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 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 >>
Glucagon In The Treatment Of Hypoglycemia In Newborn Infants Of Diabetic Mothers
Thesis Infants of diabetic mothers are at high risk to develop hypoglycemia after birth. After birth, glucose and ketone bodies are the main substrates of brain energy. Under normal condition, the adrenergic response seen immediately after birth suppresses insulin release and stimulates glucagon secretion which enhances gluconeogenesis and ketogenesis. An inversion of the insulin/glucagon ratio is seen soon after birth as a normal, physiologic phenomenon. Consequently, a post delivery glucose nadir is reached between 30 to 90 minutes after birth, followed by a spontaneous recovery before 3-4 hours of age. In infants of diabetic mothers, this inversion of the ratio is postponed and a more profound and sustained hypoglycemia is seen. Early feeding is of great importance to diminish the severity and incidence of hypoglycemia. But, if despite an appropriate calorie intake, low levels of sugar are seen, an intravenous infusion of glucose should be commenced. In case that IV glucose is not effective or can't be supplied immediately, intramuscular glucagon is a therapeutic alternative. We hypothesize that a single intramuscular injection of glucagon together with the appropriate oral intake of nutrients is a safe and an effective alternative to the IV infusion of glucose alone in the treatment of hypoglycemia in term infants of diabetic mothers. Methods Appropriately grown or large for date, term infants of insulin treated diabetic mothers, with no other known medical problems, are potential candidates for our study. Hypoglycemia will be defined as serum glucose level lower than 45 mg%. Infants of diabetic mothers will arrive to the nursery and immediately receive early feeding before 30 minutes of life. At that time, glucose will be checked. If glucose level is lower than 45 Continue reading >>
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 >>
I Have Gestational Diabetes. How Will It Affect My Baby?
Will gestational diabetes hurt my baby? Most women who develop diabetes during pregnancy go on to have a healthy baby. Dietary changes and exercise may be enough to keep blood sugar (glucose) levels under control, though sometimes you may also need to take medication. But untreated gestational diabetes can cause serious problems. If blood sugar levels remain elevated, too much glucose ends up in the baby's blood. When that happens, the baby's pancreas needs to produce more insulin to process the extra sugar. Too much blood sugar and insulin can make a baby put on extra weight, which is stored as fat. This can make the baby grow very large (macrosomia). Also, high blood sugar levels during pregnancy and labor increase the risk of a baby developing low blood sugar (hypoglycemia) after delivery. That's because the baby's body produces extra insulin in response to the mother's excess glucose. Insulin lowers the amount of sugar in the blood. The signs and symptoms of hypoglycemia in an infant include: jitteriness weak or high-pitched cry floppiness lethargy or sleepiness breathing problems skin that looks blue trouble feeding eye rolling seizures A baby may also be at higher risk for breathing problems at birth, especially if blood sugar levels aren't well controlled or the baby is delivered early. (If you have gestational diabetes, your baby's lungs tend to mature a bit later). The risk of newborn jaundice is higher too. If your blood sugar control is especially poor, the baby's heart function could be affected as well, which can contribute to breathing problems. Gestational diabetes sometimes thickens a baby's heart muscle (hypertrophic cardiomyopathy), causing the baby to breathe rapidly and not be able to get enough oxygen from her blood. It's understandable to feel anxi Continue reading >>
Babies Born To Diabetic Mothers Have Increased Risk For Chd
Background Diabetes has long been associated with maternal and perinatal morbidity and mortality. Before the discovery of insulin in 1921, women with diabetes rarely reached reproductive age or survived pregnancy. Fetal and neonatal mortality rates were as high as 65% before the development of specialized maternal, fetal, and neonatal care. Since then, infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates. 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% had type 1 diabetes mellitus, and 65% had type 2 diabetes mellitus. 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 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. Pathophysiology Understanding the physiology of fetal glucose control is necessary to appreciate the causes of the associated complications. Increased levels of both estrogen and progesterone affect glucose homeostasis as counter-regul Continue reading >>
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 Mom
Q1. You are a 3rd year resident in a NICU taking care of a 2 hour old full term baby boy, born by C section to a 26 year old mother with a 10 year history of Type 1 Diabetes Mellitus (T1DM). Your main concerns in the next following days related to DM include the following, except: A. Hypoglycemia B. Hypomagnesemia C. Hypothermia D. Hypocalcemia E. Polycythemia F. Hyperbilirubinemia G. Hypoxemia H. Hyperthermia I. All of the above Q2. You are in your office with the mother of a 2 week old baby girl. The mother says that that she has Type 2 DM (T2DM) and was on Insulin during pregnancy. She wishes to return to her previous Glyburide regimen. The baby otherwise healthy. The mother is eager to breastfeed her baby. Which of the following statements regarding breastfeeding is FALSE? A. The oral anti-diabetic agents thought to be generally safe during lactation are Glyburide and Metformin B. The maternal history of diabetes is a contraindication for breastfeeding C. Exclusive breastfeeding decreases the risk of obesity and diabetes later in life D. Mothers with diabetes may have delayed lactation by 2-3 days compared to healthy women E. All of the statements listed above are TRUE A. Breastfeeding exclusively for 6 months and continued breastfeeding for at least 12 months B. Limit juice intake to 10 oz a day when the baby is going to be 1 year old C. 20% of the diet should consist of carbohydrates D. After 1 year of age, keep the child on a strict diet to prevent obesity Q4. TRUE or FALSE: Women with DM during pregnancy have lower nutritional requirements compared to healthy women because they have to maintain a tighter glucose control. Q5. TRUE or FALSE: The perinatal morbidity and mortality of infants of diabetic mothers reach levels close to those found in general population Continue reading >>
Disproportionate Body Composition And Neonatal Outcome In Offspring Of Mothers With And Without Gestational Diabetes Mellitus
OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm3) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA. RESEARCH DESIGN AND METHODS This prospective population-based cohort study was performed using data Continue reading >>
Infant Of Diabetic Mother
A fetus (baby) of a mother with diabetes may be exposed to high blood sugar (glucose) levels throughout the pregnancy. Causes Women may have diabetes during pregnancy in 2 ways: 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. Symptoms The infant is often larger than most babies born after the same amount of time in the mother's womb (called gestational age.) Other symptoms, mostly caused by low blood sugar, may include: Exams and Tests Before the baby is born: Ultrasound performed on the mother in the last few months of pregnancy to monitor the baby's size. Lung maturity testing may be done on the amniotic fluid if the baby is going to be delivered more than a week before the due date. After the baby is born: Tests may show that the infant has low blood sugar and low blood calcium. An echocardiogram may show an abnormally large heart, which can occur with heart failure. Treatment All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms. If an infant Continue reading >>
Infant Of Diabetic Mother
How does Diabetes in the mother affect the baby before birth? When a mother has diabetes, her body does not control blood sugar normally. Blood sugar is controlled mainly by insulin. Normally, blood sugar rises after meals. The body responds by putting insulin into the blood stream. The insulin helps the sugar get into the body's cells that use the sugar for energy and growth. With diabetes, there is not enough insulin released by the body causing the blood sugar rise abnormally high. When a mother's blood sugar is high, so is her baby's inside her because sugar travels across the placenta to the baby. The baby's body can and does make insulin. If the blood sugar is high, the baby makes extra insulin to keep its own blood sugar normal. Diabetes may be present before pregnancy, or it may appear during pregnancy. Diabetes which occurs only during pregnancy is called "gestational diabetes" and appears after the first few months of pregnancy. In gestational diabetes, diet alone often controls the blood sugar level, but sometimes the body needs extra insulin. Diabetes which exists before pregnancy usually requires insulin and often gets worse during pregnancy. Keeping blood sugar in the normal range is very important in pregnancy. If a woman has diabetes for several years, the blood vessels in her body may be more narrow or show changes of aging. These same changes can occur in the blood vessels to the placenta. Problems of the developing baby can include: Large size. The high sugar and high insulin together may make the baby grow larger than normal. Small size. Usually when the mother has had diabetes for several years and has changes in her blood vessels. Increased risk for malformations or birth defects. This is more common when diabetes started before pregnancy and/or wh Continue reading >>
The Value Of Real-time Continuous Glucose Monitoring In Premature Infants Of Diabetic Mothers
Abstract To determine the feasibility of using a real-time continuous glucose monitoring system (RTGMS) in intensive care units, our study focus on preterm infants with diabetic mothers owing to their high risk of blood sugar abnormalities. Thirty preterm babies (M = 15 and F = 15; ≤ 36 week gestation age) were studied from within 72 hours of delivery. These babies were admitted to the newborn intensive care and were further categorized into groups based on whether their mothers with or without diabetic mellitus. Blood sugar levels were monitored by both RTGMS and the traditional intermittent arterial line (A-Line) glucose method. Continuous glucose monitoring were well tolerated in 30 infants. There were good consistency between RTGMS and A-Line glucose concentration measurements. Of the preterm infants, 33.33% experienced abnormal glucose levels (hypoglycemia or hyperglycemia) between the checkpoint intervals of the intermittent A-Line blood sugar measurements. RTGM showed advantages with regards to reduced pain, greater comfort, the provision of real-time information, high sensitivity (94.59%) and specificity (97.87%) in discovering abnormalities of blood sugar, which are especially valuable for premature infants of diabetic mothers. RTGMS is comparable to A-line measurement for identifying fluctuations in blood glucose in premature infants. RTGMS detects more episodes of abnormal glucose concentration than intermittent A-line blood glucose measurement. High risk infants, especially premature infants with diabetic mothers, should receive more intensive blood sugar level checks by using continuous RTGMS. Continue reading >>
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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 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 >>
