Case 18 - Infant of a Diabetic Mother

Question 1

Management after IDM (Infant of DM mother) being born

Answer 1

stabliize the Cardiorespiratory status, then frequently check the blood glucose

Question 2

Abnormal blood glucose after birth (especially in IDM)

Answer 2

< 40mg/dL (2.2 mmol), must feed immediately, <20mg/dL (1.5mmol) is treated with IV glucose.

Question 3

Complication of infant of DM mother

Answer 3

Complication to baby:
premature birth,

hypoglycemia,

macrosomia,

increased fetal oxygen&raquo_space; placental insufficiency&raquo_space; respiratory distress&raquo_space; respiratory distress syndrome (surfactant deficiency)» perinatal asphyxia

increased fetal oxygen» increased production of erythropoietin.&raquo_space; Elevated hematocrit (Hct)&raquo_space; polycythemia&raquo_space; elevated bilirubin levels and can
cause renal vein thrombosis

Hypocalcemia&raquo_space; irritability
or decreased myocardial contractility

High risk of congenital malformations, including congenital heart disease, neural tube defects, caudal regression syndrome and small left colon syndrome

Complicated delivery - shoulder dystocia

IDM may be small for gestational age if the mother’s diabetes
is associated with severe vascular disease and resultant placental insufficiency.
IDMs may be small in childhood but are often overweight in adolescence.

Question 4

When should the woman screen for the gestational blood glucose

Answer 4

between 24-28 gestation weeks.

The fetal pancreas begins producing insulin during the fourth month of gestation and becomes functionally significant after week 26, so for higher risk ( high maternal age, preexisting diabetes, multiparity, early macrosomia symptoms etc) group may need to screen at the early gestation week