Infant of a Diabetic Mother (IDM)

Etiology

• IDM is caused by chronic hyperglycemia in the mother

• e.g., gestational diabetes mellitus or long-term diabetes mellitus with
or without vascular changes.
Pathophysiology
Hyperglycemia in the mother without vascular changes causes large amounts of
amino acids, free fatty acids, and glucose to be transferred to the fetus, but
maternal insulin does not cross the placenta.

The fetal response to these transferred substances includes:

• Islet cells of the pancreas enlarge (hypertrophy). Hypertrophic cells produce
large volumes of insulin, which acts as a growth hormone, and protein
synthesis accelerates.
• Fat and glycogen are deposited in fetal tissue, and the fetus grows large
(macrosomia), especially if maternal blood glucose levels are not well
controlled in the third trimester.
In maternal long-term diabetes with vascular changes, the newborn may be
SGA because of compromised placental blood flow, maternal hypertension, or
pregnancy-induced hypertension, which restricts uteroplacental blood flow.
Associated complications in IDM include:
• Fractures and nerve damage may occur from birth trauma if the infant is
LGA.
• Hypoglycemia may result after birth from lack of glucose from the mother,
but continued production of insulin by the newborn.
• Hypocalcemia may result from decreased parathyroid hormone production.
• Polycythemia (ie, hematocrit exceeding 65%) may result from placental
insufficiency causing chronic fetal hypoxia and increased fetal
erythropoietin production.
• Organ damage may result from decreased blood flow and renal vein
thrombosis.
• Hyperbilirubinemia may result from breakdown of excess RBCs after birth.
Signs and Symptoms of Hypoglycemia
Shakiness, dizziness
Sweating
Pallor, cold, clammy skin
Disorientation, irritability
Headache
Hunger
Blurred vision
Nervousness
Weakness, fatigue
Shallow respirations, but normal pulse rate
Urine negative for glucose and acetone
Blood glucose level below 60 mg/dL
Signs of Hypocalcemia
Tetany
Paresthesia of fingers and around the
mouth
Muscle twitching
Cramps
Laryngospasms
Elevated phosphorous levels
Assessment Findings
1. Clinical manifestations

Congenital anomalies are more likely in IDMs who are SGA than in other SGA
newborns.
Size differences and variations are more common in IDMs who are LGA than in
other LGA newborns.
Greater size results from fat deposits and hypertrophic liver, adrenals, and heart.
Length and head size are usually within normal range for gestational age.
Observation reveals the characteristics appearance of a round, red face and an
obese body.
Possible signs and symptoms of hypoglycemia include jitteriness, irritability,
diaphoresis, and blood glucose level less than 45 mg/dL.
Possible signs and symptoms of hypocalcemia include jitteriness, twitching, and a
high-pitched cry.
2. Laboratory and diagnostic study findings.

Blood glucose evaluation at 30 and 60 minutes and at 2,4,6, and 12

hours after birth as directed by nursery protocol
If results are abnormal, repeat testing every 30 to 60 minutes until
newborn achieves stable level; also test before each feeding for 24
hours.
If reagent strips indicate blood glucose levels less than 45 mg/dL,
findings should be verified by laboratory and reported to pediatrician.
Serum electrolyte studies may reveal hypocalcemia (total serum calcium
mg/dL).
Hematocrit level may be elevated, indicating polycythemia.
Nursing Management
1. Establish an initial database.
•Review the mother’s health history and history of the pregnancy.
•Complete an initial newborn examination and assess for birth injuries.
2. Monitor for complications.
•Monitor for signs and symptoms of hypoglycemia .
• Feed the newborn
• If signs and symptoms continue after feeding, observe for other complications.
•Monitor for signs of hypocalcemia
•Obtain hematocrit value; report the findings to the physician.
•Observe for signs of respiratory distress (e.g., nasal flaring, grunting, retractions, and
tachypnea).
•Initiate gavage feeding if the newborn cannot suck well or if the respiratory rate exceeds
normal (30 to 60 breaths per minute).
3. Maintain a neutral thermal environment.
4. Provide education and emotional support.
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