Effect of DCC on Neonatal Jaundice and Blood Gas Analysis in Infants Born to GDM Mothers
Effect of DCC on Neonatal Jaundice and Blood Gas Analysis in Infants Born to GDM Mothers
Evidence for benefited newborns following delayed cord clamping (DCC), including increasing
 hemoglobin and hematocrit levels, improving iron stores, and decreasing need for blood
 transfusion and incidence of intraventricular hemorrhage, in term or preterm infants led the
 American College of Obstetricians and Gynecologists (ACOG) to recommend a delayed cord
 clamping at least 30-60 seconds in vigorous term and preterm infants at birth. Although DCC
 has been found to be beneficial to infants, the additional blood provided by DCC could
 increase the incidence of jaundice that requires phototherapy and the hyperbilirubinemia, and
 the time prolonged by DCC might jeopardize timely resuscitation efforts, if needed. The
 acid-base status in umbilical cord blood at birth reflects the newborn's aerobic and
 anaerobic intrauterine metabolisms and is an objective measure of the fetal exposure and
 response to hypoxia during labour.

 Gestational diabetes mellitus (GDM) is a condition in which glucose intolerance develops
 during pregnancy. It has been estimated in 2009 that nearly 7% of pregnancies are complicated
 by diabetes and approximately 86% of these cases represented women with GDM. The
 Hyperglycemia and Adverse Pregnancy Outcome study (HAPO) revealed that the infants of
 diabetic mothers (IDMs) are at increased risk of neonatal hypoglycemia, hyperbilirubinemia,
 shoulder dystocia, and birth trauma. And newborns to diabetic mothers are at increased risk
 of neonatal respiratory distress syndrome (RDS) and hypoxia, a major cause of admission in
 neonatal intensive care units. There is little direct evidence on the implementation of
 delayed umbilical cord clamping in the risk group of IDMs. Therefore, it no clear that the
 effectiveness and impairment of DCC in IDMs.

 Therefore, the investigators conducted a prospective study in performing DCC in the infants
 of diabetic mothers versus the newborns with early cord clamping (ECC) to assess the effect
 of DCC on neonatal bilirubin levels, hyperbilirubinemia incidence, acid-base status and
 hypoxia in IDMs.
Inclusion Criteria:

 People in the study should meet the following inclusion criteria:

 -  Must be a singleton pregnancy

 -  Clinical diagnosis of gestational diabetes mellitus according to ACOG Practice
 Bulletin

 Exclusion Criteria:

 -  Pregnant women and neonates were excluded if they met the exclusion criteria (not
 included in if meeting one of following items )

 -  Maternal clinical diseases (hypertension disorders, abnormal liver function, Rhesus
 negative blood group or other blood system disease)

 -  Maternal other pregnancy complications (polyhydramnios, oligohydramnios, placenta
 praevia, and abruptio placentae).

 -  Delivery before 37 weeks or after 42 weeks

 -  Neonatal weight was < 2.5 kg or>4.0 kg

 -  Neonates had major congenital malformations (congenital anal atresia, congenital
 biliary atresia, congenital heart disease and so on, whether prenatal suspicion or
 diagnosis postpartum)

 -  Neonatal septicemia, hemolytic disease or other diseases affecting bilirubin
 metabolism.