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Infant Of Diabetic Mother Management

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 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 >>

The Infant Of The Diabetic Mother. Pathophysiology And Management

The Infant Of The Diabetic Mother. Pathophysiology And Management

Abstract Fetal complications such as macrosomia, hypoglycemia, respiratory distress, and congenital anomalies are associated with the diabetic pregnancy. However, strict control of maternal glucose during pregnancy, labor, and delivery has been shown to favorably influence the perinatal outcome. Continue reading >>

Infant Of A Diabetic Mother

Infant Of A Diabetic Mother

What are the classifications of maternal diabetes? Why are the classifications important? What are the risks to the infant? What can be done to decrease the risk of complications to the infant? What special tests may be required for a diabetic mother during pregnancy? What special tests may be required for the infant after birth? What special treatments may be required for the infant after birth? What is the risk of the infant developing insulin-dependant diabetes? Jan E. Paisley, M.D. Fellow in Neonatal-Perinatal Medicine William W. Hay, Jr., MD 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 Denver, Colorado What are the classifications of maternal diabetes? The classifications of maternal diabetes are outlined in Table 1. Why are the classifications important? 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 Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Definition 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. Alternative Names IDM Causes High blood sugar level in a pregnant woman can affect the infant after birth. Infants who are born to mothers with diabetes are often larger than other babies. Organs such as the liver, adrenal glands, and heart are likely to be enlarged. These infants may have periods of low blood sugar (hypoglycemia) shortly after birth because of increased insulin level in their blood. Insulin is a substance that moves sugar (glucose) from the blood into body tissues. The infant's blood sugar level will need to be closely monitored in the first 12 to 24 hours of life. Mothers with poorly controlled diabetes are also more likely to have a miscarriage or stillborn child. The delivery may be difficult if the baby is large. This can increase the risk for brachial plexus injuries and other trauma during birth. If the mother had diabetes before her pregnancy, her infant has an increased risk of birth defects if the disease was not well controlled. Symptoms The infant is often large for gestational age. Other symptoms may include: Blue or patchy (mottled) skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure) Newborn jaundice (yellow skin) Poor feeding, lethargy, weak cry (signs of severe low blood sugar) Puffy face Reddish appearance Tremors or shaking shortly after birth Exams and Tests Before the baby is born: Ultrasound performed on the mother in the last few months of pregnancy to assess the baby’s development will show that the baby is large for gestational age. Lung maturity testing may be done on the amniotic fluid if the baby is going to be deliver Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

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: 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. Continue reading >>

Neonatal Management Of The Infant Of Diabetic Mother

Neonatal Management Of The Infant Of Diabetic Mother

1 Department of Pediatrics, Dana Dwek Children’s Hospital, Sackler School of Medicine Tel Aviv University, Israel 2 Department of Obstetrics and Gynecology, Clalit Sherutey Briut, Tel Aviv, Israel 3 Department of Neonatology, Laniado Hospital, Natanya, Israel, Technion-Israel Institute of Technology, Haifa *Corresponding Author: Department of Pediatrics Dana Dwek Children’s Hospital 10 Weizman street, Tel Aviv, Israel Tel: 972-3-6974271 E-mail: [email protected] Citation: Mimouni FB, Mimouni G, Bental YA (2013) Neonatal Management of the Infant of Diabetic Mother. Pediat Therapeut 4:186. doi:10.4172/2161-0665.1000186 Copyright: © 2013 Mimouni FB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Pediatrics & Therapeutics Abstract Many controversies exist about the management of neonatal conditions frequent in the infant of diabetic mother such as asymptomatic neonatal hypoglycemia, hypocalcemia, or polycythemia. In this article, we review the pathophysiology and management of major neonatal complications of diabetes in pregnancy, taking into consideration the major current controversies. Keywords Diabetic; Hypoglycemia; Polycythemia Introduction A Medline search performed on August, 2013, using the key word of “infant of diabetic mother” and the limit of “clinical guidelines” failed to find any article in the English language that represents some kind of consensus opinion on the neonatal management of the Infant of Diabetic Mother (IDM). We retrieved only one paper, in German, published 15 years ago, and written on behalf of German Continue reading >>

Neonatal Hypertrichosis In An Infant Of A Diabetic Mother With Congenital Hypothyroidism

Neonatal Hypertrichosis In An Infant Of A Diabetic Mother With Congenital Hypothyroidism

Hypertrichosis in a newborn girl infant of a diabetic mother with congenital hypothyroidism is reported. Both neonatal hyperinsulism and increased testosterone levels were documented. The hypertrichosis resolved after 3 months’ of thyroxine replacement treatment. The possible causal association between hypothyroidism, and hypertrichosis has not been previously reported in neonatal period. Thyroid function should be evaluated in all newborn babies with hypertrichosis or abnormal distribution of body hair. Congenital hypothyroidism (CH) is a relatively common congenital disorder occurring in about one of 3000 to one of 4000 live births.1 As few signs or symptoms are present in the neonatal period, routine screening is the only means of detection.2 Hypertrichosis, a rare condition, can be defined as an excessive growth of hair (terminal, vellus or lanugo) in areas of the body that are not predominantly androgen-dependent, and is independent of age, race or sex.3 Hypothyroidism is usually associated with loss of hair,4, 5 however, in older children has been associated with an increased amount of hair.6, 7, 8 In addition, neonatal hairy pinna has been reported as pathognomonic sign in infants of diabetic mothers.9 We wish to report a newborn girl infant of a diabetic mother with CH with significant hypertrichosis that resolved after 3 months’ replacement treatment with thyroxine. This association has not been previously reported. A 3-day-old female infant with seizures was referred to our University Hospital. The baby was born by spontaneous vaginal delivery at 38 weeks of gestation. She was the seventh child of a 35-year-old mother and a healthy 40-year-old father. The parents were first-degree relatives. The family's first five children were healthy. The sixth child di Continue reading >>

Management Of Infants Of Diabetic Mothers

Management Of Infants Of Diabetic Mothers

Objective To describe the clinical outcome of infants born to mothers with gestational diabetes mellitus (GDM) and preexisting insulin-dependent diabetes mellitus (IDDM). Setting A tertiary care regional perinatal center with a specialized diabetes-in-pregnancy program. Design Case series. Results Five hundred thirty infants were born to 332 women with GDM and 177 women with IDDM. Thirty-six percent of these 530 newborns were large for gestational age, 62% were appropriate for gestational age, and only 2% were small for gestational age. Seventy-six (14%) of all infants were born before 34 weeks' gestation, 115 (22%) between 34 and 37 weeks of gestation, and 339 (64%) at term. Two hundred thirty-three infants (47%) were admitted to the neonatal intensive care unit due to respiratory distress syndrome (RDS), prematurity, hypoglycemia, or congenital malformation. Hypoglycemia (more common among infants of maternal diabetic classes C through D-R) was documented in 137 (27%) of all newborns. One hundred eighty-two infants (34%) had RDS of varying severity. Polycythemia (5% of infants), hyperbilirubinemia (25%), and hypocalcemia (4%) were other morbidities present. Two hundred forty-four infants were admitted for routine care and enteral feedings. Forty-three of these newborns required subsequent transfer to the neonatal intensive care unit for treatment of hypoglycemia (16 cases), RDS (19 cases), or both (8 cases). Routine care failures were more common among infants whose mothers had advanced diabetes, but less frequent among breast-fed infants. Conclusions With modern management, fewer morbidities can be expected in infants of diabetic mothers. Those infants born to women with IDDM remain at risk for hypoglycemia, which can be treated in one half of the cases by enteral fe Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Women may have diabetes during pregnancy in 2 ways: Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy. If the diabetes is not well controlled during pregnancy, the baby is exposed to high blood sugar levels. This can affect the baby and mom during the pregnancy, at the time of birth, and after birth. Infants who are born to mothers with diabetes are often larger than other babies. Larger infants make vaginal birth harder. This can increase the risk for nerve injuries and other trauma during birth. Also, C-sections are more likely. The infant is more likely to have periods of low blood sugar (hypoglycemia) shortly after birth, and during first few days of life. Mothers with poorly controlled diabetes are also more likely to have a miscarriage or stillborn child. If the mother had diabetes before her pregnancy, her infant has an increased risk of birth defects if the disease was not well controlled. Continue reading >>

Infant Of A Diabetic Mother

Infant Of A Diabetic Mother

1. Infant of diabetic mother Yassin AlSaleh Dr.Sameer AlAbdi 2. ‫بسم ا الرحمن‬ ‫الرحيم‬ ‫) هو الذ ي‬ ‫وُ ا َ َّ ي يِ‬ ‫يصوركم ف ي‬ ‫وُ ا َ رِّ وُ وُ ف ْ ي يِ‬ ‫ف ْ ا َ ي يِ ا َ ف ْ ا َ‬ ‫ال ا َرحمام كيف‬ ‫ا َ ا َ‬ ‫ا َ ا َ‬ ‫يشماء ل ا َ إ ي يِلهـه إ ي يِل َّ‬ ‫وُ ا َ ف ْ ا َ ي يِ وُ‬ ‫هو العزيز‬ ‫الحكيم(‬ ‫ف ْ ا َ ي يِ وُ‬ ‫سورة آل عمران‬ 3. Objectives • • • • • • Introduction Pathophysiology Epidemiology Complications Management Prognosis 4. Introduction • Diabetes is the most common medical complication of pregnancy. • Fetal and neonatal mortality rates were as high as 65%. • nowadays nearly 30-fold decrease in morbidity and mortality rates. • there is still an increased risk of complications. 5. Definitions Gestational diabetes mellitus (GDM): any abnormal glucose intolerance that begins or is first recognized during pregnancy using glucose tolerance test. 7.  estrogen and progesterone beta-cell hyperplasia  insulin (hyper insulinism)  human placental lactogen  lipolysis in the mother  glycerol and fatty acids preserving the glucose and aminoacid for the fetus Glucose and amino acids traverse the placental membrane Before 20 weeks' gestation, fetal islet cells are incapable of responding, subjecting the fetus to unchecked hyperglycemia (IUGR) before 9 week (malformation)* After 20 weeks' gestation, the fetus responds to hyperglycemia with pancreatic beta-cell hyperplasia and  insulin levels (macrosomia).(TTN) (birth injure) (cardiomegally)  fetal basal metabolic rate and oxygen consumption  erythropoieten Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. I was an ordinary doctor until I found Medscape. A wonderful resource tool with great updates. ” Continue reading >>

Pediatrics In Practice: Evaluation And Management Of Infants Of Diabetic Mothers

Pediatrics In Practice: Evaluation And Management Of Infants Of Diabetic Mothers

Selected Podcast << Back To List Printable Version The prevalence of gestational diabetes is increasing due to increasing rates of obesity. Gestational diabetes increases the chances of adverse outcomes for both the mother and infant. In this Pediatrics in Practice podcast Jessica Brunkhorst, MD, neonatologist, reviews fetal anomalies and conditions associated with maternal diabetes, describes initial evaluation and management for infants of a diabetic mother, and discusses current recommendations regarding the management of hypoglycemia. Featured Speaker: Jessica Brunkhorst, MD, is a neonatal/perinatal specialists at Children’s Mercy Kansas City and Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. She received her medical degree from the University of Missouri-Kansas City School of Medicine. She completed her residency in pediatrics and a fellowship in neonatal/perinatal medicine both at Children’s Mercy. Learn more about Jessica Brunkhorst, MD Continue reading >>

Ucsd Medical Center

Ucsd Medical Center

Women & Infant Services POLICY/PROCEDURE TITLE: INFANT OF THE DIABETIC MOTHER – MEDICATION CONTROLLED RELATED TO: [ ] Medical Center Policy (MCP) [ ] Nursing Practice Stds. [ x ] TJC [ ] Patient Care Stds. [ ] QA [ ] Other [ ] Title 22 [ ] ADMINISTRATIVE [ x] CLINICAL PAGE 1 OF4 Effective date: 03/04 Revision date: 01/04, 03/04, 04/04, 05/04, 06/05, 5/10, 7/10 Reviewed: 04/08, 5/09 Unit/Department of Origin: ISCC Other Approval: L&D, FMCC, Birth Center POLICY STATEMENT: I. To provide guidelines for early identification and appropriate management of the term infant of a medication controlled diabetic mother. A. Infants of Diabetic mothers have increased incidence of: · Stillbirth · Congenital malformations · Premature delivery · Perinatal mortality · Neonatal mortality · Infant mortality · Cerebral palsy B. Possible effects on the baby of maternal hyperglycemia: · Fetal hyperinsulinism · Macrosomia and subsequent birth injury · Respiratory distress · Hypoglycemia · Hypocalcemia · Hypomagnesemia · Polycythemia · Hyperbilirubinemia · Thrombotic events C. Care of the IDM infant: Review Maternal History · Type of diabetes · Degree of maternal control · Prior OB history · Other pregnancy complications · Maternal medications, especially insulin or oral hypoglycemic agents. · Intrapartum meds, glucose drip, insulin, etc. · Fetal assessment In the DR, assess for: · ABC’s · Macrosomia · Birth injury · Anomalies (cardiac, musculosketetal, CNS) · Respiratory distress D. Who Goes to the ISCC? · Any symptomatic hypoglycemic infant · Any asymptomatic infant unable to maintain adequate glucose on oral feeds (see Hypoglycemia Policy & Procedure) · Any infant with significant malfor Continue reading >>

Risks To Infants Of Diabetic Mothers

Risks To Infants Of Diabetic Mothers

A fetus growing inside a woman who has diabetes may be exposed to high levels of blood glucose during the pregnancy if the diabetes is not well controlled. There are two types of diabetes that may put a baby at risk during pregnancy, namely, gestational diabetes and pre-gestational diabetes. Gestational diabetes is a condition that develops during pregnancy in women who did not previously have diabetes. Pre-gestational diabetes refers to type 1 or type 2 diabetes that a woman already had prior to becoming pregnant and requires blood sugar lowering medications or insulin to treat it. It is important to ensure that the diabetes is well controlled during pregnancy, otherwise the baby will be exposed to excess blood sugar levels that can affect it during pregnancy, during birth and after birth. When the diabetes is not properly controlled, the excess blood glucose is transferred to the fetus during pregnancy, which causes the baby to produce excess amounts of insulin. The infant is then at risk of various complications including hypoglycemia, excessive birth weight, pre-term birth, respiratory distress syndrome, and birth injury. If a woman has insulin-dependent diabetes, there is also an increased risk of birth defects that affect the formation of the heart, spinal cord, brain gastrointestinal system, and urinary tract. Unlike insulin-dependent diabetes, in gestational diabetes, the blood glucose levels are generally normal throughout the critical first three months of pregnancy, when the baby’s organs are forming. Risks to the Baby Some of the complications that diabetes can lead to if it is not carefully managed during pregnancy are described in more detail below. Excessive birth weight If there is an excess of glucose in the maternal blood, it crosses the placenta and Continue reading >>

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