Infant of Diabetic Mother
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GDM-- Carb intolerance in pregnancy
affects 3-5% of pregnancies
Risk factors - ↑ maternal age , obesity
↑ BMI , strong family history
southeast Asians, African Americans etc
↑ perinatal and Neonatal mortality with poor
glycemic control
Introduction
• Frequency: 3-10% of pregnant women
have diabetes
– 88% have gestational diabetes
– 12% have known diabetes
• 35% with Type I diabetes
• 65% with Type II diabetes
Risk of Complications
• Higher with poor glucose control
• Higher with pre-gestational Diabetes
• ↑ risk of other compl in the mother
-- eg: PIH is 2 times more common in
diabetic pregnancies
LGA and SGA babies
CASE -- 1
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Baby G , a 36wk IDM with birth wt of
3.8kg, NVD, good APGARS was with mum,
breast fed at 2 and 5 hrs of age, presented at
10hrs of age with
• H/O 1. multiple apnea
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2. severe lethargy, pale, mottled
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Case -1---contd
• GRBS– 30mg%
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Maternal hyperglycemia
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• glucose and a. a cross placenta(not insulin )
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• ↑ bl sugar in fetus →ß cell hyperplasia
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hyperinsulinemia
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Routine monitoring in IDM is Important
Glucose reqd is much higher than normal
Reqr may go upto 15mg/kg/min
If not maintained on oral feeds, start IV fluids
↑ volume and conc of glucose –
may need a central line for Glucose > 12%
MONITORING VITAL – 48HRS
Case --2
• 2.1 kg Term IDM, on full feeds and normal
GRBS presents on day 2 with
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1. Cyanosis
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2. lethargy, resp distress
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3. Convulsions
Case 2 ---contd
• PCV– 66 % , Hb - 22gm/dl –
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Polycythemia
• ↑ Hb A1 in mother and baby –hypoxia
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placental insufficiency
• Needs Partial Exch transfusion to
prevent CNS morbidity
• Haematuria, NEC, PPHN may also occur
Preventable CNS morbidity
• Hypoglycemia – microcephaly, C.P ,learning
disability in 30-50% of symptomatic cases
• Polycythemia -- hemiplegia, cerebral infarct
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mental retardation , limb weakness
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PREVENTABLE MORBIDITIES
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MONITORING IS THE KEY
Case 3
• Term baby 3.8 kg, IDM presents on day 3
with
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1. Resp Distress -80/min
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H.R. – 190/min, poor pulses, sPo2 94%
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features of CCF , Systolic murmur
Cardiac complications
• H O C M - Lasix, Propranolol
• Resolves by 4-6 mos
• Deposition of fat and glucose along the
septum
• Others-- TOGV, ASD, Coarctation
Hypertrophic Cardiomyopathy
Case 4
• Term baby 39wks, 3.7 kg , IDM presents with
severe resp distress at 1 hr of age
RDS
TTN
Case 5
• 4- day old preterm IDM 36wks- 1.8 kg has
• feed intolerance, vomiting, abd distension
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bilious aspirates
Small Left Colon Syndrome
Pathophysiology of Fetal Effects
• Maternal hyperglycemia acts like a teratogen ->
spontaneous abortions and malformations
Situs Inversus
Anencephaly and Caudal Regression Syndrome
Birth Injuries
Birth Injury
 Macrosomia puts infant at risk for injuries
during delivery
Shoulder dystocia can lead to:
Clavicular and/or humeral fractures
Brachial plexus injuries
Traumatic delivery or need for vacuum/forceps
assistance can lead to:
Cephalohematomas
Facial bruising
Facial nerve injuries
Problems of IDM babies
• At Birth
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Still birth
preterm
Macrosomia
asphyxia
birth injury
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Problems after birth
LGA
SGA
Hypoglycemia
Hypocalcemia
RDS, TTN
HOCM
Polycythemia
Hyperbil
Anomalies
( CNS,CVS GIT )
Sepsis
Role of Obstetrician
• Preconception counselling
• good maternal glucose control
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Paediatrician
• Anticipate, monitor, treat complications