infant to diabetic mother

Which molecule is able to cross the placenta and which molecule isn’t (diabetes)?

1. Can cross > glucose

2. Can’t cross > insulin

What is the result of high glucose in the maternal circulation?

High glucose crosses the placenta and leads to high glucose in the fetus and therefore stimulating high insulin in the fetus and leading to a large for gestation age / macrosomia (25%)

If maternal renovascular / cardiac disease is present what effects would be present in the neonate? (2)

1. Intrauterine growth restriction or

2. Small for gestational age

What are the effects of poor maternal glycemic control during pregnancy in the first trimester? (2)

1. Major birth defects

2. Spontaneous abortions

What are the effects of poor maternal glycemic control during pregnancy in the 2nd & 3rd trimester? (2)

1. Hyperinsulinemia

2. Macrosomia

Both lead to excessive fat & organomegaly due to increased foetal substrate uptake

What are the CNS congenital abnormalities of diabetic embryopathy in maternal type 1 diabetes? (2)

1. Neural tube defects (anencephaly, myelomenigocele)

2. Holoprosencephaly

What are the cardiac congenital abnormalities of diabetic embryopathy in maternal type 1 diabetes? (4)

1. Hypertrophic intraventricular septum

2. Atrium septal defect

3. Ventricular septal defect

4. Transposition of the great arteries

What are the renal congenital abnormalities of diabetic embryopathy in maternal type 1 diabetes? (2)

1. Renal agenesis / dysplasia

2. Hydronephrosis

What are the GIT congenital abnormalities of diabetic embryopathy in maternal type 1 diabetes? (3)

1. Small left colon

2. Bowel atresia

3. Ano-rectal malformation

What is the skeletal congenital abnormality of diabetic embryopathy in maternal type 1 diabetes? (2)

1. Caudal regression syndrome > sacral agenesis

What are the facial congenital abnormalities of diabetic embryopathy in maternal type 1 diabetes? (3)

1. Midline clefts

2. Microsomia

3. Microtia/ anotia

What are the delivery complications of infant to the diabetes mother? (5)

1. Shoulder dystocia

2. Brachial plexus injury

3. Humerus fracture

4. Clavicle fracture

5. Visceral trauma

What are the postnatal problems of infants to the diabetic mother? (8)

1. Poor feeding

2. Hypoglycaemia secondary to hyperinsulinism

3. Respiratory distress syndrome > low surfactant production due to hyperinsulinemia which results in low cortisol levels

4. Transient tachypnoea of the newborn > macrosomia increases the likelihood of C-section delivery

5. Polycythemia > may cause stroke, renal vein thrombosis & seizures

6. Jaundice > secondary to Polycythemia

7. Hypcoalcemia & hypomagnesemia > secondary to TTN

8. Thrombocytopenia > secondary to excess RBC precurors in bone marrow

What is the management of infant to the diabetic mother? (6)

1. Prevent hypoglycaemia early by frequent feeding

2. Monitor serum glucose levels

3. Identify como,ovations (TSH, Ca, Mg)

4. Screen for congenital abnormalities using CXR, cardiac & renal sonar

5. Brachial plexus injuries > refer to specialists

6. Hypertrophic cardiomyopathy may require B-blockers