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Infants of mothers with DM (Complications (Pregnancy complications …
Infants of
mothers with DM
Definition
Children born to a mother
with DM (pre-xisting or
gestational)
Pathophysiology
Large babies
Maternal hyperglycaemia causes foetal hyperglycaemia
Increased insulin secretion by foetus
Insulin promotes glucose uptake and storage, also is a growth hormone, causing organomegaly, macrosomia, polycythaemia
Small biabies
Maternal vascular disease can cause placental issues
resulting in IUGR (rare)
Diagnosis
Examination
Neonatal examination
Measurements - LGA or SGA
General - jaundice/polycythaemic,
heart defects, NTDs
Abdominal
BMI, SFH (small, large)
Investigations
Bedside
Obs (maternal, infant)
BMs (maternal, infant)
Bloods
Maternal: FBC, U+E, LFT, lipids, glucose, HbA1C
Infant: FBC (polycythaemia), U_Es (electrolyte disturbance),
LFTs (jaundice), glucose (hypos)
Imaging
Neonatal USS if suspect cardiac/GI etc abnormalities
History
POH
Gravity/parity, deliveries, gestation,
birth weights, complications
PGH
Known gynae conditions, menses,
contraception, STIs, smears
Current pregnancy
Gestation, scans/bloods, growth,
foetal movement, general health
PMH
Known diabetes - control, medications, last bloods
Other medical conditions, surgeries
PC
Asymptomatic, DM complications
DH
DM medications, allergies
FH
DM, congenital diseases
SH
Occupation, diet, smoking, alcohol
Management
Conservative
Education and advice
Optomise glycaemic control during pregnancy
Complications
Pregnancy complications
Miscarrage, IUD, prematurity
Metabolic
Neonatal hypoglycaemia
Hypo-Ca, hypo-Mg
Congenital abnormalities
Caudal regression syndrome
Hypertrophic cardiomyopathy
Small left colon syndrome
NTDs
Medical problems
Respiratory distress
Jaundice
Haematological
Polycythaemia (thus thrombosis)