The Infant of the Diabetic Mother


Significant advances have been made in reducing perinatal mortality for the infant born to the mother with diabetes mellitus.

However, the infant of the diabetic mother (IDM) is likely to manifest a variety of problems, all of which require anticipation, recognition, and appropriate therapy.

Classification of Maternal Diabetes

Knowledge of the mother's diabetes, prior medical and pregnancy history, and complications during this pregnancy permits anticipation of many of the problems likely to be present in the postnatal period.

White's Classificaton permits assessment of severity of maternal diabetes. Classes B-H require medication.

Class A:

Chemical diabetes: positive glucose tolerance tests prior to or during pregnancy.

Prediabetes: history of large babies more than 4 kg or unexplained stillbirths after 28 weeks. Any age of onset or duration.

Class B: Onset after 20 years of age; duration less than 10 yrs.

Class C:

C1:   Onset at 10-19 years of age.

C2:   Duration 10-19 years.

Class D:

D1: Onset before 10 years of age.

D2: Duration 10 years.

D3: Calcification of vessels of the leg (macrovascular disease).

D4: Benign retinopathy (microvascular disease).

D5: Hypertension

Class E: Same as D, but with calcification of pelvic vessels.

Class F: Nephropathy

Class G: Many reproductive failures.

Class H: Diabetic cardiomyopathy

Class R: Malignant retinopathy

Class RF: Both nephropathy and retinopathy

Pedersen's prognostic signs of pregnancy permit more accurate predictions of poor outcome. These are: clinical pyelonephritis, precoma or severe acidosis, toxemia and neglectors (women who are uncooperative with the treatment plan.)

Maternal-Fetal Problems


Diabetic women have normal fertility. In the first trimester there is an increased rate of spontaneous abortions. The incidence of these early losses varies with the diabetic classification:

Class A, 5-10% (not significantly different from the general population); Class B, 10%; Class C, 24%; Class D, 30%; and Class E, 74%.

Problems during pregnancy and delivery

Pregnancy Management

Good metabolic control of maternal diabetes improves the perinatal outcome.

Timing of delivery is individualized in each case and requires decision based on the risks of in utero fetal distress and stillbirth compared to the problems of prematurity.

Types of tests:

Evaluation of the Infant

Once the baby has been delivered, a careful assessment made on the basis of the Apgar score should indicate the need for any resuscitative efforts. In the delivery room, a screening physical examination for major congenital anomalies should be performed.

In the nursery, a more complete physical examination with special attention to the heart, kidneys, and extremities is performed. Close observation for potential problems should begin.

Specific Problems Encountered by the Infant

Critical Paths for the Infant of a Diabetic Mother

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