An infant of a diabetic mother is a baby born to a mother with diabetes. These infants are at risk for problems including respiratory distress, abnormal growth, low blood sugar, and birth defects. During pregnancy, tight control of the mother's blood sugar and monitoring for issues like high blood pressure and kidney function are important. Close monitoring of the infant after birth is also needed to check for low blood sugar, high red blood cell count, calcium and bilirubin levels.
An infant of a diabetic mother is a baby born to a mother with diabetes. These infants are at risk for problems including respiratory distress, abnormal growth, low blood sugar, and birth defects. During pregnancy, tight control of the mother's blood sugar and monitoring for issues like high blood pressure and kidney function are important. Close monitoring of the infant after birth is also needed to check for low blood sugar, high red blood cell count, calcium and bilirubin levels.
An infant of a diabetic mother is a baby born to a mother with diabetes. These infants are at risk for problems including respiratory distress, abnormal growth, low blood sugar, and birth defects. During pregnancy, tight control of the mother's blood sugar and monitoring for issues like high blood pressure and kidney function are important. Close monitoring of the infant after birth is also needed to check for low blood sugar, high red blood cell count, calcium and bilirubin levels.
An infant of a diabetic mother is a baby born to a mother with diabetes. These infants are at risk for problems including respiratory distress, abnormal growth, low blood sugar, and birth defects. During pregnancy, tight control of the mother's blood sugar and monitoring for issues like high blood pressure and kidney function are important. Close monitoring of the infant after birth is also needed to check for low blood sugar, high red blood cell count, calcium and bilirubin levels.
Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1/ 17
INFANT OF DIABETIC MOTHER
Definition & physiology
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.
Potential Morbidity 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
Fetal problems Congenital malformations Intrauterine growth restriction (IUGR) : *In mothers with long standing microvascular disease > Macrosmia :*Glucose crosses the placenta fetal hyperglycemia
Neonatal problems > Hypoglycemia : transient hypoglycaemia during the 1st day of life from fetal hyperinsulinismprevented by early feeding > Respiratory distress syndrome (RDS) : more common as lung maturation is delayed > Hypertrophic cardiomyopathy > Polycythaemia : makes the infant look plethoric ( venous hematocrit >0.65)
Congenital malformations of infants of diabetic mother
Anomaly Caudal Regression Spina Bifida, Hydrocephalus, or other CNS defects
Ratio of incidences
Gestational age after
ovulation in weeks
252
Anencephalus
Heart anomalies Transposition of great vessels Ventricular septal defect Atrial septal defect
1. Eye Examination -Pregnancy can worsen diabetic retinopathy (mild) -Retina usually returns to its prepregnancy condition within several months after delivery. -Follow up examination is every three months until delivery -Some experts recommended C-section but real life, most women can attempt a vaginal delivery.
2. Blood Pressure Monitoring
High blood pressure often improves during the first half of pregnancy, but returns to baseline or worsens in the second half. Methyldopa, calcium channel blocking agents, hydralazine, or beta blockers. Beta blockers can mask some symptoms of low blood glucose and should be used with caution. Angiotensin converting enzyme (ACE) inhibitors (captopril, lisinopril, enalapril) and angiotensin II receptor blockers (ARBs, losartan, valsartan) are not safe for the fetus. Gestational hypertension (high blood pressure during pregnancy) and preeclampsia (high blood pressure and protein in the urine during pregnancy) are more common in women with diabetes.
3. Kidney Function Monitoring
Pregnancy does not cause diabetes-related kidney disease (called diabetic nephropathy), but it can worsen existing disease. Diabetic nephropathy may increase the risk of developing other pregnancy complications, such as preeclampsia, preterm delivery, and babies who are small for their age (intrauterine growth restriction). Increased risk of having a small infant because blood flow to the placenta may be reduced. Condition is temporary and reverts to the prepregnancy condition within several months of delivery
4. Ultrasound To screen for birth defects - Ultrasound examination is recommended at 18 to 20 weeks gestation - Risk for neural tube defects and heart defects - most birth defects develop by the 10th week of pregnancy. To monitor amniotic fluid levels -Polyhydramnios is an abnormal increase in the amount of amniotic fluid. Polyhydramnios is more common in women with diabetes than in women without diabetes. - Polyhydramnios related to diabetes is usually mild and does not cause problems. If the fluid levels become severely elevated, maternal discomfort, uterine contractions, premature rupture of the membranes ("breaking the water"), and preterm delivery can occur.
To monitor the baby's growth
- Macrosomia is a condition in which an infant weighs more than nine pounds (4000 grams) at term (37 weeks of pregnancy), and is more common in women with diabetes. - High fetal insulin levels, which can develop in response to elevated maternal blood glucose levels, are one potential cause of macrosomia since insulin stimulates fetal growth
Infant of diabetic mother
Management during delivery Assessment of the APGAR score to indicate the need for resuscitation Drying, warming and cleaning the airways gently No immediate stomach suction because the risk of reflex bradycardia and apnea with pharyngeal stimulation Examine the placenta and the infant for congenital anomalies Cord blood sample is examined for blood glucose and pH
macrosomia & mental retardation Higher risk early initiation of feedings (highly recommended) Asymptomatic no need for I.V dextrose
HEMATOCRIT LEVELS
< 65%: may be symptomatic
partial volume exchange transfusion. > 65%: may remain asymptomatic hydrated with I.V fluid at a rate of 100 mL /kg/day & the hematocrit measured daily for 1st 3 days.
CALCIUM LEVELS
Only IDM + symptomatic
hypocalcemia
10% calcium gluconate administration (through a central venous catheter)
BILIRUBIN LEVELS
Serum
bilirubin concentrations monitored starting in the 1st 24 hours & followed up to 5 days outpatient assessment
Risk of IDDM in Offspring of
Diabetic Parents
Tips for Diabetic Mother Before
& While & After Pregnancy
Diabetic father 6% risk of
having IDDM by the age of 20 Diabetic mother 1.3% risk
Regular prenatal care, routine
testing can diagnose gestational diabetes early Control blood sugar Lung maturity testing may help prevent breathing complications due to immature lungs if the baby is being delivered more than a week before the due date. Carefully monitoring the infant in the first hours after birth may prevent complications due to low blood sugar. Monitoring and treatment in the first few days may prevent complications due to high bilirubin levels.
