Diabetic mother

Question 1

Diabetic mother- what are the fetal (in utero) and neonatal (at birth) consequences

Answer 1

Congenital malformations 6%- range of normal pop, but increased risk cardiac, agenesis, hypoplastic L colon, duodenal atresia, CP disproportion, Infections.

IUGR: 3 fold increase ( due to microvascular disease)
OR
Macrosomia: glucose crosses barrier:insulin secreted –>growth–> 25% above 4kg. Birth injury, shoulder dystocia, asphyxia.

Neural tube defects, renal defects (hydronephrosis, PCKD,RVT), skeletal, CNS (hydrocephaly, ancephaly,..)
Hypoglycemia <40mg/dL–> due to hyperinsulinemia with not enough substrate after birth and fetal liver decreased production

Hypomagnesemia in mother–> hypoPTH, hypocalcemia <7mg/dl , hypomagnesemia in fetus.

Organomegaly–> hyperglycemia ( pancreas hyperplasia), therefore hyperinsulinemia (cell growth)

Respiratory distress (with transient tachypnea): hyperglycemia reduces surfactant production

Hypertrophic cardiomyopathy

Polycythemia therefore hyperbilirubinemia- Venous Hc >70% is symptomatic (debatable)- + neonate RBC less deformabletreat with partial exchange transfusion (Iv saline and remove blood- formula: how much to exchange: (blood volume(85ml) /kg) x (observed Hc-desired(50%) Hc) / observed Hc

therefore can present with symptoms related to any of these consequences: eg: polycythemia with acrocentric cyanosis, irritabiity, muddy appearence,…

Question 2

Gestational vs T1D

Answer 2

Gestational does not carry increased risk of congenital malformations, however T1D does.

Question 3

Diagnostic tests:

Answer 3

Glycemia
Magnesemia
Calcemia
Bilirubinemia
Hc
Rx
ECG, ECHO

Question 4

Symptoms hypoglycemia newborn

Answer 4

Apnea, irregular respirations, Irritability, hypotonia, poor sucking or feeding, exaggerated Moro reflex, cyanosis, tremors, pallor, eye rolling, seizures, lethargy, changes in levels of consciousness, temperature instability, coma

Question 5

Treatment hypoglycemia newborn

Answer 5

Asymptomatic hypoglycemia
-early feeding
-glc<25mg/dl parenteral glucose
Symptomatic hypoglycemia
-parenteral glucose (10%glucose solution: 6-8mg/kg/min – 16-20 mg /kg/min)
-glucagon
-corticosteroids(hydrocortisone, prednisone)

Question 6

DD hypoglycemia in newborn (3 types)

1. transient

Answer 6

TRANSIENT hypoglycemia
perinatal stress
sepsis
asphyxia or hypoxic – ischemic  encephalopathy
hypothermia
polycythemia
shock 
maternal drugs (beta-symphatomimetic  agents)

Question 7

DD hypoglycemia in newborn (3 types)

2. Low glucose store

Answer 7

IUGR, preterm,postterm

Question 8

DD hypoglycemia in newborn (3 types)

3.Recurs or persists

Answer 8

• Hyperinsulinism due to diabetic mother, Beckwith-Wiedman (genetic overgrowth syndrome), islet adenoma, dyplasia islet cells.
• low GH, CHT, T3T4, Adrenaline, glucagon, cortisol, pituitary hypoplastic
• hereditary carbohydrate,fat,protein met problems