Infant of the Diabetic Mother

Introduction

• IDMs are a special group of babies (high risk).
• Diabetic women have an increased risk of abortions & stillbirths.
• Neonatal mortality rate is 5 times that of non-diabetics & is higher at all gestational ages, especially after 32 weeks and for every birth weight for gestational age category.

Pathophysiology

• Maternal hyperglycemia leads to fetal hyperglycemia and subsequent fetal hyperinsulinism.
• Consequences include macrosomia (large birth weight) and hypoglycemia after birth.
• Congenital malformations are correlated with poor metabolic control in the mother.

Problems

• Macrosomia: Maternal hyperglycemia leads to increased glucose transfer to the fetus, resulting in excessive growth and macrosomia, which can contribute to perinatal asphyxia and birth trauma.
• Hypoglycemia: The fetus, adapted to high glucose levels in utero, experiences a sudden drop in glucose levels after birth, as its own insulin production increases, leading to hypoglycemia.
• Hypocalcemia: Maternal diabetes can affect calcium metabolism in the fetus, potentially leading to hypocalcemia after birth.
• Polycythemia: Fetal hypoxia caused by maternal diabetes can stimulate increased red blood cell production, resulting in polycythemia.
• Immaturity of Organs: Maternal diabetes can delay organ maturation, particularly in the liver and lungs, increasing the risk of non-physiologic jaundice and respiratory distress syndrome (RDS).
• IUGR (Intrauterine Growth Restriction): Maternal hypertensive disorders or nephropathy can lead to reduced blood flow to the fetus, resulting in intrauterine growth restriction.
• Congenital Malformations: Poor metabolic control in the mother can lead to congenital malformations in various systems:
• CNS (Central Nervous System): Neural tube defects may occur due to disrupted neural tube development.
• CVS (Cardiovascular System): Septal defects, transposition of the great vessels (TGV), and cardiomyopathy can arise due to abnormal heart development.
• GIT (Gastrointestinal Tract): Hypoplastic left bowel syndrome can result from impaired gastrointestinal development.
• MSS (Musculoskeletal System): Sacral agenesis, characterized by the absence of sacral vertebrae, can occur due to disrupted musculoskeletal development.

Management

• Before Delivery: Conduct a biophysical profile to assess fetal well-being and monitor potential complications.
• At Delivery: Evaluate the need for immediate resuscitation based on the condition of the newborn.
• Examination: Perform a thorough examination to identify any congenital malformations.
• Investigations: Conduct the following tests:
• RBS (Random Blood Sugar): Monitor blood sugar levels over the first 48 to 72 hours of life, with hourly monitoring for the first 6 hours.
• PCV (Packed Cell Volume): Assess the hematocrit level to monitor for polycythemia.
• SB (Serum Bilirubin): Monitor serum bilirubin levels to assess the risk of hyperbilirubinemia and jaundice.

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