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    Infant of A Diabetic Mother

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    Elvis
    This document discusses infants of diabetic mothers (IDMs). It summarizes that 3-10% of pregnant women have diabetes, with 88% having gestational diabetes and 12% having pre-existing diabetes. Maternal hyperglycemia, especially in the first trimester, increases the risk of major birth defects and spontaneous abortions in IDMs. The risks of congenital anomalies are directly related to the level of maternal blood sugar control. Common anomalies seen in IDMs include neural tube defects, cardiac malformations, renal and gastrointestinal issues, and skeletal abnormalities. IDMs also face risks of complications after birth like hypoglycemia, macrosomia, and long term developmental and metabolic issues. Proper screening and management of IDMs

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    Infant of A Diabetic Mother

    Uploaded by

    Elvis
    65 views20 pages
    This document discusses infants of diabetic mothers (IDMs). It summarizes that 3-10% of pregnant women have diabetes, with 88% having gestational diabetes and 12% having pre-existing diabetes. Maternal hyperglycemia, especially in the first trimester, increases the risk of major birth defects and spontaneous abortions in IDMs. The risks of congenital anomalies are directly related to the level of maternal blood sugar control. Common anomalies seen in IDMs include neural tube defects, cardiac malformations, renal and gastrointestinal issues, and skeletal abnormalities. IDMs also face risks of complications after birth like hypoglycemia, macrosomia, and long term developmental and metabolic issues. Proper screening and management of IDMs

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    Infant of a Diabetic Mother

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    This document discusses infants of diabetic mothers (IDMs). It summarizes that 3-10% of pregnant women have diabetes, with 88% having gestational diabetes and 12% having pre-existing diabetes. Maternal hyperglycemia, especially in the first trimester, increases the risk of major birth defects and spontaneous abortions in IDMs. The risks of congenital anomalies are directly related to the level of maternal blood sugar control. Common anomalies seen in IDMs include neural tube defects, cardiac malformations, renal and gastrointestinal issues, and skeletal abnormalities. IDMs also face risks of complications after birth like hypoglycemia, macrosomia, and long term developmental and metabolic issues. Proper screening and management of IDMs

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views20 pages

    Infant of A Diabetic Mother

    Uploaded by

    Elvis
    This document discusses infants of diabetic mothers (IDMs). It summarizes that 3-10% of pregnant women have diabetes, with 88% having gestational diabetes and 12% having pre-existing diabetes. Maternal hyperglycemia, especially in the first trimester, increases the risk of major birth defects and spontaneous abortions in IDMs. The risks of congenital anomalies are directly related to the level of maternal blood sugar control. Common anomalies seen in IDMs include neural tube defects, cardiac malformations, renal and gastrointestinal issues, and skeletal abnormalities. IDMs also face risks of complications after birth like hypoglycemia, macrosomia, and long term developmental and metabolic issues. Proper screening and management of IDMs

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    INFANT OF A DIABETIC MOTHER

    Leonard Buya
    Mount Kenya University.
    Department of Child Health and Pediatrics
    EPIDEMIOLOGY
    Frequency: 3-10% of pregnant women have
    diabetes
    88% have gestational diabetes
    12% have known diabetes
    35% with Type I diabetes
    65% with Type II diabetes
    PATHOPHYSIOLOGY
    CONT...
    Glucose Control and Malformations

    MALFORMATION RATES BY LEVEL Of MATERNAL


    HEMOGLOBIN A1c
    6.9 or less - 0 %
    7.0-8.5 - 5.1 %
    8.6 or greater - 22.4 %
    IDM- 1ST TRIM

    Congenital anomalies of diabetic


    embryopathy
    Central nervous system
    Cardiac malformations
    Renal , urinary
    GI tract anomalies
    Skeletal anomalies
    ABORTIONS
    CNS anomalies

    • Neural tube defects


    – Anencephaly
    – Meningomyelocele
    • Hydrocephaly
    • Holoprosencephaly
    Cardiac anomalies

    • Cardiac functional abnormalities are present in up


    to 30% of IDMs
    – intraventricular septal hypertrophy and
    cardiomyopathy
    – Transposition of great vessels
    – Coarctation of the aorta
    – Atrial & Ventricular septal defects
    – Dextrocardia
    – Single ventricle, hypoplastic left heart
    – Patent ductus arteriosus
    GI anomalies

    • GI: Small Left Colon Syndrome


    • Bowel atresia
    • Bowel dysmotility
    (feeding intolerance)
    Skeletal Anomalies

    • Caudal Dysplasia or Regression SD


    – Rare disorder (1/25000) Sacral agenesis
    – The most specific malformation related
    to diabetes 200-400 times more often
    in IDMs
    – Sacral agenesis with hypoplastic pelvis
    – Usually with other malformations like:
    femoral hypoplasia, extrophy of the
    bladder, and club foot

    CAUDAL
    Sacral agenesis
    DYSPLASIA
    IDM – 2ND AND 3RD TRIM

    Fetal and Neonatal Complications

    • Poor late control (Hyperglycemic fetus)


    - Risk for Hyperinsulinemia (growth factor)
    CONT...
    Fetal and Neonatal Complications of
    Hyperinsulinemia
    – Macrosomia
    – Hypoglycemia
    – Polycythemia
    -Hyperbilirubinemia
    – Cardiomyopathy
    -Perinatal hypoxia
    – Respiratory distress
    -Rds
    -Hypocalcemia /hypomagnesemia
    -Neurological dysfunctions
    Long Term Prognosis of IDM

    IDMs are at increased risk for delayed motor and


    cognitive development due to-
    -Birth asphyxia
    -Hypoxemia
    -Hypo- or hyperglycemia,
    -Acidosis,
    -Iron deficiency.
    Risk of Developing Insulin Dependent DM
    . Diabetic mother 2%
    . Diabetic father 6%
    Workup for IDM

    • CBC count
    • RBS
    •ELECTROLYTES- Magnesium ,Calcium
    • Bilirubin level
    • Arterial blood gas
    • Chest radiography
    • Abdominal, pelvic, or lower extremity radiography
    – When caudal dysplasia is present,
    • Cardiac echocardiography
    • Barium enema
    – Infants with feeding intolerance, abdominal distention,
    nonbilious emesis, or poor passage of meconium may require a
    barium enema.
    Summary

    • Maternal hyperglycemia in the first trimester


    time of
    conception, during fetal organogenesis result in
    major
    birth defects and spontaneous abortions
    • Diabetic embryopathy can be prevented by
    control of
    diabetes BEFORE CONCEPTION
    NBU –MNX OF IDM
    • Keep baby warm

    • • Monitor:
    • - blood sugar at 1, 2, 3, 6, 9, 12, 24, 48 hrs
    - calcium levels at 6, 12, 24, 48 hrs
    - haematocrit at 1 & 24 hrs
    - bilirubin levels at 24 & 48 hrs
    • • Oral dextrose 10% 60 ml/kg/day to all babies
    • • If hypoglycaemic (blood sugar <2.2mmol/L)
    • - dextrose 10% 10 ml/kg STAT OR dextrose 50% 2 ml/kg IV STAT then IV dextrose 10% 60 ml/kg/24 hrs
    • • If hypocalcaemic (serum calcium <7 mg%)

    • - 3 ml/kg of 10% calcium gluconate slowly IV STAT


    •
    • If haematocrit >65%

    • - partial exchange transfusion 10-20 ml of fresh plasma/kg

    • Jaundice –phototherapy, exchange transfusion


    ( REFERENCE- MOH.. KENYA 2002)
    • THANK YOU

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