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 Infants of Diabetic Mothers
Infants who are born to a diabetic mother, whether type I, type II or gestational diabetes (type III) have a higher risk of mortality and morbidity. For example, infants who are born to mothers with gestational diabetes account for five to nine percent of major congenital malformations and account for thirty to fifty percent of perinatal deaths.
Infants who are born to mothers with pre-existing diabetes face even greater odds. Here are some of their grim statistics;
- Five times greater chance for still birth and perinatal mortality
- Neonatal mortality rates are five times higher than the general population
- Three times more likely to be born by c-section
- Twice as likely to suffer serious birth injury
- Four times as likely to be admitted to the Newborn Intensive Care Unit
Some of the major causes of morbidity in these infants are; large for gestational age, small for gestational age, hypoglycemia, prematurity, respiratory distress, and intrapartum asphyxia.
How Maternal Diabetes Affect the Neonate
The affect of diabetes on the fetus can be broken into the first twenty weeks and post twenty weeks. First, for those infants whose mothers have pre-existing diabetes, congenital abnormalities can occur in the first trimester if the glucose levels are not in control. Not only when the newborn is conceived but studies have shown the uncontrolled glucose plasma levels for up to one year before the pregnancy can affect early fetal development.
Also, during the first twenty weeks, the fetus is subjected to high levels of glucose during times of maternal hyperglycemia. At this point in development, the fetal islet cells are incapable of responding. The effects of this unchecked hyperglycemia can cause decreased fetal growth.
Macrosomia
After twenty weeks, the fetus is able to respond by increasing its own insulin levels. If the maternal blood glucose levels have been consistently high then the fetal pancreas senses the increased amount of glucose and produces more insulin. This is done in an attempt to use the extra glucose in circulation. The extra glucose is then stored as large deposits of fat. Fetal growth acceleration can be noted by ultrasound by twenty-four weeks – especially in those infants whose mothers have fluctuating maternal levels.
Respiratory Distress Syndrome
Too much insulin during fetal development can cause a delay in surfactant production. Surfactant is needed in order for the lungs to completely open as needed at birth. Without sufficient surfactant, the infant will likely require some sort of respiratory support after birth.
Treatment
Treatment will vary depending on the way the infant presents after birth (respiratory status, cardiac status, etc.). After birth, all infants born to mothers of diabetics should be tested for low blood sugar even if they do not display symptoms. If the infant has even one low blood glucose, testing will need to continue over several days. Treatment for low blood sugar levels can vary. Typically, the first line of treatment is early feeding. If the infant continues to have difficulty, then intravenous glucose is required. In rare circumstances, medication administration and possibly an endocrinology consult is warranted. Often times, neonatal units have very specific guidelines regarding treatment for these infants.
Long-term sequela for these infants greatly depends on their presenting symptoms. For some, intervention may include early feeding. Other infants will have significant problems that have very long-term consequences including cardiac defects, and neurological defects. Sub-specialists who are often involved in the care of these infants include; neonatalogists, pediatric cardiologists, pediatric neurologists, and pediatric endocrinologists.
If you have a case that involves diabetes during pregnancy and would like information on how our services can be of service to you, contact us today at info@medicaljurisprudence.com.
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