Infants of diabetic mothers (IDMs)

Notes

## Basic introduction

  • In mothers with insulin-dependent diabetes mellitus (IDDM), hypoglycemia and ketosis can occur during fetal organogenesis with associated increase in incidences of fetal anomalies
  • The risk is minimal in gestational diabetes as glucose intolerance does not occur during organogenesis
  • Glucose from the maternal blood system is transported across the placenta to the fetal circulation system. This results in fetal hyperglycemia that stimulates beta-cell hypertrophy, raising insulin production and fetal oxygen consumption. This leads to increased anabolic effects on adipocytes, skeletal and cardiac muscles, hepatic, and connective tissue (but not the brain).

## Statistics

  • Globally, 3-10% of pregnancies are affected by abnormal glucose regulation and control
Symptoms
  • Congenital anomalies

_Transposition of the great arteries

_Double outlet right ventricle

_Ventricular septal defect

_Truncus arteriosus

_Tricuspid atresia

_Patent ductus arteriosus

_Neural tube defects

_Intestinal complications (such as “small left colon syndrome”)

_Orthopedic anomalies

  • Prematurity
  • Respiratory Distress Syndrome (RDS)
  • Perinatal asphyxia
  • Macrosomia (due to fetal hyperglycemia and hyperinsulinemia that promote growth)
  • Intrauterine growth restriction (in case of advanced maternal diabetes)
  • Neonatal hypoglycemia (that is caused by fetal hyperinsulinism as a result of maternal hyperglycemia)
  • Reduced bone density (due to increased bone resorption)
  • Neonatal hypocalcemia and hypomagnesemia (due to loss of Mg++ and Ca++ ions as a result of maternal glycosuria)
  • CNS disorders: meningomyelocele, anencephaly and holoprosencephaly
  • Unexplained fetal demise
  • Hyperbilirubinemia
  • Poor feeding
Diagnosis
  • Glucose monitoring within 1-2hrs after birth (pre-prandial and continue for the first 12-24hrs of life)
  • Check hematocrit 12hrs after birth
  • Assessment of cardiac and respiratory system
  • Monitor for jaundice
  • Monitoring of calcium and magnesium levels (occasionally)
Differential
  • Not applicable
Prevention
  • Adequate management of diabetes before and during pregnancy
Reference

1. Mimouni, F. B., Mimouni, G., & Bental, Y. A. (2013). Neonatal management of the infant of diabetic mother. Pediatrics &Therapeutics, 4, 186.

2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

Management
  • Enhanced delivery room management due to high risk of dystocia (difficult birth) and neonatal depression
  • Management of respiratory distress
  • Screening for and management of polycythemia, neonatal hypocalcemia, and hypomagnesemia

## Management of neonatal hypoglycemia (NHP)

  • The signs of NHP may include: cyanosis, seizures, apneic episodes, jitteriness, tachypnea, weak or high-pitched cry, poor feeding, floppiness or lethargy, eye-rolling, and comaa.
  • A cut-off for treating NHP is 40 mg/dl (2.2mMol/dl)
  • Rx: IV Glucose (200mg/kg, 2 ml/kg dextrose 10% in water)
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