diabetestalk.net

Infant Of A Diabetic Mother Uptodate

Malformations In Infants Of Diabetic Mothers

Malformations In Infants Of Diabetic Mothers

Go to: EVIDENCE THAT INFANTS OF DIABETIC MOTHERS HAVE HIGHER MALFORMATION RATES Evidence that infants of diabetic mothers have higher malformation rates has accumulated over the last several decades. Initially, centers reporting their experience with diabetic pregnancies noted high malformation rates in the infants of diabetic mothers. The author is aware of more than a dozen studies reporting malformation rates of 6% or more. Since malformations were not the primary focus of most of these studies, they were frequently uncontrolled and, hence, useful mainly to direct attention to the question of teratogenesis. Numerous animal studies (to be discussed in detail later) were then performed to define the relationship between diabetes and malformations. Rats and mice made diabetic by alloxan or streptozotocin consistently produced more malformed offspring than expected. One recent experiment (Sadler, ’79) took serum from diabetic rats and injected it into mouse embryo cultures. The injected (but not control) embryos developed a dose-related increase in malformations, suggesting that some diabetic factor, not the alloxan or streptozotocin, is teratogenic. The definitive study relating diabetes to malformations in humans has not yet been reported. Before discussing specific studies comparing malformation rates in infants of diabetic mothers with control infants, it would be wise to consider some of their methodologic weaknesses. The diabetic group may not be representative of all diabetics. This is particularly true at university hospitals with referral populations, since those with more severe disease or complications are more likely to be referred. If, for example, vasculopathy were responsible for the increased malformation rate, the university hospitals would be likely t Continue reading >>

Risk Of Hypoglycemia In Newborns From Mothers With Gestational

Risk Of Hypoglycemia In Newborns From Mothers With Gestational

RISK OF HYPOGLYCEMIA IN NEWBORNS FROM MOTHERS WITH GESTATIONAL DIABETES FINAL DEGREE PROJECT AUTHOR: Cynthia Morales Ãlvarez DEGREE: Medicine TUTOR: Alex Suárez BerrÃo Risk  of  hypoglycemia  in  newborns  from  mothers  with  gestational  diabetes     |   Cynthia  Morales   2  INDEX 1. SUMMARY................................................................................................................. 4 2. INTRODUCTION.........................................................................................................4 2.1. Epidemiology.....................................................................................................4 2.2. Definition of hypoglycemia.................................................................................6 2.3. Problem statement............................................................................................7 2.4. Pathogenesis.....................................................................................................8 2.5. Clinical manifestations.......................................................................................9 2.6. Justification......................................................................................................10 3. BIBLIOGRAPHY.......................................................................................................10 4. QUESTION................................................................................................................14 5. HYPOTHESIS...........................................................................................................14 6. OBJECTIVES............................................................................................................14 6.1. Primary objecti Continue reading >>

Infants Of Diabetic Mothers: The Effects Of Hyperglycemia On The Fetus And Neonate

Infants Of Diabetic Mothers: The Effects Of Hyperglycemia On The Fetus And Neonate

News that a woman with diabetes is about to deliver brings up images of a macrosomic infant. This infant may experience birth injuries, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia/hyperviscosity syndrome, asymmetric septal hypertrophy,and other congenital malformations. Uncontrolled diabetes has profound effects on embryogenesis, organogenesis, and fetal and neonatal growth, and evidence increasingly indicates that some of these effects are lifelong and may contribute to adult obesity. Preconception control of diabetesand monitoring throughout pregnancy are important in reducing the impact of diabetes on the fetus and newborn. No Reference information available - sign in for access. No Citation information available - sign in for access. Neonatal Network, established in April 1981, is a peer-reviewed journal dedicated to assisting neonatal nurses and related health care professionals remain current in their fields. Neonatal Network acts as a vehicle for the exchange of information by providing up-to-date, relevant articles in the areas of evidence-based clinical practice, research, and education. Neonatal Network is issued six times a year; January/February, March/April, May/June, July/August, September/October, and November/December. With a circulation of 10,000, Neonatal Network goes to more than 1,000 recognized Level II and Level III neonatal intensive care units in the United States. Continue reading >>

The Newborn Infant Knowledge For Medical Students And Physicians

The Newborn Infant Knowledge For Medical Students And Physicians

Infants are usually born at term, or after 37 to 42 weeks of gestation. Approximately 10% of births are preterm, occurring prior to 37 completed weeks of pregnancy . Most infants born at term require very little medical attention in order to successfully adapt to extrauterine life. Routine management of a newborn infant immediately after birth consists of removing airway secretions, drying the newborn , and providing him or her with warmth. Health care providers also clamp and cut the umbilical cord . The Apgar score is typically used to gauge the clinical status of newborn infants at one and five minutes after birth using the following parameters: heart rate, respiratory effort, muscle tone, reflex irritability to tactile stimulation, and skin color. Infants who are born at term or late preterm and are breathing and moving satisfactorily should immediately be given to their mother for skin-to-skin contact and initiation of breastfeeding. Infants who are born prematurely, lack muscle tone, or are not breathing or crying may require supplemental oxygen or additional resuscitation. Preventive medicine measures in the delivery room include the administration of ophthalmic antibiotics and vitamin K. Within 24 hours of birth , a detailed assessment of the newborn should take place. This typically includes a history of the pregnancy and a physical exam from head to toe, as well as measurements of length and weight. 1. Zacharias N. Perinatal Mortality. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. . Last updated June 3, 2016. Accessed May 10, 2017. 2. Dutta DC, Konar H. Textbook of Obstetrics. New Delhi, India: Jaypee Brothers Medical Publishers; 2015. 3. American College of Obstetricians and Gynecologists. ACOG Committee Opinion: Definition of term pregnancy. Obstet Gyne Continue reading >>

Infant Of A Diabetic Mother

Infant Of A Diabetic Mother

Professor of Pediatrics, Director of the Training Program in Neonatal-Perinatal Medicine Director of the Neonatal Clinical Research Center Section of Neonatology, Department of Pediatrics University of Colorado School of Medicine What are the classifications of maternal diabetes? The classifications of maternal diabetes are outlined in Table 1. The classification of diabetes during pregnancy is important because the outcome of both the mother and the baby are related to the severity and the duration (represented by the different classes) of the mother's diabetic condition. In mothers with gestational diabetes, there is an increased risk of large (macrosomic) babies and babies with low blood sugars (hypoglycemia) after birth; however, the overall risk of complications is low. Large babies and babies with low blood sugars also are associated with Classes A, B, C, and D.1 Large (macrosomic) babies increase the need for cesarean section delivery because the baby can be too big to pass through the mother's pelvis and vaginal canal. Class F mothers have the highest risk of delivering abnormally small babies with poor growth while inside the mother's uterus.1 Class F mothers also have an increased risk of anemia, high blood pressure (hypertension), and decreased kidney function. Class H mothers have an increased risk of a heart attack or heart failure and sudden death, along with an increased risk of producing abnormally small babies. Class R mothers have an increased risk of worsened retinopathy, bleeding into the eye (vitreous hemorrhage), or detachment of the retina. They also have an increased risk of delivering small babies, most often by cesarean section. All classes have an increased risk of abnormally large amounts of amniotic fluid (polyhydramnios). Polyhydramnios in Continue reading >>

Infant Of A Mother With Diabetes

Infant Of A Mother With Diabetes

What is an infant of a mother with diabetes? An infant of a mother with diabetes is a baby who is born to a mother with diabetes. Because the mother has diabetes, the baby is at risk for problems. People with diabetes have high levels of sugar in their blood (hyperglycemia). Over time, this can lead to serious health problems. Keeping your blood sugar under control lowers your risk for complications. You can manage diabetes by eating a nutritious diet, getting regular exercise, and taking medicine. Two types of diabetes can happen in pregnancy. These are: Gestational diabetes. In this condition, you don’t have diabetes before pregnancy. You develop it during pregnancy. This type of diabetes goes away after your baby is born. Pre-gestational diabetes. In this condition, you have diabetes before getting pregnant. You may have type 1 or type 2 diabetes. People with type 1 diabetes don’t make insulin. Your body needs insulin to use blood sugar. You’ll need to take insulin shots. People with type 2 diabetes can’t use the insulin they make. Or their bodies don’t make enough insulin. You’ll need blood sugar-lowering medicine and possibly insulin. It’s important to manage your blood sugar during pregnancy. This can lower your baby’s risk for problems. What causes problems for an infant of a woman with diabetes? In pregnancy, the placenta gives a growing baby nutrients and water. It also makes hormones you need for healthy pregnancy. Some of these hormones can block insulin. This often starts at 20 to 24 weeks of pregnancy. As the placenta grows, it makes more of these hormones. This means that the pancreas must make more insulin. Normally, the pancreas is able to make enough insulin. If it doesn’t, gestational diabetes occurs. Pregnancy may also change the ins Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

infant of diabetic mother Neonatology An infant born to a ♀ with a high serum glucose during pregnancy Features Larger than other infants with enlarged organs, pospartum hypoglycemia, given ↑ fetal production of insulin, ↑ risk of stillbirth. See Gestational diabetes. Continue reading >>

Infants Of Diabetic Mothers

Infants Of Diabetic Mothers

Ongoing controversies regarding etiology, diagnosis, treatment OVERVIEW: What every practitioner needs to know Are you sure your patient has symptoms of an infant of a diabetic mother? What are the typical findings for this disease? The most common attributes of an infant of a diabetic mother (IDM) are: History of maternal diabetes: (Type 2 diabetes mellitus (DM), gestational DM, requiring insulin or not requiring insulin, or insulin-dependent Type I diabetes mellitus or IDDM). Large for gestational age: (LGA, weight >95%tile for age) or 4000 gm birth weight infant, often plethoric and Cushingoid in appearance, and often with hypoglycemia in the first 2-4 hours of life. If the mother had longstanding DM with vascular disease, the infant may actually be growth restricted (IUGR) rather than LGA. Hypoglycemia: Hypoglycemia is transient and generally resolves within 24-48 hours with feedings and IV glucose therapy when needed. Only 5% of IDMs continue to have hypoglycemia at two days of age. Infants of insulin-dependent Type 1 diabetic mothers are more likely to have moderate to severe hypoglycemia. Over 50% of IDM infants have glucose 39 mg%, and 20% have glucose <30 mg%, compared with only 15% incidence of glucose 39 mg% in infants of gestational, noninsulin-dependent diabetic mothers. Hypoglycemia may be asymptomatic, or may present as any combination of poor feeding, diaphoresis, tremors and jitteriness, hypotonia, hypothermia, lethargy, irritability, abnormal cry, cyanosis, pallor, tachypnea, apnea, or seizures. Prematurity: IDMs are frequently late preterm (34-36 completed weeks of gestation) or early term (37-38 completed weeks of gestation), and frequently manifest exaggerated hyperbilirubinemia, respiratory distress syndrome, and other problems related to prematur Continue reading >>

Gestational Diabetes

Gestational Diabetes

Overview Gestational diabetes develops during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. Any pregnancy complication is concerning, but there's good news. Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy. In gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you've had gestational diabetes, you're at risk for type 2 diabetes. You'll continue working with your health care team to monitor and manage your blood sugar. Symptoms For most women, gestational diabetes doesn't cause noticeable signs or symptoms. When to see a doctor If possible, seek health care early — when you first think about trying to get pregnant — so your doctor can evaluate your risk of gestational diabetes as part of your overall childbearing wellness plan. Once you're pregnant, your doctor will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need more-frequent checkups. These are most likely to occur during the last three months of pregnancy, when your doctor will monitor your blood sugar level and your baby's health. Your doctor may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy. To make sure your blood sugar level has returned to normal after your baby is born, your health care team wil Continue reading >>

Infant Of A Diabetic Mother

Infant Of A Diabetic Mother

INTRODUCTION Diabetes in pregnancy is associated with an increased risk of fetal, neonatal, and long-term complications in the offspring. Maternal diabetes may be pregestational (ie, type 1 or type 2 diabetes diagnosed before pregnancy with a prevalence rate of about 1.8 percent) or gestational (ie, diabetes diagnosed during pregnancy with a prevalence rate of about 7.5 percent). The outcome is generally related to the onset and duration of glucose intolerance during pregnancy and severity of the mother's diabetes. (See "Pregestational diabetes: Preconception counseling, evaluation, and management".) This topic will review the complications seen in the offspring of mothers with diabetes and the management of affected neonates. The prenatal management of pregestational and gestational diabetic mothers is discussed in separate topic reviews. (See "Diabetes mellitus in pregnancy: Screening and diagnosis" and "Pregestational diabetes mellitus: Obstetrical issues and management" and "Gestational diabetes mellitus: Obstetrical issues and management" and "Gestational diabetes mellitus: Glycemic control and maternal prognosis" and "Pregestational diabetes: Preconception counseling, evaluation, and management".) FETAL EFFECTS Poor glycemic control in pregnant diabetic women leads to deleterious fetal effects throughout pregnancy, as follows [1]: In the first trimester and time of conception, maternal hyperglycemia can cause diabetic embryopathy resulting in major birth defects and spontaneous abortions. This primarily occurs in pregnancies with pregestational diabetes. The risk for congenital malformations is only slightly increased with gestational diabetes mellitus (GDM) compared with the general population (odds ratio [OR] 1.1-1.3). The risk of malformations increases as mate Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes mellitus (GDM) is defined as the state of carbohydrate (glucose) intolerance that has its onset or first recognition during late pregnancy and has many similarities to non-insulin dependent diabetes mellitus (NIDDM). GDM presents in two forms. The terms overt and gestational diabetes are used to describe the type of GDM, and are based primarily on gestational age at diagnosis. Diagnosis of diabetes at 24 to 28 weeks of gestation is consistent with "gestational diabetes," while diagnosis at the first prenatal visit (in early pregnancy) is more consistent with "overt diabetes".1Risk factors such as a previous history of gestational diabetes, previous delivery of a baby > 9 pounds, obesity with BMI > 30 kg/m2, glycosuria at the first prenatal visit, and first degree relatives with diabetes will likely predispose these women to GDM.1 Pregnant women with GDM have an increased incidence ofpreeclampsia, preterm labor, pyelonephritis, polyhydramnios, and cesarean delivery. The long-term complications include a higher risk of developing NIDDM and cardiovascular disease.2 In addition, there are many potential effects of GDM on the fetus. Short-term effects include a much larger birth weight (fetal macrosomia), shoulder dystocia, difficult or operative delivery, stillbirth, increased perinatal morbidity and mortality. Long-term effects include an increased incidence of childhood obesity, early adulthood type 2 diabetes mellitus, and impaired intellectual-motor impairment.3 Therefore, it is imperative for clinicians to diagnose and treat GDM in pregnant women as soon as possible to prevent perinatal complications and to identify patients who may benefit from early interventions such as improved nutrition, weight loss, and a regular exercise program to prevent Continue reading >>

What Are The Potential Complications Infants Of Diabetic Mothers May Have?

What Are The Potential Complications Infants Of Diabetic Mothers May Have?

Patient Presentation A 26-year-old female with Type I diabetes for 11 years, is referred to you by her obstetrician for a general prenatal appointment to specifically discuss what will happen to her child after delivery. This is the first pregnancy for the mother. She has had pre-conception and prenatal care from her obstetrician and endocrinologist and has been in good glycemic control using frequent daily testing and insulin. There have been no other complications to the pregnancy. Obstetrical ultrasound has identified no obvious abnormalities. The diagnosis of a fetus at risk for a variable constellation of problems was made. These mainly include metabolic problems, respiratory distress syndrome, polycythemia and congenital anomalies. In addition to regular prenatal information, the mother was counseled about the additional monitoring and testing that would be needed especially for potential respiratory, glucose, and calcium problems and polycythemia. She was also told that additional testing and treatment may be needed if congenital abnormalities were identified. Discussion Although, infants of diabetic mothers (IDM) generally are healthy and do well with today’s obstetrical and neonatal care, they are at risk for complications. The risk has been associated with the duration, severity and control of the mother’s diabetes. Important maternal historical information includes: Gestational age of the infant Obstetrical diabetes class (i.e. White’s Classes) Maternal therapy (i.e. diet, oral hypoglycemic drugs, insulin, etc.) Degree of chronic glucose control Delivery – time of last maternal insulin injection, amount and type of IV fluids in labor and delivery Learning Point There are many potential complications for IDMs which include: Prenatal/Natal risks Sudden Continue reading >>

Neonatal Small Left Colon Syndrome (nslcs): Rare But Important Complication In An Infant Of Diabetic Mother

Neonatal Small Left Colon Syndrome (nslcs): Rare But Important Complication In An Infant Of Diabetic Mother

Neonatal small left colon syndrome (NSLCS): Rare but important complication in an infant of diabetic mother 1Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford, United Kingdowm 2Woodland Neonatal Unit, West Hertfordshire Hospitals NHS Trust, Watford, UK Correspondence to Dr Sankara Narayanan, cnarayanan{at}nhs.net A female infant born at 35+6 weeks by caesarean section to a mother with poorly controlled type 1 diabetes was admitted to the neonatal unit due to hypoglycaemia. Birth weight was 3.2 kg (9198th centile). On day 1, the baby required a glucose load of 10 mg/kg/min to maintain normoglycaemia. By day 2, her blood sugar levels stabilised, feeds were started and intravenous fluids were weaned. With the introduction of feeds, she had milky vomits and abdominal distension. Feeds were stopped and an abdominal X-ray showed a dilated transverse colon with an abrupt transition zone at splenic flexure (figure 1, arrow indicates Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Author: Charles F Potter, MD; Chief Editor: Ted Rosenkrantz, MD more... Infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates since the development of specialized maternal, fetal, and neonatal care for women with diabetes and their offspring. Before then, fetal and neonatal mortality rates were as high as 65%. Today, 3-10% of pregnancies are affected by abnormal glucose regulation and control. Of these cases, 80-88% are related to abnormal glucose control of pregnancy or gestational diabetes mellitus. Of mothers with preexisting diabetes, 35% have been found to have type 1 diabetes mellitus, and 65% have been found to have type 2 diabetes mellitus. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following: Growth abnormalities (large for gestational age [LGA], small for gestational age [SGA]) Hypocalcemia , hypomagnesemia, and iron abnormalities These infants are likely to be born by cesarean delivery for many reasons, among which are such complications as shoulder dystocia with potential brachial plexus injury related to the infant's large size. These mothers must be closely monitored throughout pregnancy. If optimal care is provided, the perinatal mortality rate, excluding congenital malformations, is nearly equivalent to that observed in normal pregnancies. Communication between members of the perinatal team is of crucial importance to identify infants who are at the highest risk for complications from maternal diabetes. Fetal congenital malformations are most common when maternal glucose control has been poor during the first trimester of pregnancy. As such, the need for preconceptional glycemic control in women with diabetes cannot be overst Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, high blood sugar levels are not good for your baby. About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk for developing type 2 diabetes later on. Your child is also at risk for obesity and type 2 diabetes. Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier. If you already have diabetes, the best time to control your blood sugar is before you get pregnant. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy - even before you know you are pregnant. To keep you and your baby healthy, it is important to keep your blood sugar as close to normal as possible before and during pregnancy. Either type of diabetes during pregnancy increases the chances of problems for you and your baby. To help lower the chances talk to your health care team about A meal plan for your pregnancy A safe exercise plan How often to test your blood sugar Taking your medicine as prescribed. Your medicine plan may need to change during pregnancy. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>

More in diabetes