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INFANT OF DIABETIC MOTHER

Definition & physiology


An infant of a diabetic mother is
a baby who is born to a mother
with diabetes. The baby's
mother had high blood sugar
(glucose) levels throughout
her pregnancy.

Potential Morbidity
Infants born to mothers with glucose intolerance are at an increased risk
of morbidity and mortality related to the following:
Respiratory distress
Growth abnormalities (large for gestational age [LGA], small for
gestational age [SGA])
Hyperviscosity secondary to polycythemia
Hypoglycemia
Congenital malformations
Hypocalcemia, hypomagnesemia, and iron abnormalities

Fetal problems
Congenital
malformations
Intrauterine growth
restriction (IUGR) : *In
mothers with long
standing microvascular
disease
> Macrosmia :*Glucose
crosses the placenta
fetal hyperglycemia

Neonatal
problems
> Hypoglycemia : transient
hypoglycaemia during the 1st
day of life from fetal
hyperinsulinismprevented
by early feeding
> Respiratory distress
syndrome (RDS) : more
common as lung maturation
is delayed
> Hypertrophic
cardiomyopathy
> Polycythaemia : makes the
infant look plethoric ( venous
hematocrit >0.65)

Congenital malformations of infants of diabetic mother


Anomaly
Caudal Regression
Spina Bifida,
Hydrocephalus, or
other CNS defects

Ratio of incidences

Gestational age after


ovulation in weeks

252

Anencephalus

Heart anomalies
Transposition of
great
vessels
Ventricular septal
defect
Atrial septal defect

Anal/Rectal atresia

Renal anomalies
Agenesis
Cystic kidney
Ureter duplex

5
6
4
23

5
5
5

5
6
6

Management During Pregnancy


1. Eye Examination
-Pregnancy can worsen diabetic retinopathy
(mild)
-Retina usually returns to its prepregnancy
condition within several months after delivery.
-Follow up examination is every three months
until delivery
-Some experts recommended C-section but real
life, most women can attempt a vaginal delivery.

2. Blood Pressure Monitoring


High blood pressure often improves during the first half
of pregnancy, but returns to baseline or worsens in the
second half.
Methyldopa, calcium channel blocking agents,
hydralazine, or beta blockers. Beta blockers can mask
some symptoms of low blood glucose and should be
used with caution.
Angiotensin converting enzyme (ACE) inhibitors
(captopril, lisinopril, enalapril) and angiotensin II
receptor blockers (ARBs, losartan, valsartan) are not
safe for the fetus.
Gestational hypertension (high blood pressure during
pregnancy) and preeclampsia (high blood pressure and
protein in the urine during pregnancy) are more
common in women with diabetes.

3. Kidney Function Monitoring


Pregnancy does not cause diabetes-related
kidney disease (called diabetic nephropathy), but
it can worsen existing disease.
Diabetic nephropathy may increase the risk of
developing other pregnancy complications, such
as preeclampsia, preterm delivery, and babies
who are small for their age (intrauterine growth
restriction).
Increased risk of having a small infant because
blood flow to the placenta may be reduced.
Condition is temporary and reverts to the
prepregnancy condition within several months of
delivery

4. Ultrasound
To screen for birth defects
- Ultrasound examination is recommended at 18 to 20 weeks
gestation
- Risk for neural tube defects and heart defects
- most birth defects develop by the 10th week of pregnancy.
To monitor amniotic fluid levels
-Polyhydramnios is an abnormal increase in the amount of
amniotic fluid. Polyhydramnios is more common in women
with diabetes than in women without diabetes.
- Polyhydramnios related to diabetes is usually mild and does
not cause problems. If the fluid levels become severely
elevated, maternal discomfort, uterine contractions,
premature rupture of the membranes ("breaking the water"),
and preterm delivery can occur.

To monitor the baby's growth


- Macrosomia is a condition in which an infant
weighs more than nine pounds (4000 grams)
at term (37 weeks of pregnancy), and is more
common in women with diabetes.
- High fetal insulin levels, which can develop in
response to elevated maternal blood glucose
levels, are one potential cause of macrosomia
since insulin stimulates fetal growth

Infant of diabetic mother


Management during delivery
Assessment of the APGAR score to indicate the need for
resuscitation
Drying, warming and cleaning the airways gently
No immediate stomach suction because the risk of reflex
bradycardia and apnea with pharyngeal stimulation
Examine the placenta and the infant for congenital
anomalies
Cord blood sample is examined for blood glucose and pH

BLOOD
GLUCOSE
GOAL
PREVENT
NEONATAL
LEVELS
HYPOGLYCEMIA

MAINTAINING
TIGHT
GLUCOSE
CONTROL

REDUCING
ISLET
CELL
HYPERPLASIA

Watched
closely

macrosomia
&
mental
retardation
Higher risk early initiation of
feedings (highly recommended)
Asymptomatic no need for
I.V dextrose

HEMATOCRIT LEVELS

< 65%: may be symptomatic


partial volume exchange
transfusion.
>
65%:
may
remain
asymptomatic hydrated with
I.V fluid at a rate of 100 mL
/kg/day & the hematocrit
measured daily for 1st 3 days.

CALCIUM LEVELS

Only IDM + symptomatic


hypocalcemia

10%
calcium
gluconate
administration (through a
central venous catheter)

BILIRUBIN LEVELS

Serum

bilirubin
concentrations monitored
starting in the 1st 24 hours &
followed up to 5 days
outpatient assessment

Risk of IDDM in Offspring of


Diabetic Parents

Tips for Diabetic Mother Before


& While & After Pregnancy

Diabetic father 6% risk of


having IDDM by the age of
20
Diabetic mother 1.3%
risk

Regular prenatal care, routine


testing can diagnose
gestational diabetes early
Control blood sugar
Lung maturity testing may
help prevent breathing
complications due to
immature lungs if the baby is
being delivered more than a
week before the due date.
Carefully monitoring the infant
in the first hours after birth
may prevent complications
due to low blood sugar.
Monitoring and treatment in
the first few days may prevent
complications due to high
bilirubin levels.