defects.30 An article from Oman medical journal, has mentioned about a re