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Infant Of A Diabetic Mother Uptodate

Learning About Infant Of Diabetic Mother Syndrome

Learning About Infant Of Diabetic Mother Syndrome

What is infant of diabetic mother syndrome? If you have diabetes and are pregnant, high blood sugar can cause problems for you and your baby. Your baby may grow too large. This can cause problems during the birth. Your baby also may be born with low blood sugar. Sometimes these problems can occur when women get diabetes while they are pregnant (gestational diabetes). With treatment, most women who have diabetes or get diabetes during pregnancy are able to control their blood sugar and give birth to healthy babies. Your doctor can help you manage your blood sugar. Most babies born to mothers who have diabetes do not have problems. If your baby does have problems, such as low blood sugar, he or she can be treated. What are the symptoms? Your baby may have problems such as: Being large at birth. Low blood sugar (hypoglycemia). A yellow tint to the skin and the whites of the eyes (jaundice). Trouble breathing. How can infant of diabetic mother syndrome be treated? Your doctor will closely watch your baby after he or she is born. This is to make sure there are no problems, such as low blood sugar. A baby with low blood sugar will be fed more often. The baby may be given glucose (sugar) through a tube that goes into a vein (IV). When your baby can eat enough milk, his or her blood sugar levels should become normal. Your doctor will check your baby's blood sugar levels. A baby who has trouble breathing will get treatments such as extra oxygen. If your baby has jaundice, it can also be treated. An IV tube may be used if your baby has symptoms and his or her low blood sugar is more severe. Some babies may be fed glucose through a tube. This is a tube that goes into the nose and down into the stomach. Follow-up care is a key part of your child's treatment and safety. Be sure to m 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 >>

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 >>

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 >>

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 >>

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 >>

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 >>

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 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 >>

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 >>

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 >>

A Mechanism Of Hypoglycemia In Infants Of Diabetic Mothers. 1394

A Mechanism Of Hypoglycemia In Infants Of Diabetic Mothers. 1394

A MECHANISM OF HYPOGLYCEMIA IN INFANTS OF DIABETIC MOTHERS. 1394 Infants of diabetic mothers (IDM) have a propensity to hypoglycemia. In the newborn, gluconeogenesis is necessary to maintain plasma glucose concentration. Hypoglycemia in the IDM may be due to decreased gluconeogenesis. The mechanism of decreased gluconeogenesis is not well understood. Glucose transporters provide facilitated glucose transport into and out of the hepatocyte. Hyperglycemia increases GLUT1 in animals and cells. Therefore, maternal hyperglycemia may increase GLUT1 in the liver of the fetus. GLUT1 can transport glucose into cells at low glucose concentrations because of the high affinity of GLUT1 for glucose. Increased glucose transport into hepatocytes could result in decreased gluconeogenesis. Hypothesis: IDM have decreased gluconeogenesis, and increased GLUT1 gene expression. Materials and Methods: Pregnant Sprague-Dawley rats were given an IP injection of streptozotocin (STZ, 65mg/kg) on day 12 of gestation to induce diabetes. Uninjected dams were used as controls (C). On day 21 of gestation, fetuses were obtained by Cesarian section. The fetuses were deprived of food and kept in an infant incubator. Blood and livers were collected at zero or six hours after Cesarian section. Maternal and fetal plasma glucose and insulin concentrations were determined. Messenger RNA abundance of GLUT1, GLUT2 and PEPCK in the liver at zero and six hours were determined. Results: STZ treated dams were significantly hyperglycemic compared to controls, 366121 mg/dl vs. 11024 mg/dl, p<0.05. IDM were significantly hyperglycemic at zero hours compared to controls. In the table , mRNA expressed as arbitrary density units. Conclusion: Alterations in glucose transporter and PEPCK mRNA abundance suggest decreased g 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 >>

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 >>

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 >>

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