Infant of a Diabetic Mother
Diabetics on the pregnancy has an effect on fetal neonatal and growing children. The mother may have presentational diabetics/type 1 and type 2 / or diabetics during pregnancy called gestational diabetics. Type 1 diabetes develops when the pancreatic b cells do not produce enough insulin, causing high blood glucose levels. It can be caused by genetic or environmental influences or an autoimmune response that destroys the b cells. Type 2 diabetes involves insulin resistance or reduction in insulin sensitivity so the body does not respond well to high glucose levels, this type of diabetes mellitus can occur with advancing age, obesity. The third type of diabetes is gestational diabetes mellitus, with this disorder, there is an increase in blood glucose levels or glucose intolerance during pregnancy. Usually, gestational diabetics mellitus disappears after pregnancy; however, many mothers will develop diabetes, usually type 2, in the years following pregnancy (Lois W.,Gena D.,&Wendy B.,2005).
During normal pregnancy, resistance to insulin action increases because of the stimulations of the mother’s pancreas by increased level of estrogen progesterone and other hormones. In most pregnancies, pancreatic beta cells are able to compensate for increased insulin demands, and normal glucose level is maintained. In contrast, women who develop gestational diabetic mellitus have deficits in beta-cell response leading to insufficient insulin secretion to compensate for the increased insulin demands. So, 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 /http://www.impcna.com/intranet/Nelson%20Pediatric/Newborn/InfantsDiabeticMothers%5B1%5D.pdf/
Presentational diabetics/ type 1 and type 2/ or gestational diabetes mellitus develops hyperglycemia of variable severity with the onset of pregnancy. Low insulin secretion or increase in insulin resistance is common during pregnancy to replace the glucose for the fetus. In a normal pregnancy, fetal and placental growth increases cortisol, growth hormone, human placental lactogen, progesterone, estrogen and prolactin levels. This triggers excess insulin, insulin resistance, low glucose and postprandial excess glucose. Thus, there is a decrease in peripheral sensitivity to insulin and an increase in demand, so compensatory increase in insulin secretion maintains a normal glucose homeostasis. However; gestational diabetic mellitus occurs if pancreatic b-cells are unable to face the increased insulin demand during pregnancy. Furthermore, in response to the high level of insulin, peripheral utilization of glucose by the muscles and peripheral glycogen storage increase in an attempt to maintain balance / http://library.umac.mo/ebooks/b28357899.pdf/.
As the age of pregnancy increases, the compensatory mechanisms may be insufficient resulting an imbalance between insulin secretion and insulin demand during pregnancy. Women with poorly controlled diabetes prior to or during early pregnancy brings complication on the fetus and the mother.
Sign and Symptoms
The complication associated with infant of the diabetic mother can be manifested during pregnancy or after pregnancy.
Infants born to mothers with poorly controlled insulin tend to be larger than normal. The infant’s large size is a result of fetal hyperglycemia. If the maternal blood has excess glucose, the pancreas of the fetus detects the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus changes the excess glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The mixture of high blood glucose coming from the mother and high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large. As a result, macrosomia develops because of the increased insulin secretion and its effects on the growth of the infant in utero. So that infants born with high adipose tissue, high liver glycogen, and larger size of other organs.
Low blood glucose in an infant of a diabetic mother results from the sudden interruption of the glucose supply from the mother at birth. The high insulin secretion of the fetus continues, and the infant’s glucose level can drop to low level. This causes different symptoms like restlessness/jumpiness, limpness/ inactivity, cyanosis, convulsions, feeding problems, sweating, hypothermia and seizures.
Polycythemia, Hyperbilirubinemia, and Thrombosis
A relative hypoxemia can occur in utero as a result of maternal and fetal high blood glucose and, subsequently, excess glucose in the fetus. metabolic rate and oxygen consumption increase to metabolize the excess sugar. With this relative low oxygen in utero, the fetus produces more erythropoietin, resulting in more red blood cells to transport oxygen. Therefore, RBCs number increases resulting polycythemia and the slow blood f low (hyper viscosity) and higher levels of jaundice following breakdown of the red blood cells after birth results hyperbilirubinemia. Renal vein thrombosis also develops as a result of the slow blood flow, causing clots to form in the renal vein and other areas.
Respiratory Distress Syndrome
Respiratory distress is another common problem in the infants of a diabetic mother. Excess insulin in a baby’s system due to diabetes can delay surfactant synthesis which is needed for lung maturation ,this affects both preterm and term neonates.
The high glucose levels early in pregnancy can cause abnormalities in the developmental processes. Caudal agenesis is one of the more common anomalies associated with insulin-dependent diabetes during pregnancy. Other abnormalities that have occurred are ventricular septal defect and other cardiac abnormalities, neural tube defects, small left colon syndrome, and genitourinary abnormalities.
Diabetes can cause dangerous complications for the infants, these include: premature birth, breathing problems, cardiomegaly, low calcium levels, high hematocrit, polycythemia, birth defects, kidney abnormalities, miscarriage, stillbirth and electrolyte imbalances.
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. Treatment may include:
a. Monitoring of blood glucose levels
b. Giving the baby a quick source of glucose
c. checking for low calcium levels
d. monitoring respiratory distress
e. prevention of problems associated with infants of diabetic mothers
Management for Infant of a diabetic mother
Prenatal care is important when a mother has diabetes in pregnancy. Diet management, blood glucose monitoring, and insulin therapy can help keep a mother’s blood glucose levels at normal levels and decrease the potential risks on baby. Watching hypoglycemia in the night time helps to prevent ketoacidosis. It is also important to treat other disorders such as preeclampsia and urinary tract infections that can interfere with normal glucose metabolism and use. During delivery clamping the umbilical cord helps to prevent excessive blood transfusion from the placenta.
Infant of a Diabetic Mother