Introduction

• Diabetes has long been associated with maternal and

perinatal morbidity and mortality.
• Before the discovery of insulin in 1921, women with
diabetes rarely reached reproductive age or survived
pregnancy.
• In fact, pregnancy termination was routinely
recommended for women with diabetes because of high
mortality rates.
 Diabetes in pregnancy:
• There are two types of diabetes that occur in pregnancy:
• Gestational diabetes - when a mother who does not
have diabetes before becoming pregnant and develops a
resistance to insulin because of the hormones of
pregnancy.
• Pre-existing diabetes - women who already have
insulin-dependent diabetes and become Pregnant.
 Incidence
• Today, 3-10% of pregnancies are affected by abnormal
glucose regulation and control.
• Women of Asian, Indian, or Middle-Eastern descent are at a
higher risk than the general population for diabetic
complications of pregnancy.
 Clinical features

• Fetal macrosomia
• Impaired fetal growth
The major cause of impaired fetal growth is maternal diabetic
nephropathy. Maternal vascular disease compromises
uteroplacental blood flow and impairs fetal nutrient supply.
• Pulmonary disease
Insulin restricts substrate availability for surfactant
biosynthesis and interferes with the normal timing of
glucocorticoid-induced biosynthesis.They are at increased
risk for respiratory distress syndrome, transient tachypnea
of the newborn and persistent pulmonary hypertension
• Metabolic abnormalities
High levels of fetal insulin with cessation of continued maternal
glucose supply take place after birth. The neonatal shift to
gluconeogenesis with fatty acid use may provide an
insufficient supply of substrate, and, thus, the infant may
experience hypoglycemia
Cardiovascular anomalies
Fetal growth is regulated by insulin binding to cell receptors.
Compared with adults, fetuses have an increased number of
receptors. Because the fetal heart is particularly rich in
receptors, this may lead to increased myocardial protein,
glycogen, and fat synthesis with hyperplasia and hypertrophy
of myocardial cells
 Clinical features contd…

• Very plump and full faced

• Abundant vernix caseosa
• Plethora
• Listlessness and lethargy
• Large placenta and umbilical cord
• Meconium stained at birth
 Diagnostic measures
• History collection
• Physical examination
• Maternal blood examination during pregnancy
• Blood test of the infant
 LGA infants should be routinely screened for hypoglycemia
 Hypocalcaemia or hypomagnesemia may also be apparent in the
first few hours after birth
 Thrombocytopenia:
 Hyperbilirubinemia:
• Ultrasonogrphy during pregnancy
 Treatment

• Treatment of a baby born to a diabetic mother often depends

upon the control of diabetes during the last part of pregnancy
and during labor. Specific treatment will be determined by
physician based on:
 Baby's gestational age, overall health, and medical history
 Extent of the condition
 Baby's tolerance for specific medications, procedures, or
therapies
 Expectations for the course of the condition
 Parents opinion or preference
• Treatment may include:
• Careful monitoring of blood glucose levels.
• Giving glucose immediately to the child:-This may be as
simple as giving a glucose/water mixture as an early feeding.
Or, the baby may need glucose given intravenously. The baby's
blood glucose levels are closely monitored after treatment to
watch for hypoglycemia to occur again.
• Checking for hypocalcaemia (low calcium levels) which may
also occur in IDM
• Giving oxygen or using a ventillator(if respiratory distress
occurs)
• Care for any problems arising from a birth injury
• Care for any problems that occur with a birth defect
 Complications

• Renal (eg, hydronephrosis, renal agenesis, ureteral duplication),

• Cardiovascular (eg, single umbilical artery, VSDs, atrial septal

defects, TGA, coarctation of the aorta, cardiomegaly)

• GI (eg, duodenal or anorectal atresia, small left colon syndrome)

anomalies are more frequent in these infants.
 Major causes of morbidity include the
following
• Abnormalities in fetal growth (either
overgrowth or undergrowth)
• Hypoglycemia
• Prematurity
• Respiratory distress syndrome
• Intrapartum asphyxia
 Nursing diagnosis

• Risk for injury related to hyperinsulinemia, secondary to

gestational diabetes as evidenced by hypoglycemia
• Ineffective airway clearance related to increase tracheo bronchial
secretions and obstruction.
• High risk for hypothermia related to decreased subcutaneous
tissue, immature body temperature control
• High risk for impaired skin integrity related to immature skin,
poor nutrition and immobility
 Nursing management

• Early examination for congenital anomalies

• Detection of signs of possible respiratory or cardiac problems
• Maintenance of adequate thermoregulation
• Early introduction of carbohydrate feedings as appropriate
• Monitoring of serum glucose levels
• Careful monitoring of IV glucose infusion