Infant of a diabetic mother
- Arieh Riskin, MD, MHA
Arieh Riskin, MD, MHA
- Department of Neonatology
- Bnai Zion Medical Center, Israel
- Clinical Associate Professor
- Rappaport Faculty of Medicine, Technion, Israel
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
Diabetes in pregnancy is associated with an increased risk of fetal, neonatal, and long-term complications in the offspring. Maternal diabetes may be pregestational (ie, type 1 or type 2 diabetes diagnosed before pregnancy with a prevalence rate of about 1.8 percent) or gestational (ie, diabetes diagnosed during pregnancy with a prevalence rate of about 7.5 percent). The outcome is generally related to the onset and duration of glucose intolerance during pregnancy and severity of the mother's diabetes. (See "Pregestational diabetes: Preconception counseling, evaluation, and management".)
This topic will review the complications seen in the offspring of mothers with diabetes and the management of affected neonates. The prenatal management of pregestational and gestational diabetic mothers is discussed in separate topic reviews. (See "Diabetes mellitus in pregnancy: Screening and diagnosis" and "Pregestational diabetes mellitus: Obstetrical issues and management" and "Gestational diabetes mellitus: Obstetrical issues and management" and "Gestational diabetes mellitus: Glycemic control and maternal prognosis" and "Pregestational diabetes: Preconception counseling, evaluation, and management".)
Poor glycemic control in pregnant diabetic women leads to deleterious fetal effects throughout pregnancy, as follows :
●In the first trimester and time of conception, maternal hyperglycemia can cause diabetic embryopathy resulting in major birth defects and spontaneous abortions. This primarily occurs in pregnancies with pregestational diabetes. The risk for congenital malformations is only slightly increased with gestational diabetes mellitus (GDM) compared with the general population (odds ratio [OR] 1.1-1.3). The risk of malformations increases as maternal fasting blood glucose levels and body mass index (BMI) increases when GDM is diagnosed early in pregnancy. These findings suggest that some of these mothers are probably undiagnosed women with type 2 diabetes [2,3]. (See 'Congenital anomalies' below and "Pregestational diabetes: Preconception counseling, evaluation, and management".)
●Diabetic fetopathy occurs in the second and third trimesters, resulting in fetal hyperglycemia, hyperinsulinemia, and macrosomia.
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- FETAL EFFECTS
- NEONATAL EFFECTS
- Congenital anomalies
- Preterm delivery
- Perinatal asphyxia
- - Birth injury
- Respiratory distress
- - Respiratory distress syndrome
- - Other causes of respiratory distress
- Metabolic complications
- - Hypoglycemia
- - Hypocalcemia
- - Hypomagnesemia
- Polycythemia and hyperviscosity syndrome
- Low iron stores
- NEONATAL MANAGEMENT
- LONG-TERM OUTCOME
- Metabolic risks
- - Diabetes
- - Obesity and glucose metabolism
- Neurodevelopmental outcome
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS