Infant of a diabetic mother (IDM)

Question 1

What are the risks associated with diabetes in pregnancy for the offspring?

Answer 1

Diabetes in pregnancy is associated with an increased risk of fetal, neonatal, and long-term complications for the offspring.

Question 2

When can maternal hyperglycemia cause diabetic embryopathy, and what are its potential outcomes?

Answer 2

Maternal hyperglycemia can cause diabetic embryopathy, primarily in the first trimester and at the time of conception. This can result in major birth defects and spontaneous abortions in the offspring

Question 3

How does the risk of congenital anomalies relate to maternal HbA1c levels in pregnancies with pregestational diabetes?

Answer 3

The risk of congenital anomalies increases with higher maternal HbA1c levels, particularly in pregnancies with pregestational diabetes.

Question 4

What is diabetic fetopathy, and when does it typically occur during pregnancy?

Answer 4

Diabetic fetopathy occurs in the second and third trimesters of pregnancy. It is characterized by fetal hyperglycemia, hyperinsulinemia, and macrosomia (large birth weight).

Question 5

IDM vs newborn infants in mortality and morbidity

Answer 5

IDMs are at increased risk for mortality and morbidity compared to newborn infants
born to a non-diabetic mother

Question 6

Risk for IDM

Answer 6

i. Congenital anomalies.
ii. Prematurity.
iii. Perinatal hypoxia.
iv. Macrosomia, which increases the risk of birth injury (e.g. brachial plexus injury)
v. Respiratory distress.
vi. Metabolic complications including hypoglycemia, hypocalcemia and
hypomagnesimia.
vii. Hematologic complications including polycythemia and hyperviscosity.
viii.Low iron stores.

Question 7

features on general examination

Answer 7

-macrosomiua and hirsutism
-plethora
-jaundice

Question 8

macrosomia and hirsutism

Answer 8

Excess subcutaneous fat especially
over face and shoulders. Their
bodies are usually larger than their
heads. Consequence of maternal
hyperglycaemia leading to fetal
hyperglycemia, pancreatic islet cell
hyperplasia and increased insulin
levels (anabolic hormone).

Question 9

plethora

Answer 9

Polycythemia occurs as a result
of increased fetal erythropoietin
concentration caused by chronic fetal
hypoxemia

Question 10

Jaundice

Answer 10

Jaundice is associated with
polycythaemia, prematurity and
bruising

Question 11

examination on respiratory system

Answer 11

May be related to TTN or more
commonly HMD. TTN may be as result
of reduced fluid clearance in the
diabetic fetal lung.
Reason for HMD is two fold – IDMs
are more likely to be delivered
prematurely than infants born to
non-diabetic mothers and neonatal
hyperinsulinism delays surfactant
production.

Question 12

What are the potential causes of respiratory distress in infants of diabetic mothers (IDMs)?

Answer 12

Respiratory distress in infants of diabetic mothers (IDMs) may be related to transient tachypnea of the newborn (TTN) or, more commonly, hyaline membrane disease (HMD).

Question 13

How does TTN potentially develop in infants of diabetic mothers?

Answer 13

TTN in infants of diabetic mothers may result from reduced fluid clearance in the fetal lung, leading to retained lung fluid and subsequent respiratory distress.

Question 14

What are the primary reasons for the development of HMD in infants of diabetic mothers?

Answer 14

: The development of HMD in infants of diabetic mothers is attributed to two main factors:

IDMs are more likely to be delivered prematurely compared to infants born to non-diabetic mothers.
Neonatal hyperinsulinism associated with maternal diabetes delays surfactant production in the fetal lung, contributing to the development of HMD.

Question 16

What aspects of the central nervous system should be examined in infants of diabetic mothers (IDMs)?

Answer 16

In infants of diabetic mothers, the central nervous system should be examined for signs of encephalopathy with altered primitive reflexes. Additionally, all limbs should be assessed for reduced upper limb/hand movement, and any abnormal movements or jitteriness should be noted, as they may indicate symptomatic hypoglycemia.

Question 17

Why are IDMs prone to shoulder dystocia and difficult deliveries?

Answer 17

IDMs are prone to shoulder dystocia and difficult deliveries due to macrosomia (large birth weight), which can lead to challenges during the birthing process. Shoulder dystocia occurs when the infant’s shoulder becomes impacted behind the mother’s pubic bone, often requiring medical intervention to facilitate delivery.

Question 18

What are the potential birth-related injuries that IDMs may experience during the birthing process?

Answer 18

During the birthing process, IDMs are at risk for brachial plexus injuries and clavicle fractures due to shoulder dystocia and difficult deliveries. These injuries may occur as a result of excessive force applied during delivery or due to the baby’s large size relative to the birth canal.

Question 19

What percentage of anomalies in infants of diabetic mothers involve the cardiovascular system and central nervous system?

Answer 19

Approximately two-thirds of anomalies in infants of diabetic mothers involve the cardiovascular system and central nervous system.

Question 20

congenital anomalies of CVS

Answer 20

i. Cyanotic and acyanotic congenital cardiac lesions
(VSD, PDA, TGA, Truncus arteriosus, Tricuspid
atresia)
ii. Hypertrophic obstructive cardiomyopathy
(may be reversible in first 6–12 months)

Question 21

congenital anomalies in CNS

Answer 21

i. Neural tube defects
ii. Anencephaly
iii. Holoprosencephaly

Question 22

congenital anomalies in gastrointestinal system

Answer 22

i. Small left colon syndrome
ii. Duodenal atresia
iii. Imperforate anus

Question 23

congenital anomalies in skeletal system

Answer 23

i. Caudal regression syndrome (sacral agenesis)
ii. Hemi-vertebrae

Question 24

congenital anomalies in urinary system

Answer 24

i. Hydronephrosis
ii. Renal agenesis
iii. Ureteral duplication

Question 25

When is the critical period for teratogenesis, and why is it important to establish normal glycemic control before pregnancy?

Answer 25

The critical period for teratogenesis occurs within the first 3-6 weeks after conception. It is crucial to establish normal glycemic control before pregnancy to prevent birth defects because maternal hyperglycemia during this critical period can significantly increase the risk of congenital abnormalities in the developing fetus.

Question 26

What is the recommended target for HbA1c in early pregnancy, and why?

Answer 26

A target HbA1c of 6 to 6.5% is recommended in early pregnancy. These levels are associated with the lowest rates of adverse fetal outcomes. Maintaining optimal glycemic control during early gestation can reduce the risk of congenital abnormalities and other complications in the fetus.

Question 27

management

Answer 27

i. Thorough clinical examination to assess for congenital abnormalities.
ii. Monitor for complications particularly hypoglycaemia
iii. Prevent hypoglycaemia by immediate institution of milk feeds and one may need
to consider instituting intravenous fluids.
iv. In cases of persistent hyperinsulinism associated with hypoglycaemia one may
need to add hydrochlorothiazide and diazoxide in order to block insulin release
and maintain euglycaemia.

Question 28

How can primary prevention of birth defects in infants of diabetic mothers be achieved?

Answer 28

Primary prevention of birth defects in infants of diabetic mothers involves planning for pregnancy and establishing normal glycemic control before conception. Mothers should book early prenatal care and undergo early first-trimester ultrasound scanning to assess for congenital abnormalities, allowing for early detection and intervention if necessary.