Prenatal Diagnosis of Fetal Encephalomalacia after Maternal Diabetic Ketoacidosis

Abstract

Introduction Encephalomalacia in a developing fetus is a rare and devastating neurological finding on radiologic imaging. Maternal diabetic ketoacidosis (DKA) can lead to metabolic and vascular derangements which can cause fetal encephalomalacia.

Case We report the case of a 27-year-old pregnant woman with White's Class C diabetes mellitus who presented in the 25th week of gestation with DKA. Four weeks after her discharge, marked fetal cerebral ventriculomegaly was noted on ultrasound. A subsequent fetal magnetic resonance imaging (MRI) demonstrated extensive, symmetric cystic encephalomalacia, primarily involving both cerebral hemispheres. The pregnancy was continued with close fetal and maternal surveillance. The patient underwent a repeat cesarean delivery in her 37th week. The infant had a 1 month neonatal intensive care unit stay with care rendered by a multiple disciplinary team of pediatric subspecialists. The postnatal course was complicated by global hypotonia, poor feeding, delayed development and ultimately required anticonvulsants for recurrent seizures. He died at the age of 9 months from aspiration during a seizure.

Discussion Although the maternal mortality from DKA has declined, DKA still confers significant neurological fetal morbidity to its survivors.

Keywords

diabetic pregnancy - diabetic ketoacidosis - encephalomalacia

Note

This article was presented at the American College of Obstetricians and Gynecologists Armed Forces District Annual Meeting, Baltimore, MD, October 2013.

• References

• 1 Volpe JJ. Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res 2001; 50 (5) 553-562
• 2 Pappalardo EM, Militello M, Rapisarda G , et al. Fetal intracranial cysts: prenatal diagnosis and outcome. J Prenat Med 2009; 3 (2) 28-30
• 3 Inder TE, Volpe JJ. Mechanisms of perinatal brain injury. Semin Neonatol 2000; 5 (1) 3-16
• 4 de Veciana M. Diabetes ketoacidosis in pregnancy. Semin Perinatol 2013; 37 (4) 267-273
• 5 Stenerson MB, Collura CA, Rose CH, Lteif AN, Carey WA. Bilateral basal ganglia infarctions in a neonate born during maternal diabetic ketoacidosis. Pediatrics 2011; 128 (3) e707-e710
• 6 Verma PK, Panerai RB, Rennie JM, Evans DH. Grading of cerebral autoregulation in preterm and term neonates. Pediatr Neurol 2000; 23 (3) 236-242