Fetal complications 2/2 DM

Question 1

What is the ideal fasting blood glucose level to avoid adverse effects of gestational diabetes?

Answer 1

Above 95 mg/dL

Question 2

What additional risks does poorly controlled gestational diabetes mellitus pose for the infant?

Answer 2

Macrosomia, hypocalcemia, hypoglycemia, hyperviscosity due to polycythemia, respiratory difficulties

Question 3

List the complications that can arise from maternal hyperglycemia during the first trimester.

Answer 3

• Neural tube defects
• Sirenomelia (fusion of limbs)
• Congenital heart disease
• Small left colon syndrome
• Spontaneous abortion

Question 4

What is a complication associated with maternal hyperglycemia during the second and thrid trimesters?

Answer 4

fetal hyperglycemia and hyperinsulinemia

Maternal hyperglycemia can lead to various complications in the fetus.

Question 5

What is the term for increased erythropoiesis in response to fetal hypoxemia?

Answer 5

Polycythemia, this results from increased metabolic demands seen in fetal hyperglycemia and hyperinsulinemia.

Polycythemia occurs when there’s an increase in red blood cell mass, often due to low oxygen levels.

Question 6

What is a possible outcome of fetal hyperglycemia and hyperinsulinemia?

Answer 6

Macrosomia

Macrosomia refers to a larger than average fetal size, often due to increased insulin levels.

Question 7

What conditions result from fetal Macrosomia?

Answer 7

Shoulder dystocia, leading to shoulder dystocia, brachial plexopathy, and perinatal asphyxia.

Question 8

True or False: Maternal diabetes can lead to perinatal asphyxia.

Answer 8

True

Perinatal asphyxia can occur due to various complications associated with maternal diabetes.

Question 9

What is a skeletal complication that can arise during delivery of an infant with maternal diabetes?

Answer 9

Clavicle fracture

Clavicle fractures can occur during delivery, particularly in cases of macrosomia.

Question 10

What cardiac condition may develop in infants of mothers with diabetes?

Answer 10

Hypertrophic cardiomyopathy due to increased glycogen synthesis, leading to glycogen deposition in the interventricular septum. This condition usually reverses with glycemic control.

Hypertrophic cardiomyopathy is characterized by the thickening of the heart muscle, often related to fetal hyperinsulinemia.

Question 11

What causes fetal hyperinsulinemia that leads to transient hypertrophic cardiomyopathy?

Answer 11

Maternal and fetal hyperglycemia

Question 12

Fill in the blank: Transient hypertrophic cardiomyopathy is caused by fetal _______ in response to maternal and fetal hyperglycemia.

Answer 12

hyperinsulinemia

Question 13

What is a consequence of insulin in the context of transient hypertrophic cardiomyopathy?

Answer 13

Glycogen synthesis

Question 14

Does transient hypertrophic cardiomyopathy always require treatment?

Answer 14

No treatment is required if the patient is asymptomatic.

Question 15

What can occur if left ventricular outflow is obstructed in infants?

Answer 15

Congestive heart failure manifestations

Question 16

What are the manifestations of congestive heart failure in infants?

Answer 16

Respiratory distress, tachycardia, hypoxia, failure to thrive

Question 17

What is the treatment for transient hypertrophic cardiomyopathy in infants if heart failure occurs?

Answer 17

Propranolol and IV fluids.

Question 18

When does transient hypertrophic cardiomyopathy typically occur during pregnancy?

Answer 18

Late second to early third trimesters

Question 19

Where is excess glycogen and fat deposited in the myocardium in transient hypertrophic cardiomyopathy?

Answer 19

Interventricular septum

Question 20

What may contribute to the selective thickening of the interventricular septum?

Answer 20

Increased oxidative stress

Question 21

Is a hypertrophic interventricular septum usually symptomatic?

Answer 21

No, it is usually asymptomatic

Question 22

Can crackles be auscultated in infants with pulmonary edema due to transient hypertrophic cardiomyopathy?

Answer 22

No, crackles may not be auscultated

Question 23

What might be evident on a chest radiograph in cases of transient hypertrophic cardiomyopathy?

Answer 23

Pulmonary congestion and cardiomegaly

Question 24

What diagnostic tool confirms the diagnosis of transient hypertrophic cardiomyopathy?

Answer 24

Echocardiography

Question 25

What common cause of tachypnea in newborns is mentioned as a differential diagnosis?

Answer 25

Transient tachypnea of the newborn