Infant of Diabetic Mother
Diabetes in pregnancy:There are two types of diabetes that occur in pregnancy:
- gestational diabetes - when a mother who does not have
diabetes before becoming pregnant develops a resistance to insulin
because of the hormones of pregnancy.
- pre-existing diabetes - women who already have
insulin-dependent diabetes and become pregnant.
With both types of diabetes, there can be complications for the baby.
It is very important for a mother to maintain very close control of her
diabetes during pregnancy.
What causes diabetes in pregnancy?The placenta supplies a growing fetus with nutrients and water,
as well as produces a variety of hormones to maintain the pregnancy. Some
of these hormones (estrogen, cortisol, and human placental lactogen) can
have a blocking effect on insulin. This is called contra-insulin effect,
which usually begins about 20 to 24 weeks into the pregnancy.
As the placenta grows, more of these hormones are produced, and insulin
resistance becomes greater. Normally, the pancreas is able to make
additional insulin to overcome insulin resistance, but when the production
of insulin is not enough to overcome the effect of the placental hormones,
gestational diabetes results.
Pregnancy also may change the insulin needs of a woman with existing
diabetes as a medical condition. Insulin-dependent mothers may require
more insulin as pregnancy progresses, sometimes as much as 30 percent over
the pre-pregnancy dose.
Who is affected by diabetes in pregnancy?Approximately 2 percent of all pregnant women in the United
States are diagnosed with gestational diabetes. Gestational diabetics make
up the vast majority of pregnancies with diabetes. About one pregnant
woman in 1,000 has insulin-dependent diabetes.
Why is diabetes in pregnancy a concern?The mother's excess amounts of blood glucose are transferred to
the fetus during pregnancy. This causes the baby's body to secrete
increased amounts of insulin, which results in increased tissue and fat
deposits. The infant of a diabetic mother (IDM) is often larger than
expected for the gestational age.
The infant of a diabetic mother may have higher risks for serious
problems during pregnancy and at birth. Problems during pregnancy may
include increased risk of birth defects and stillbirth. It is thought that
poor control of blood glucose is linked to the development of congenital
abnormalities. These may include abnormalities in the formation of the
heart, brain spinal cord, urinary tract, and gastrointestinal system.
Unlike insulin-dependent diabetes, gestational diabetes generally does
not cause birth defects. Birth defects usually originate sometime during
the first trimester (before the 13th week) of pregnancy. But, the insulin
resistance from the contra-insulin hormones produced by the placenta does
not usually occur until approximately the 24th week. Women with
gestational diabetes generally have normal blood glucose levels during the
critical first trimester.
A newborn infant of a diabetic mother may develop one, or more, of the
following:
- hypoglycemia
Hypoglycemia refers to low blood glucose in the baby immediately after
delivery. This problem occurs if the mother's blood glucose levels have
been consistently high causing the fetus to have a high level of insulin
in its circulation. After delivery, the baby continues to have a high
insulin level, but it no longer has the high level of glucose from its
mother, resulting in the newborn's blood glucose level becoming very
low. The baby's blood glucose level is checked after birth, and if the
level is too low, it may be necessary to give the baby glucose
intravenously.
- macrosomia
Macrosomia refers to a baby that is considerably larger than normal. All
of the nutrients the fetus receives come directly from the mother's
blood. If the maternal blood has too much glucose, the pancreas of the
fetus senses the high glucose levels and produces more insulin in an
attempt to use this glucose. The fetus converts the extra glucose to
fat. Even when the mother has gestational diabetes, the fetus is able to
produce all the insulin it needs. The combination of high blood glucose
levels from the mother and high insulin levels in the fetus results in
large deposits of fat which causes the fetus to grow excessively large.
- birth injury
Birth injury may occur due to the baby's large size and difficulty being
born.
- respiratory distress (difficulty breathing)
Too much insulin in a baby's system due to diabetes can delay surfactant
production which is needed for lung maturation
Treatment for infants of diabetic mothers:Treatment of a baby born to a diabetic mother often depends
upon the control of diabetes during the last part of pregnancy and during
labor. Specific treatment will be determined by your baby's physician
based on:
- your baby's gestational age, overall health, and medical history
- extent of the condition
- your baby's tolerance for specific medications, procedures, or
therapies
- expectations for the course of the condition
- your opinion or preference
Treatment may include:
- careful monitoring of blood glucose levels
Blood may be drawn from a heel stick, with a needle in the baby's arm,
or through an umbilical catheter (a tube placed in the baby's umbilical
cord). Generally, a baby with low blood glucose levels less needs
treatment.
- giving the baby a quick source of glucose
This may be as simple as giving a glucose/water mixture as an early
feeding. Or, the baby may need glucose given intravenously. The baby's
blood glucose levels are closely monitored after treatment to watch for
hypoglycemia to occur again.
- checking for hypocalcemia (low calcium levels) which may also occur
in IDM
- giving oxygen or using a breathing machine (if respiratory distress
occurs)
- care for any problems arising from a birth injury
- care for any problems that occur with a birth defect
Prevention of problems associated with infants of
diabetic mothers:Prenatal care is essential to a healthy outcome when a mother
has diabetes in pregnancy. Careful diet management, blood glucose
monitoring, and insulin therapy can help keep a mother's blood glucose
levels at normal levels and decrease many of the risks to her baby.
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