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Infant of Diabetic Mother

Infant of Diabetic Mother. GDM-- Carb intolerance in pregnancy affects 3-5% of pregnancies Risk factors - ↑ maternal age , obesity ↑ BMI , strong family history southeast Asians, African Americans etc ↑ perinatal and Neonatal mortality with poor

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Infant of Diabetic Mother

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  1. Infant of Diabetic Mother • GDM-- Carb intolerance in pregnancy • affects 3-5% of pregnancies • Risk factors - ↑ maternal age , obesity • ↑ BMI , strong family history • southeast Asians, African Americans etc • ↑ perinatal and Neonatal mortality with poor glycemic control

  2. Introduction • Frequency: 3-10% of pregnant women have diabetes • 88% have gestational diabetes • 12% have known diabetes • 35% with Type I diabetes • 65% with Type II diabetes

  3. Risk of Complications • Higher with poor glucose control • Higher with pre-gestational Diabetes • ↑ risk of other compl in the mother -- eg: PIH is 2 times more common in diabetic pregnancies

  4. LGA and SGA babies

  5. CASE -- 1 • Baby G , a 36wk IDM with birth wt of 3.8kg, NVD, good APGARS was with mum, breast fed at 2 and 5 hrs of age, presented at 10hrs of age with • H/O 1. multiple apnea • 2. severe lethargy, pale, mottled

  6. Case -1---contd • GRBS– 30mg% • Maternal hyperglycemia ↓ ↓ • glucose and a. a cross placenta(not insulin ) • ↓ • ↑ bl sugar in fetus →ß cell hyperplasia • ↓ • hyperinsulinemia

  7. Routine monitoring in IDM is Important • Glucose reqd is much higher than normal • Reqr may go upto 15mg/kg/min • If not maintained on oral feeds, start IV fluids • ↑ volume and conc of glucose – • may need a central line for Glucose > 12% • MONITORING VITAL – 48HRS

  8. Case --2 • 2.1 kg Term IDM, on full feeds and normal GRBS presents on day 2 with • 1. Cyanosis • 2. lethargy, resp distress • 3. Convulsions

  9. Case 2 ---contd • PCV– 66 % , Hb - 22gm/dl – • Polycythemia • ↑ Hb A1 in mother and baby –hypoxia • placental insufficiency • Needs Partial Exch transfusion to prevent CNS morbidity • Haematuria, NEC, PPHN may also occur

  10. Preventable CNS morbidity • Hypoglycemia – microcephaly, C.P ,learning disability in 30-50% of symptomatic cases • Polycythemia -- hemiplegia, cerebral infarct • mental retardation , limb weakness • PREVENTABLE MORBIDITIES • MONITORING IS THE KEY

  11. Case 3 • Term baby 3.8 kg, IDM presents on day 3 with • 1. Resp Distress -80/min • H.R. – 190/min, poor pulses, sPo2 94% • features of CCF , Systolic murmur

  12. Cardiac complications • H O C M - Lasix, Propranolol • Resolves by 4-6 mos • Deposition of fat and glucose along the septum • Others-- TOGV, ASD, Coarctation

  13. Hypertrophic Cardiomyopathy

  14. Case 4 • Term baby 39wks, 3.7 kg , IDM presents with severe resp distress at 1 hr of age

  15. RDS

  16. TTN

  17. Case 5 • 4- day old preterm IDM 36wks- 1.8 kg has • feed intolerance, vomiting, abd distension • bilious aspirates

  18. Small Left Colon Syndrome

  19. Pathophysiology of Fetal Effects Situs Inversus Maternal hyperglycemia acts like a teratogen -> spontaneous abortions and malformations

  20. Anencephaly and Caudal Regression Syndrome

  21. Birth Injuries

  22. Birth Injury • Macrosomia puts infant at risk for injuries during delivery • Shoulder dystocia can lead to: • Clavicular and/or humeral fractures • Brachial plexus injuries • Traumatic delivery or need for vacuum/forceps assistance can lead to: • Cephalohematomas • Facial bruising • Facial nerve injuries

  23. Problems of IDM babies • At Birth • Still birth • preterm • Macrosomia • asphyxia • birth injury

  24. Problems after birth • L G A Polycythemia • S G A Hyperbil • Hypoglycemia Anomalies • Hypocalcemia ( CNS,CVS GIT ) • R D S , T T N Sepsis • H O C M

  25. Role of Obstetrician • Preconception counselling • good maternal glucose control • Paediatrician • Anticipate, monitor, treat complications

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