Autopsies of Stillborn Infants of Diabetic Mothers

A friend recently asked me to review the autopsies of stillborn infants of diabetic mothers. I searched my Filemaker database of autopsies I have performed for the category “IDM” (infant of a diabetic mother and found 28 autopsies.

Five  were neonatal. Nine were intrapartum, of which five were inductions prior to a viable gestation for severe malformation, and four others were of a viable gestation.  Of these 3 died during labor, and 1 was a  30 week induction for anencephaly. Of the 14 antepartum stillbirths. 2 were before viability, one was a stillbirth with absent kidneys, and the other was due to maternal renal failure. That left twelve infants who died in utero at greater than 33 weeks of gestation.

There were no simple common causes of death in these infants. As with many autopsy results there were often remaining questions, and gaps in the determination of the complete pathogenesis of death. The infants did show many of the expected features of infants of diabetic mothers, but increased adipose tissue, cardiomegaly, large body size, and hyperinsulinemia (documented by islet cell hypertrophy) are also present in surviving infants. The postmortem intrauterine retention time varied from less than 12 hours to more than 3 days. The cases had variable material accessible for review.

If nothing else, reviewing these cases demonstrates the difficulty in creating simple categories for the cause of death. I believe the most productive use of the autopsy is as a collaborative investigation of the pathologist with clinical colleagues, and not as the equivalent of a test result. To that end, I am going to post some of the individual cases.