Infant of diabetic mother

A fetus (baby) of a mother with diabetes may be exposed to high blood sugar (glucose) levels throughout the pregnancy.

Causes

Women may have diabetes during pregnancy in 2 ways:

• Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

  Gestational diabetes

  Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

   

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• Other women have type 1 diabetes before their pregnancy begins.

  Type 1 diabetes

  Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.

   

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If the diabetes is not well controlled during pregnancy, the baby is exposed to high blood sugar levels. This can affect the baby and mom during the pregnancy, at the time of birth, and after birth.

Infants who are born to mothers with diabetes are often larger than other babies. Larger infants make vaginal birth harder. This can increase the risk for nerve injuries and other trauma during birth. Also, C-sections are more likely.

The infant is more likely to have periods of low blood sugar (hypoglycemia) shortly after birth, and during first few days of life.

Mothers with poorly controlled diabetes are also more likely to have a miscarriage or stillborn child.

If the mother had diabetes before her pregnancy, her infant has an increased risk of birth defects if the disease was not well controlled.

Symptoms

The infant is often larger than most babies born after the same amount of time in the mother's womb (called gestational age.)

Other symptoms, mostly caused by low blood sugar, may include:

• Blue or patchy (mottled) skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure)
• Newborn jaundice (yellow skin)

  Newborn jaundice

  Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replac...

   

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• Poor feeding, lethargy, weak cry, seizures (signs of severe low blood sugar)
• Puffy face
• Reddish appearance
• Tremors or shaking shortly after birth

Exams and Tests

Before the baby is born:

• Ultrasound performed on the mother in the last few months of pregnancy to monitor the baby's size.
• Lung maturity testing may be done on the amniotic fluid if the baby is going to be delivered more than a week before the due date.

After the baby is born:

• Tests may show that the infant has low blood sugar and low blood calcium.
• An echocardiogram may show an abnormally large heart, which can occur with heart failure.

Treatment

All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms.

If an infant had one episode of low blood sugar, tests to check blood sugar levels will be done over several days. Testing will be continued until the infant's blood sugar remains stable with normal feedings.

Efforts are made to ensure the baby has enough glucose in the blood:

• Feeding soon after birth may prevent low blood sugar in mild cases. Even if the plan is to breastfeed, the health care provider may suggest some formula during the first 8 to 24 hours.
• Low blood sugar that does not go away is treated with fluid containing sugar (glucose) and water given through a vein.
• In severe cases, if the baby needs (large amounts of sugar, the fluid and glucose must be given through an umbilical (belly button) vein for several days.

Rarely, the infant may need breathing support or medicines to treat other effects of diabetes. High bilirubin levels are treated with light therapy (phototherapy). Rarely, the baby's blood will be replaced with blood from a donor (exchange transfusion) for this problem.

Outlook (Prognosis)

Often, an infant's symptoms go away within hours, days, or a few weeks. However, an enlarged heart may take several months to get better.

Very rarely, blood sugars may be so low as to cause brain damage.

Possible Complications

The risk of stillbirth is higher in women with poorly managed type 1diabetes. There is also an increased risk for a number birth defects or problems:

• Congenital heart defects.
• High bilirubin level (hyperbilirubinemia).
• Immature lungs.
• Neonatal polycythemia (more red blood cells than normal). This may cause a blockage in the blood vessels or hyperbilirubinemia.

  Neonatal polycythemia

  Polycythemia can occur when there are too many red blood cells in an infant's blood.

   

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• Small left colon syndrome. Causes symptoms of intestinal blockage.

When to Contact a Medical Professional

If you are pregnant and receiving regular prenatal care, routine testing will show if you develop gestational diabetes.

If you are pregnant and have diabetes that is not under control, call your provider right away.

If you are pregnant and are not receiving prenatal care, call a provider for an appointment.

Prevention

Women with diabetes need special care during pregnancy to prevent problems. Controlling blood sugar can prevent many problems.

Carefully monitoring the infant in the first hours and days after birth may prevent health problems due to low blood sugar.