Infant of diabetic mother

Dr Mohd Maghayreh
PRINCESS RAHMA TEACHING
HOSPITAL
Epidemiology
 GD 1-5% of all pregnant women
 60,000 - 90,000 cases/yr
 .2 - .3% pregnancies complicated by pre-
existing DM
 10,000 infants born to diabetic women
 White’s Classification
 A Treated with diet
 B Onset >20 y.o.; duration < 10 yr.
 C Onset 10-19 y.o.; duration 10-20 yr.
 D Onset <10 y.o.; duration > 20 yr.
macrovascular dz., benign retinopathy, HTN
 E Calcification of pelvic vessels
 F Nephropathy
 G Many reproductive failures
 H Heart dz.
 R Malignant retinopathy
 T Prior renal tx.
Gestational Diabetes-Risk Factors
 Family hx of diabetes
 Obesity
 Hx of macrosomic infants

 with detection of risk factors only 10% of

gestational diabetics can be identified
Gestational Diabetes-Dx

2 or more abnormal glucose

tolerance test, that return to
normal at the end of
pregnancy & was not present
prior to pregnancy
Fetal Complications
 Macrosomia / Birth Trauma
 IUGR
 Increased mortality
 Hypoglycemia
 Hypocalcemia
 Polycythemia
 Hyperbilirubinemia
 Congenital Malformations
 Cardiorespiratory
Macrosomia-Risk factors
 Obesity
 Postdates
 Previous macrosomic infant
 Diabetes
 Gestational diabetes
 Preexisting diabetes
Macrosomic Infants
 Definition (wt., ht. & OFC)
 Degree of macrosome
 Visceral enlargement
 15-45% of class A-C
 Etiology
 Complications
Complications Of LGA Infant
 Protracted labor
 Shoulder dystocia
 Perinatal asphyxia
 Skeletal +/or nerve injury
 Increased rate of C/S (47%)
 Cardiac
 Complications of Macrosomia
Nerve injury
 Erbs palsy, Klumpke & total involvement
 Erbs
 upper cervical roots
 Affected arm limp, adducted, internally
rotated pronated with flexed wrist
 Klumpke
 Lower cervical roots
 hand is flaccid
 Erbs palsy-Tx
 Conservative with supportive splints for
good alignment
 Passive exercise after 4-5 days
 When swelling has subsided
 Recovery depends on the degree of injury
 If no recovery by 3 mths - unlikely to
happen
Cardiomegaly
 Heart wt 174% of controls
 CXR - 50% of IDM
 CHF - 5-17%
 EKG - abnormal in 40%
 Hypertrophic subaortic stenosis
 Resolves by 2-6 months
 Septal hypertrophy reported at 25wk
IUGR
 Definition (symmetrical vs.
nonsymmetrical)

 20% of class D-F

 Etiology
Hypoglycemia
 Most common complication in IDM
 .5-4% of ‘healthy’ FT infants
 Etiology / Risk factors
 Nadir 1- 2hr. recovers 4-6 hr.
 Prevention-start feedings within the 1st
hour then feed Q 2-3 hr
 Physiology
 Maternal hyperglycemia
 Glucose crosses the placenta by facilitated diffusion
(fetal glucose is 70-80% of maternal)
 Insulin does not cross the placenta
 Net effect -> fetal hyperglycemia with subsequent
hyperinsulinemia in the fetus
 Fetal insulin is a growth promoting factor
 Increased fat stores & visceral enlargement
 Once the umbilical cord is severed, glucose
supply stops & the newborn has a decreased
ability to down regulate insulin
Hypoglycemia- Symptoms
 Majority are asymptomatic
 The absence of overt symptoms does not rule
out CNS injury
 Symptoms
 tremors, jitteriness, seizures
 Lethargy, irritability
 Poor feeding, vomiting
 irreg resp., apnea, cyanosis,
 hyperthermia
 Weak or high pitched (shrill) cry
 Hypoglycemia-Tx
 Irrespective of symptoms - treat
 very easily treatable and therefore needs to be
anticipated, even in infants who appear well
 Tx
 Feedings po/pe
 Bolus - 2 cc/kg D10W
 followed by a continuous infusion of 8 mg
glucose/k/min. 110 ml/k/d gives 8mg/k/min.
 Recheck glucose q 30-60 min until stable.
 Some infants will need 12 to 15 mg of
dextrose/k/min.
Hypoglycemia
 Bedside Reagent strips are a good
screening tool & have widespread use
 Reagent strips measure whole blood
glucose which is 15% lower than plasma
levels.
 results should be confirmed by a lab
glucose but treatment should be not be
delayed
Hypocalcemia
 Definition
 15-30% of IDM
 Symptoms
 HypoMg (<1.5) assoc. c decreased Ca++
 Pathogenesis
 Tx
Resp. Distress
 40-50% of IDM
 TTN vs. RDS
 RDS; 3-8% of IDM <38.5wk
 L/S ratio (nl >2; >3-3.5)
 Etiology
 TTN­ Risk Factors
◆ Infant born by C/S s labor
◆ Prematurity
◆ Maternal sedation
◆ Maternal fluid administration
◆ Maternal asthma
◆ Fetal asphyxia
 TTN­ CXR
◆ Mildly overexpanded lungs
◆ Prominent fissures
◆ Perihilar fullness 
◆ Pleural effusions
Polycythemia
 Hct > 65%
 Peaks at 2 hr., decreases by 6hr.
 Etiology:
 increased erythropoietin 20 chronic intrauterine
hypoxia from decreased placenta perfusion
 S.E. hypoglycemia, hyperbilirubinemia (20-40% of
IDM), organ damage 2° decrease blood
flow/ischemia, NEC , thrombosis-renal v.
thrombosis, intrauterine limb thrombosis
 Tx- hydration / partial exchange
Congenital Anomalies
 4-10% of IDM (GD not assoc c birth defect)
 Dose response (33% class F)
 Greatest sensitivity (3-6 wk p conception)
 Skeletal; caudal regression syndrome
 (200x’s c IDM but only 16% CRS)
 CNS; anencephaly, MM and neural tube
defects
Congenital Anomalies
 Cardiac; TGV, VSD, ASD, single vent,
HLV, coarctation
 GI; sm L colon (presents as a fix bowel
obstruction), TEF, imperforated anus
 GU; agenesis, dbl ureters, hypospadius,
multicystic dz. renal v. thrombosis
 Minor anomalies; 2 vessel cord,
hypertrichosis pinnae
Hypoplastic Left Colon Syndrome
 Presents in the first 48 hours of life
 Failure to pass meconium
 Abdominal distention
 Bile-stained emesis
Hypoplastic Left Colon Syndrome
 Presents in the first 48 hours of life
 Failure to pass meconium
 Abdominal distention
 Bile-stained emesis
Hypoplastic Left Colon Syndrome
 Functional obstruction from decrease
colonic motility
 Radiographs - multiple dilated loops
 Contrast enema diagnostic & therapeutic
 rare to need surgical intervention
F/U Neurodevelopment
 CP 3-5x’s more common
 Increase risk for IDDM
 Increase risk of obesity
 IQ scores wnl but inversely correlated c
maternal glucose levels
Please take good care of me!

I’m the Future!