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The Infant of a Diabetic Mother• Is infant born to a mother with diabetes or
gestational diabetes, severity of the problem
depend on the severity of maternal diabetes.
• Altered physiology: hyperinsulinemia in utero
secondary to decreased epinephrine and glucose
response result in the following in the infant:
Altered physiology• Amount of body fat.• Hypoglycemia can occur immediately or within 2-12
hours post delivery.• IDM may symptomatic or not with blood glucose
below 20 mg/dl.• Hypocalcemia: associated with prematurity, difficult
labor and or asphyxia at birth, can occur during first 24-48 h after birth.
• Birth trauma such as cephallhematom due to large size of infant.
Altered physiology cont… • Hyperbilirubinemia: occur 48-72 h due to immature
liver and inability to conjugate bilirubin.• Prematurity or SGA associated with placental
insufficiency.• Respiratory problems may occur.• Polycythemia: HCT more than 65% or Hb% 22gm/dl,
which the risk of thrombosis, RDS, hypoglycemia & hypocalcemia.
• Congenital anomalies: (cardiac & skeletal).• Infection.
Diabetes Mellitus
A chronic metabolic disorder involving
complete or decreased insulin secretion
or other insulin dysfunction resulting in
increased serum glucose concentration.
Diagnostic criteria
• Family or mother history of DM.• Determine gestational age.• Blood studies:• Blood glucose, HCT, Hb%, blood gases, bilirubin,
electrolytes. • Clinical manifestations:• Marcosomia, cardiomegaly, hepatomegaly,
abundent fatty, hair, vernix caseosa• May SGA
Diabetes- ADA Classification
• Type 1: IDDM (Juvenile diabetes)- early onset, lack of insulin,
presence of antibodies against B-cells; insulin needed, ketoacidosis
seen.
• Type 2: NIDDM (Adult diabetes, Maturity onset)- older patients,
insulin resistance common, decreased insulin sensitivity,
overweight patients, significant genetic component.
• Gestational Diabetes : Carbohydrate intolerance with onset or first
recognition during pregnancy
Morbidities in Infants of Diabetic Mothers
• Macrosomia• Hypoglycemia• RDS• IUGR• Hypocalcemia• Hyperbilirubinemia
• Congenital Anomalies• Polycythemia• Hyper viscosity• Cardiomyopathy• Increased fetal death• Postnatal problems
Macrosomia• Common Definition: Infant with
Bwt >4000 grams and/or Head
Circumference & Length > 90th
percentile .
• IDMs have increased fat cells
and fat cell hypertrophy.
• Excess non-fatty tissue in
shoulders and scapular areas.
Macrosomia• ¼ th of insulin dependent mothers
have Macrosomic infants.
• Excess growth happens in 3rd
trimester.
• GDM mothers have same
incidence of Macrosomic infants as
other diabetics.
Macrosomia- Complications
• Birth Injuries- Brachial Plexus injury,
Fracture Clavicle or Humerus, Facial
nerve injury, Cephalhematoma.
• Shoulder Dystocia (2-4 fold more)
• Hypoglycemia
• Increased risk for asphyxia
• Increased recurrence risk in mother.
Morbidities- Congenital Anomalies
• Upto 4-fold increase in infants of IDDMs
• Malformations shown to occur before 8th week of gestation.
• Etiology: not clear, ? Hyperglycemia. ? Glucose as a teratogen.
Congenital Anomalies
• Many reported.
• Most common are CV, Musculo-Skeletal & CNS.
• Incidence decreased with tight glucose control in mothers.
Respiratory Distress Syndrome• Increased risk of RDS in IDMs <37 weeks GA
• Possible insulin interference with surfactant composition
and delayed maturation of surfactant system• Metabolic Complications• Hypoglycemia• Hypocalcemia• Hypomagnesemia
Hypoglycemia
• Occurs in up to 25 % of IDMs.
• Half of hypoglycemia occurs in first 24 hours.
• Less likely when mother’s glucose tightly
controlled.
• May be asymptomatic.
Hypocalcemia & Hypomagnesemia
• Occur in 50% or more of IDMS born to mothers who are IDDM
• Decreased parathormone or parathyrin hormon (PTH) secretion in IDMs
• IDMs may have decreased calcium transfer
• Decreased Mg++ levels in mothers
• ? Decreased Mg++-Decreased PTH
Polycythemia/ Hyperbilirubinemia
• Fetal hypoxiaPolycythemia hyperbilirubinemia
• ? Ineffective RBC Production
• Polycythemia may lower glucose levels
Management of IDMs
• Delivery:
Consider as high risk. (mother & infant)
Follow basic steps of resuscitation for infant.
Management
• Post-delivery Observe / Evaluate for: Asphyxia.Birth injury.Malformations.Macrosomia.Hypoglycemia.Respiratory Distress.
Management of Hypoglycemia
• May be asymptomatic• Can occur within 30 minutes.• May last up to 48 hrs or more.• Check Blood Glucose as soon as possible
after birth and at regular intervals for 48 hrs.• Early feeds.• Blood Glucose < 30 mg/dl IV dextrose
recommended.
Prognosis
• IDMs 10 x more likely to be obese (1960)• Macrosomic infants 6 X likely to be obese at
age 7 (Vohr 1980)• Increased risk for teenage obesity• Increased risk for glucose intolerance as
young adults (19%)• No developmental problems noted in
asymptomatic hypoglycemic infants.
Follow up for the IDM
• Developmental risk:• CP , seizures 3-5 X common. SGA IDM infants
have increased risk for cognitive delay at 3-5 years.
• Metabolic Risk:• IDMs with 1 parent Type 2DM have 1-6 % risk
of DM themselves