32 - The infant of the diabetic mother

Summary

Introduction

The infant of the diabetic mother (IDM) is the premier example of the metabolic dysequilibrium that potentially exists in the neonate secondary to a maternal condition, i.e., diabetes. Developmentally, the normal neonate is in a transitional state of glucose homeostasis. The fetus is completely dependent on his/her mother for glucose delivery and the adult is considered to have precise control of glucose homeostasis. However, maintenance of glucose homeostasis may be a major problem for the neonate born to the nondiabetic mother. The precarious nature of this equilibrium is emphasized by the numerous morbidities producing or associated with neonatal hypo- and hyperglycemia during the neonatal period. Although many IDMs have an uneventful perinatal course, there is still an increased risk of complications. Many can be minimized, but not currently eliminated, with appropriate obstetric and pediatric intervention. In fact, a recent analysis indicated that there is still much room for improvement due to the multiplicity of factors that impact on any specific pregnancy. This discussion will enumerate many of the difficulties that the IDM may encounter, evaluate the pathophysiologic basis of their occurrence, and suggest treatment modalities.

Perinatal mortality and morbidity

Theoretically, the more metabolically controlled the diabetic pregnant patient is, the greater the potential for producing a normal neonate. Certainly the pregnancy of the diabetic mother should be considered to be of high risk.