The co-occurrence of diabetes and pregnancy poses a potential risk for both the mother and the child. Infants born to mothers with diabetes face a significantly elevated risk of perinatal morbidity and mortality [1] . In all such cases, it is a high-risk pregnancy that necessitates rigorous and comprehensive management [2] . In newborns, various complications can occur, such as congenital malformations, perinatal morbidity and mortality, prematurity, macrosomia, fetal trauma, respiratory distress, as well as metabolic disorders including hypoglycemia, hypocalcemia, and hyperbilirubinemia [3] . The prognosis of these newborns can be improved through better management, including pregnancy planning with strict glycemic control and careful monitoring through multidisciplinary collaboration. Our retrospective study examines the medical records of newborns of diabetic mothers hospitalized over one year in our neonatology department. We aim to identify the main complications and provide valuable information to guide clinical practices and research in this crucial field of neonatal health.

The aim of this study was:

To analyze risk factors associated with neonatal complications, including maternal glycemic control and duration of diabetes.

Diabetes represents a major global public health concern. The incidence of diabetes during pregnancy continues to rise in the current environment characterized by the ongoing obesity and type 2 diabetes epidemics [1] . It is estimated that between 3 to 10% of pregnancies are affected by some form of dysregulated glycemic control. In our series, its frequency during pregnancy (11.23%) is higher than those reported by D. Boiro in Dakar in 2017 (2.46%) [4] , Firouzeh and Mahdaviani in Iran in 2004, and Kay Mcfarland and Ezzat in the United States (2.6%) [5] [6] .

In pregnancies complicated by diabetes, delivery is typically scheduled around 38-39 weeks of gestation. However, many healthcare providers tend to adopt more interventionist approach when managing gestational diabetes, opting to induce delivery prematurely. This is often done with the aim of mitigating the risk of late fetal mortality or shoulder dystocia, which may occur in cases of fetal macrosomia [7] . The findings from our study align with the broader medical literature, reporting a mean gestational age at delivery of 37.5 ± 2.6 weeks.

Rates of cesarean delivery tend to be considerably higher among pregnant women with diabetes compared to the general obstetric population. While cesarean rates hover around 17% for non-diabetic pregnancies, they can exceed 60% for those complicated by diabetes. This suggests that awareness of a patient’s diabetic status plays a significant role in shaping decisions regarding the mode of delivery [2] .

In our study cohort, the rate of cesarean delivery was 83%. This elevated cesarean rate is consistent with findings reported by other researchers in the field. For instance, Boiro documented a cesarean rate of 87.8% [4] . Among their study population [6] . Similarly, Peace Opara et al. also observed a high incidence of cesarean births in their analysis of diabetic pregnancies [8] .

One of the most common neonatal complications observed in diabetic pregnancies is macrosomia, with an elevated incidence rate of around 45% [1] . In the setting of maternal diabetes, fetal macrosomia is typically attributed to the fetus hyperinsulinemic response to the maternal hyperglycemic environment. The anabolic effects of excessive fetal insulin production contribute to increased fetal growth and larger birth weights [9] . In addition to maternal glucose levels, other substrates like amino acids, triglycerides, and free fatty acids have also been positively correlated with neonatal birth weight in these cases [9] . The findings from our study indicate that poorly controlled maternal diabetes and multiparity are both significantly correlated with the occurrence of fetal macrosomia. Specifically, we observed that suboptimal glycemic management in diabetic pregnant women, as well as having multiple prior deliveries, were independent risk factors associated with increased rates of macrosomic infants in our patient population.

Other research, such as the study by Vambergue et al., has found that fetal adiposity increases with maternal parity, potentially due to the loss of brown adipose tissue over successive pregnancies [10] . Additionally, they observed that male fetuses tended to have higher birth weights compared to female fetuses. However, the underlying physiological reasons for this gender-based difference in fetal growth patterns are not yet fully understood [10] .

Preterm birth is an increasingly common complication observed in pregnancies affected by diabetes, with reported rates ranging from 23% - 46% [11] . The main factors associated with this elevated preterm birth risk are poor maternal glycemic control and the development of preeclampsia [11] . For example, a study by Cordero et al. in the United States found a preterm birth rate of 14% before 34 weeks of gestation in their cohort of diabetic pregnancies [12] .

Infants born to mothers with diabetes are also at higher risk of developing neonatal respiratory distress syndrome. There are a few potential contributing causes: 1) the increased incidence of preterm delivery, 2) impaired fetal surfactant maturation, and 3) the higher rates of cesarean delivery, which can delay the clearance of fetal lung fluid [1] [7] .

The prevalence of congenital malformations in women with diabetes varies from 2 to 7% according to the literature [6] . A study by Cordero et al. reported a rate of 5% of malformations [12] . The risk of malformations is higher in patients with pre-existing diabetes before pregnancy, but the types of malformations observed (cardiac, skeletal, cerebral) are similar between pregestational and gestational diabetes [2] [6] .

Epidemiological analyses have been established the teratogenic role of maternal diabetes. In women with diabetes before pregnancy, the risk of having a child with a malformation is multiplied by 2 to 5, potentially reaching more than 16% of births, or even 7 to 10 times for the most severe malformations. This increased risk is even more important when the diabetes is poorly controlled [13] . Our study reported a congenital malformation rate of 17%, higher than the 5.1% observed by Boiro [4] . This can be explained by the large number of mothers with poorly controlled diabetes in our series.

In terms of metabolic complications, hypoglycemia was the most prevalent finding in our study and was significantly associated with mothers under 25 years of age and those with insulin-treated diabetes. Macrosomia was identified as a risk factor for neonatal hypoglycemia, as was poor maternal glycemic control during the peripartum period, consistent with the findings reported in the Mitanchez study [7] .

The findings from our study have significant implications for clinical practice, underscoring the need for a multidisciplinary approach to the management of pregnancies in women with diabetes, and emphasizing the importance of close monitoring and specialized care for newborns of diabetic mothers after birth.

The infant born to a mother with diabetes continues to be considered a high-risk patient. Efforts must be focused on controlling maternal diabetes. This study highlights the significant impact of maternal diabetes on neonatal complications. The results underline the importance of specific care for newborns born to diabetic mothers, with careful monitoring of pregnant women and a multidisciplinary approach to the management of neonatal complications. Diabetic mothers, with careful monitoring of pregnant women and a multidisciplinary approach to reduce the risks. These findings offer valuable insights into how to improve clinical practice and guide future research in this area.