Infant of a Diabetic Mother - Causes, Symptoms, and Treatment

Introduction

Diabetes is a condition where the body cannot regulate blood sugar levels properly. Diabetes in a pregnant mother can affect both the mother and the baby. When a woman with diabetes becomes pregnant, it is important for her to carefully manage her blood sugar levels to reduce the risks to her baby.

What Is an Infant of a Diabetic Mother?

An infant of a diabetic mother is an infant born to a mother with diabetes. The infant of a diabetic mother has a higher risk for complications during pregnancy and childbirth. The baby is at a risk for problems even after birth.

What Causes Diabetes in Mothers During Pregnancy?

Two types of diabetes can occur during pregnancy. One variant is present even before the woman becomes pregnant (pre-gestational diabetes) and the other type is acquired during the pregnancy (gestational diabetes).

• Gestational Diabetes - This type of diabetes is not present before pregnancy. The woman develops gestational diabetes during pregnancy and it goes away after the birth of the baby. Gestational diabetes may be caused due to the hormones produced during pregnancy which may block the insulin.

• Pre-gestational Diabetes - In this type, the woman has diabetes before getting pregnant. Pregestational diabetes may be type 1 or type 2.

What Are the Effects of Maternal Diabetes on Infants?

The excess blood glucose in the mother’s body gets transferred to the fetus during pregnancy. This may cause an increase in the risk of birth defects and stillbirth. Some of the potential complications that maternal diabetes has on babies are listed below:

• Macrosomia: It is a common complication in an infant of a diabetic mother. Babies are larger than average in macrosomia. Newborns of diabetic mothers have increased muscle mass, excess body fat, and bigger organs. The excess glucose from the mother's blood gets stored up as fat in the baby's body making the baby grow larger than normal.

• Metabolic Disorders:

  1. Hypoglycemia - Hypoglycemia in IDM (Infant of a diabetic mother) refers to low blood sugar levels after birth. This is because the babies are used to high glucose levels from their mother, which causes their insulin levels to be increased when they are born resulting in hypoglycemia.

  2. Hypocalcemia - Low blood calcium concentration in the infants of diabetic mothers. This is due to the decrease in calcium and vitamin D in the mother.

  3. Hyperbilirubinemia - In this condition, there is bilirubin buildup in the blood. This may cause jaundice with yellow discoloration of the eyes and skin. It is not a serious complication.

• Preterm Birth: There is an increased risk of spontaneous preterm birth in diabetic mothers. The exact cause of preterm birth in diabetic mothers is still controversial.

• Respiratory Disorders: Babies born to mothers with diabetes are at a higher risk of developing respiratory distress syndrome, a condition in which the baby’s lungs are not fully developed and they have difficulty breathing.

• Hematological Disorders: Infants of diabetic mothers have been found to have polycythemia (abnormally high red blood cell count). Hypoglycemia may be aggravated if the baby has polycythemia, this is due to the increased consumption of glucose by the increased red blood cells.

• Cardiac Disorders:

  1. Hypertrophic cardiomyopathy may be present in infants of diabetic mothers. In this condition, the heart muscles become thickened.

  2. Congenital cardiac defects in babies born to mothers with gestational diabetes may be seen.

• Neurologic Impairments:

  1. Neurologic impairments in babies with diabetic mothers are due to metabolic disorders, perinatal asphyxia (a condition in which the body is deprived of oxygen), and birth traumas.

  2. The chances for perinatal asphyxia are increased in cases of macrosomia when one of the baby’s shoulders gets stuck during delivery (shoulder dystocia).

  3. Metabolic disorders like hypoglycemia may produce signs like jitteriness, hypothermia, apnoea, apathy, seizures, and tremors.

  4. Brachial plexus injuries may occur as a result of spinal cord trauma during birth.

  5. Poor suckling patterns were found in infants of insulin-managed diabetic mothers. This is due to neurologic immaturity during the neonatal period.

How Is an Infant of a Diabetic Mother Treated?

Treatment for an infant with a diabetic mother is specifically planned considering factors like the baby’s gestational age, overall health, the extent of the condition, the baby’s tolerance to medications or procedures, etc. Common treatment includes:

• Blood Glucose Monitoring - Infants born to diabetic mothers are at risk of low blood sugar levels, and therefore early and frequent blood glucose monitoring is essential. Treatment involves feeding the baby more frequently along with intravenous administration of glucose.

• Respiratory Support: It is given to babies with respiratory distress syndrome.

• Phototherapy: Phototherapy for babies with jaundice involves exposing the baby’s skin to blue light to help break down bilirubin.

• Feeding Support: Feeding support for babies with difficulty in breastfeeding includes supplementation with formula, lactation counseling, nipple shields, etc.

• Other birth injuries and birth defects are treated accordingly.

• Monitoring for long-term complications including blood glucose levels and overall health is essential because infants born to diabetic mothers are at an increased risk of developing type 2 diabetes later in their life.

What Can Be Done to Prevent Complications in an Infant With a Diabetic Mother?

To prevent complications in an infant with a diabetic mother, it is important to manage the diabetes of the mother before and during pregnancy. Here are some steps that can be taken

• Preconception care to optimize the blood sugar level is given to women with diabetes who are planning to become pregnant.

• All women are tested for gestational diabetes between 24 to 28 weeks of pregnancy.

• Regular monitoring of the blood sugar levels is done throughout the pregnancy to ensure that they remain within a safe range.

• Medication and nutrition are adjusted according to the needs of the pregnant mother. A well-balanced diet that does not affect blood sugar levels is planned for the diabetic mother by a dietician.

• Regular exercise as advised by the doctor can help control blood sugar levels and promote a healthy pregnancy.

• Close fetal monitoring during pregnancy can help detect any potential complications early on, allowing for timely interventions.

• Depending on the mother’s diabetic management and the health of the baby, the delivery may need to be scheduled early or by C-section to reduce the risk of complications.

Conclusion

Infants of diabetic mothers are at risk for many complications. However, control of the maternal blood sugar levels during pregnancy may reduce the risks of complications in the infant. The symptoms of infants with diabetic mothers usually subside within days or weeks in most cases.