At birth infants of diabetic
mothers are at risk of hypoglycaemia secondary to hyperinsulinaemia,
which persists after delivery. Despite the above recommendations,
a recent retrospective review from Shrewsbury (presented
at the forum) revealed 64% of babies born to gestational
and pregestational diabetic mothers to have hypoglycaemia
( 1).
This was not related to glycaemic control in pregnancy
or labour, onset of diabetes, need for insulin or size
of the infant and was therefore difficult to predict.
Although infants of diabetic mothers are no longer
routinely admitted to SCBU in most units, it emphasises
the need for careful nutritional management and regular
blood glucose monitoring in these infants.
There is also a risk of neonatal hypocalcaemia because
hyperglycaemia results in glycosylated albumin, which
displaces bound calcium. This results in suppression
of parathyroid hormone. This functional hypoparathyroidism persists
temporarily post delivery.
Fetal hyperinsulinaemia also suppresses phosphotydyl
glycerol, which is a major component of surfactant.
Thus neonates are at increased risk of respiratory
distress syndrome, particularly at premature gestations.
Maternal insulin requirements are markedly reduced
post delivery; they usually return to pre pregnancy
levels and should be adjusted by the medical team.
Breast feeding should be encouraged although insulin
requirements and calorific intake may need further
adjustments for this.
Post pregnancy management should include contraceptive
advice and the chance to reinforce pre pregnancy management
for subsequent pregnancies.
1 -Cansick JC, Deshpande SA. How common is hypoglycaemia
in infants of diabetic mothers?, Abstract
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