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.

Study on neonatal morbidity in infants of diabetic mothers

“…Similar findings was seen in the study of Opara et al 16 The frequency of RDS in this study was 14% (n=12). This incidence of RDS was comparable to findings of Cordero et al 6 Congenital pneumonia and TTN were common causes of RDS in all the infants in the study. TTN is a known complication of IDMs especially in caesarean cases, which is known risk factor.…”

Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus

“…These findings suggest the need for early identification of the women with GDM (particularly those at high risk) for interventions that could potentially reduce the rate of macrosomia and other outcomes associated with macrosomia such as shoulder dystocia and caesarean section deliveries which were also higher in this study compared to the background population [50]. Although the prevalence of neonatal hypoglycaemia was higher in this study than in previous studies involving European (3-4%) [35,51] and other Pacific Islander (16.6%) women with GDM [32,35], the association with maternal BMI was consistent with reports from Brazil [42], Spain [42], Australia [43] and New Zealand [29,34] among women with GDM. The burden of adult overweight, obesity, and associated non-communicable diseases (NCDs) has been widely acknowledged in at least 17 Pacific Island countries, including Fiji, which have current national NCD plans or strategies in place [52].…”

Breast-feeding Initiation in Women With Pregestational Diabetes Mellitus

“…Hypoglycemia has been reported to affect 35% to 64% of infants born to women with PGDM. 6,8,13,23,36 The incidence of hypoglycemia among our patients (34%) is in line with newer reports of declining rates. 6,37 There is no direct evidence linking hypoglycemia and BFI, unless it is mediated by the mother-infant separation that occurs when IV dextrose is needed.…”