Infants of diabetic mothers☆
Section snippets
The Pedersen hypothesis and diabetic fetopathy
Most, but not all, of the fetal and neonatal sequelae of diabetes during gestation are a function of maternal glycemic control (Fig. 1). This concept had its ontogeny in the Pedersen hypothesis, which states that maternal hyperglycemia results in fetal hyperglycemia because glucose readily traverses the placenta [3]. Before 20 weeks' gestation, the fetal islet cells are not capable of responsive insulin secretion, and the main pathologic condition to which the embryo and early fetus are
Diabetes during the periconceptional period
Several well-done epidemiologic studies have demonstrated a strong association between maternal glycemic control at the time of conception and during early gestation and the incidence of congenital anomalies [1], [4], [5]. These studies demonstrated a fourfold higher rate of congenital anomalies of the brain, heart, kidneys, intestine, and skeleton in IDM [4]. The rate of major congenital anomalies for IDM can be predicted from maternal hemoglobin A1c values at 14 weeks' gestation. Mothers with
The effect of maternal diabetes on the developing fetus
Uncontrolled maternal diabetes has an effect on fetal growth, glucose metabolism, oxygenation, iron metabolism, and preparation for extrauterine life.
Neonatal complications in infants of mothers with diabetes
Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequelae, including abnormalities of neonatal body habitus, glucose, calcium and magnesium metabolism, hematologic status, cardiorespiratory function, bilirubin metabolism, and neurologic functioning [5]. A general approach to screening for common derangements is outlined in Table 1 [5], [22], [23].
Long-term sequelae in offspring of mothers with diabetes
The long-term health of IDMs can be affected by the periconceptional, fetal, and neonatal pathologies discussed previously. The major issues revolve around long-term risks of obesity and diabetes, neurologic outcome, and iron status. There is no strong evidence that large-for-date newborn infants grow up to be fat children and adults. Most seem to return to a genetically programmed growth curve well within the population standards. Diabetes mellitus clearly has a genetic component; thus, it is
Prenatal diagnosis and management of diabetes during gestation
Strict maternal glycemic control during a pregnancy complicated by diabetes mellitus reduces neonatal morbidity and mortality. Periconceptional glucose control seems to reduce the incidence of congenital anomalies. Fetal hyperinsulinemia and its associated metabolic abnormalities can be reduced by maintaining tight glycemic control after 28 weeks' gestation [5]. Similarly, fetal macrosomia can be prevented by appropriate glycemic control from 32 weeks' gestation until term.
Controversy has
Summary
Advances in the management of mothers with diabetes have reduced the rate of morbidity and mortality for their infants. Aggressive control of maternal glycemic status is warranted because most morbidities are epidemiologically and pathophysiologically closely linked to fetal hyperglycemia and hyperinsulinemia. Although rates of complications are lower than in previous eras, there may be a resurgence of IDMs within the next 10 years. The burgeoning public health problem of overweight and obesity
References (43)
- et al.
Controversies in labor management: shoulder dystocia
Obstet Gynecol Clin North Am
(1999) Medical complications of pregnancy: diabetes complicating pregnancy
Obstet Gynecol Clin North Am
(2001)- et al.
Neonatal hematocrit and maternal glycemic control in insulin-dependent mothers
J Pediatr
(1992) - et al.
Increased N-glycosylation and reduced transferrin binding capacity of transferrin receptor isolated from placentas of diabetic mothers
Placenta
(1997) - et al.
Liver, heart, and brain iron deficiency in newborn infants of diabetic mothers
J Pediatr
(1992) - et al.
Abnormal iron distribution in infants of diabetic mothers: spectrum and maternal antecedents
J Pediatr
(1990) Neonatal iron deficiency results in irreversible changes in dopamine function in rats
J Nutr
(2003)- et al.
Perinatal brain iron deficiency increases the vulnerability of rat hippocampus to hypoxic ischemic insult
J Nutr
(1999) - et al.
Neurophysiologic evaluation of auditory recognition memory in healthy newborn infants and infants of diabetic mothers
J Pediatr
(2000) - et al.
Iron status at 9 months of infants with low iron stores at birth
J Pediatr
(2002)
Electrophysiologic evidence of impaired cross-modal recognition memory in 8-month-old infants of diabetic mothers
J Pediatr
Infant of diabetic mother. Emedicine October 26, 2001
Fetal risks and neonatal complications of diabetes mellitus and metabolic and endocrine disorders
The pregnant diabetic and her newborn
Pregnancy complicated by diabetes mellitus
Therapy of infants of diabetic mothers
Intrauterine growth restriction
Body composition of a diabetic offspring by direct analysis
Am J Dis Child
Effect of insulin on uptake of metabolic substrates by the sheep fetus
Am J Physiol
Effects of chronic fetal hyperglycemia upon oxygen consumption in the ovine uterus and conceptus
J Clin Invest
Increased erythropoiesis and elevated erythropoietin in infants born to diabetic mothers and in hyperinsulinemic rhesus fetuses
J Clin Invest
Cited by (204)
Effects of latent iron deficiency on auditory neural maturation during early infancy in infants above 35 weeks’ gestation
2023, Pediatrics and NeonatologyCitation Excerpt :This increased red cell mass could have contributed to the low iron status, particularly in AGA patients. In SGA infants, other maternal risk factors, such as diabetes, pregnancy-induced hypertension (PIH), and intrauterine growth restriction, which are likely to be associated with reduced placental transport of iron, could have contributed to latent iron deficiency.24,26,29,30 Iron insufficiency during early postnatal life may exaggerate overt iron deficiencies during infancy.5,23
Exposome and foetoplacental vascular dysfunction in gestational diabetes mellitus
2022, Molecular Aspects of MedicineCerebral Effects of Neonatal Dysglycemia
2022, Clinics in PerinatologyGestational and pregestational diabetes: Perinatal characteristics and neonatal morbidity
2022, Anales de PediatriaDelayed maturation of P2 flash visual evoked potential (VEP) latency in newborns of gestational diabetic mothers
2021, Early Human DevelopmentEffect of Aqueous-Alcoholic Extract of Ducrosia Anethifolia Boiss on the Fetal Liver of Diabetic Rats
2024, World Journal of Traditional Chinese Medicine
- ☆
This article was supported in part by grants HD-29421 and NS-32755 to Michael K. Georgieff.