Definition of Infant of diabetic mother:

An infant of a diabetic mother is a baby born to a mother who has diabetes. The phrase specifically refers to a baby who is born to a mother who had persistently high blood sugar (glucose) levels during pregnancy.

Causes, incidence, and risk factors:

High blood sugar levels in pregnant women often have specific effects on their infants. Infants born to mothers who have diabetes are generally larger than other babies. They may have large organs, particularly the liver, adrenal glands, and heart.

These infants may have episodes of low blood sugar (hypoglycemia) shortly after birth because of increased insulin. Insulin is a substance that moves sugar (glucose) from the blood into body tissues. The infant will need close monitoring of blood sugar levels.

There is an increased chance that mothers with poorly controlled diabetes will have a miscarriage or stillborn child. If the mother was diagnosed with diabetes before the pregnancy, her infant also has an increased risk of having birth defects if the disease is not well controlled.

Symptoms:

The infant is usually large for gestational age. Other symptoms may include:

• Blue or patchy (mottled) skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure)
• Newborn jaundice (yellow skin)
• Poor feeding, lethargy, weak cry (signs of severe low blood sugar)
• Puffy face
• Reddish appearance
• Tremors or shaking shortly after birth

Signs and tests:

An ultrasound performed on the mother in the last few months of pregnancy shows that the baby is large for gestational age.

Lung maturity testing may be performed on the amniotic fluid if delivery is being considered more than a week before the due date.

After birth, tests may show that the infant has low blood sugar and low blood calcium. An echocardiogram may show an abnormally large heart, which can lead to 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. This will continue until the infant's blood sugar remains stable with normal feedings.

Early feeding may prevent low blood sugar in mild cases. Persistent low blood sugar is treated with sugar (glucose) given through a vein.

Rarely, the infant may need breathing support or medications to treat other effects of diabetes. High bilirubin levels are treated with light therapy (phototherapy), or rarely, by replacing the baby's blood with blood from a donor (exchange transfusion).

Expectations (prognosis):

Better control of diabetes and early recognition of gestational diabetes has decreased the number and severity of problems in infants born to mothers with diabetes. Usually, an infant's symptoms go away within a few weeks. However, an enlarged heart may take several months to get better.

Complications:

• Congenital heart defects
• Heart failure
• High bilirubin level (hyperbilirubinemia) -- may cause permanent brain damage
• Immature lungs
• Neonatal polycythemia (more red blood cells than normal) -- this may cause a blockage in the blood vessels or hyperbilirubinemia
• Severe low blood sugar - may cause permanent brain damage
• Small left colon syndrome - causes symptoms of intestinal blockage
• Stillbirth

Calling your health care provider:

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 difficult to control, call your doctor immediately.

If you are pregnant and are not receiving prenatal care, make an appointment with your health care provider or call the State Board of Health for instructions on how to obtain state-assisted prenatal care.

Prevention:

To prevent complications, the mother needs supportive care throughout her pregnancy. Good control of blood sugar and early diagnosis of gestational diabetes can prevent many of the problems that can occur with this condition.

Lung maturity testing may help prevent breathing complications if delivery is being considered more than a week before the baby's due date.

Careful monitoring of the infant in the first 24 hours after birth may prevent complications due to low blood sugar. Monitoring and treatment in the first few days may prevent complications due to high bilirubin levels.