Management of Infants of Diabetic Mothers

Abstract

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,orcongenitalmalformation. 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 fortyfour 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 feedings alone. The majority of cases of RDS are mild and require short admissions to special care nurseries. Optimal care of infants of diabetic mothers is based on prevention, early recognition, and treatment of common conditions.Severecongenitalmalformations,significantprematurity,RDS,recurrenthypoglycemicepisodes,andasymptomatic infants of women with advanced IDDM should be admitted to special care nurseries. Breast-feeding among women with GDM and IDDM should be encouraged.

Altered transitional circulation in infants of diabetic mothers with strict antenatal obstetric management: a functional echocardiography study

“…3,4 Still, little is known about the cardiac changes that occur during the transitional period particularly in IDMs with good glycemic control, as the majority of these infants do not receive an echocardiogram. 5,6 As the incidence of IDMs increase and as they receive better prenatal care, it is essential that we learn more about whether the well-controlled IDM is also at risk for cardiorespiratory dysfunction.…”

Aberrant Endometrial Features of Pregnancy in Diabetic NOD Mice

“…These risks include death, intrauterine growth restriction, neural tube defects, premature birth, and macrosomia (14). Risks are reduced but not eliminated by optimal maternal glycemic control, indicating a complex etiology.…”

Gestational diabetes and the neonate: challenges and solutions

“…In a retrospective study which was limited by small sample size, Das and Ankola 42 found an incidence of neonatal hypocalcemia of 6.6% in GDM compared to 32% in pregestational diabetes (P,0.002). In a larger study, Cordero et al 43 reported the risk to be ,1%.…”