What is the most common abnormality found in the infant of a diabetic mother?
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Maternal diabetes has several adverse effects on embryogenesis and fetal development and causes multiple congenital anomalies, and secondary medical complications collectively referred to as diabetic embryopathy. Diabetic mothers have 2-3 times more chances of having a gestation affected with birth defects than non-diabetic mothers. High maternal blood glucose itself is a major teratogenic agent as it alters many normal signaling pathways involved in fetal development and organogenesis, though the exact cellular reason for teratogenicity is not clear. Show Maternal high serum glucose level alters maternal as well as fetal metabolism. Both maternal and fetal hyperglycemia and ketosis have a role in pathogenesis. Environmental (maternal diabetes and intrauterine condition) and genetic predisposition interplay adversely in organogenesis.[1] The congenital malformation is likely to have occurred in early gestation because organogenesis occurs in the first trimester, and increased maternal metabolic dysregulation increases the risk of giving birth with congenital malformations. Even women with good diabetes control with insulin and tight glycemic index control show increased malformation and behavioral impairment as compared to the general population without diabetes. The diabetic status of the father does not play a role in causing malformations. However, paternal type 1 diabetes increases the risk of diabetes in children later in life. Children born from diabetic mothers have chances of increased incidence of metabolic syndrome, diabetes, and insulin resistance later on in life. Shoulder dystocia is common in a macrosomic child during delivery. Later in life, polycythemia due to fetal hypoxia stimulated erythropoietin production, and subsequent hyperbilirubinemia is evident. Other electrolyte deficiencies such as hypocalcemia, hypomagnesia are less common. Respiratory distress due to decreased surfactant levels in premature child and hypoglycemia due to maternal hyperinsulinemia has also been reported in some cases.[4][26] Maternal diabetes has toxic effects on the development of the embryo and significantly increases the risk of congenital malformations in humans. The incidence of fetal structural defects caused by maternal pregestational diabetes is three- to fourfold higher than that caused by non-diabetic pregnancy. The congenital malformations associated with diabetic pregnancy arise before the seventh gestational week. Diabetic embryopathy can affect any developing organ system, including the central nervous system (CNS) (anencephaly, spina bifida, microcephaly, and holoprosencephaly), skeletal system (caudal regression syndrome, sacral agenesis, and limb defects), renal system (renal agenesis, hydronephrosis, and ureteric abnormalities), cardiovascular system (transposition of the great vessels, ventricular septal defects, atrial septal defects, coarctation of the aorta, cardiomyopathy, and single umbilical artery), and gastrointestinal system (duodenal atresia, anorectal atresia, and small left colon syndrome). Pregnant women with fetuses with diabetic embryopathy may have chronic or unrecognized hyperglycemia and elevated levels of glycerated hemoglobin. This review emphasizes the necessity to consider hyperglycemia-induced teratogenesis during genetic counseling of parents with prenatally detected fetal malformations. Successful preconception counseling for women with diabetes mellitus and metabolic control will reduce birth defects and maternal morbidity. A fetus (baby) of a mother with diabetes may be exposed to high blood sugar (glucose) levels, and high levels of other nutrients, throughout the pregnancy. CausesThere are two forms of diabetes during pregnancy:
If diabetes is not well controlled during pregnancy, the baby is exposed to high blood sugar levels. This can affect the baby and mother during pregnancy, at the time of birth, and after birth. Infants of diabetic mothers (IDM) are often larger than other babies, especially if diabetes is not well-controlled. This may make vaginal birth harder and may increase the risk for nerve injuries and other trauma during birth. Also, cesarean births are more likely. An IDM is more likely to have periods of low blood sugar (hypoglycemia) shortly after birth, and during first few days of life. This is because the baby has been used to getting more sugar than needed from the mother. They have a higher insulin level than needed after birth. Insulin lowers the blood sugar. It can take days for babies' insulin levels to adjust after birth. IDMs are more likely to have:
If diabetes is not well-controlled, chances of miscarriage or stillborn child are higher. An IDM has a higher risk of birth defects if the mother has pre-existing diabetes that is not well controlled from the very beginning. SymptomsThe infant is often larger than usual for babies born after the same length of time in the mother's womb (large for gestational age). In some cases, especially if mothers have more longstanding illness, the baby may be smaller (small for gestational age). Other symptoms may include:
Exams and TestsBefore the baby is born:
After the baby is born:
TreatmentAll infants who are born to mothers with diabetes should be tested for low blood sugar, even if they have no symptoms. Efforts are made to ensure the baby has enough glucose in the blood:
Rarely, the infant may need breathing support or medicines to treat other effects of diabetes. High bilirubin levels are treated with light therapy (phototherapy). Outlook (Prognosis)In most cases, an infant's symptoms go away within hours, days, or a few weeks. However, an enlarged heart may take several months to get better. Very rarely, blood sugar may be so low as to cause brain damage. Possible ComplicationsThe risk of stillbirth is higher in women with diabetes that is not well controlled. There is also an increased risk for a number of birth defects or problems:
When to Contact a Medical ProfessionalIf you are pregnant and getting regular prenatal care, routine testing will show if you develop gestational diabetes. If you are pregnant and have diabetes that is not under control, call your provider right away. If you are pregnant and are not receiving prenatal care, call a provider for an appointment. PreventionWomen with diabetes need special care during pregnancy to prevent problems. Controlling blood sugar can prevent many problems. Carefully monitoring the infant in the first hours and days after birth may prevent health problems due to low blood sugar. Alternative NamesIDM; Gestational diabetes - IDM; Neonatal care - diabetic mother ReferencesGarg M, Devaskar SU. Disorders of carbohydrate metabolism in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 86. Landon MB, Catalano PM, Gabbe SG. Diabetes mellitus complicating pregnancy. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 45. Moore TR, Hauguel-De Mouzon S, Catalano P. Diabetes in pregnancy. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019: chap 59. Sheanon NM, Muglia LJ. The endocrine system. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 127. Review Date 11/9/2021Updated by: Kimberly G Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Which of the following are common problems of infants with diabetic mothers?Infant of diabetic mother. Breathing difficulty due to less mature lungs.. High red blood cell count (polycythemia). High bilirubin level (newborn jaundice). Thickening of the heart muscle between the large chambers (ventricles). What is the most likely complication of a pregnant diabetic mother with a big baby?Very large babies — those who weigh 9 pounds or more — are more likely to become wedged in the birth canal, have birth injuries or need a C-section birth. Early (preterm) birth. High blood sugar may increase the risk of early labor and delivery before the due date.
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