Causes

High blood sugar levels in pregnant women often have an effect on their infants. Infants who are born to mothers with diabetes are often larger than other babies. They may have large organs. The liver, adrenal glands, and heart are most likely to be enlarged.

These infants may have periods of low blood sugar (hypoglycemia) shortly after birth because of increased insulin levels in their blood. Insulin is a substance that moves sugar (glucose) from the blood into body tissues. The infant's blood sugar levels will need to be closely monitored in the first 12 to 24 hours of life.

Mothers with poorly controlled diabetes are more likely to have a miscarriage or stillborn child. The delivery may be difficult if the baby is large. This can increase the risk for brachial plexus injuries and other trauma during birth.

If the mother was diagnosed with diabetes before her pregnancy, her infant also has an increased risk of birth defects if the disease is not well controlled.

Symptoms

The infant is usually large for gestational age. Other symptoms may include:

• Blue or patchy (mottled) skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure)
• Newborn jaundice (yellow skin)
• Poor feeding, lethargy, weak cry (signs of severe low blood sugar)
• Puffy face
• Reddish appearance
• Tremors or shaking shortly after birth

Exams and Tests

An ultrasound performed on the mother in the last few months of pregnancy will show that the baby is large for gestational age.

Lung maturity testing may be performed on the amniotic fluid if the baby is going to be delivered more than a week before the due date.

After birth, tests may show that the infant has low blood sugar and low blood calcium. An echocardiogram may show an abnormally large heart, which can occur with heart failure.

Treatment

All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms.

If an infant had one episode of low blood sugar, tests to check blood sugar levels will be done over several days. This will be continued until the infant's blood sugar remains stable with normal feedings.

Early feeding may prevent low blood sugar in mild cases. Persistent low blood sugar is treated with sugar (glucose) and water given through a vein.

Rarely, the infant may need breathing support or medications to treat other effects of diabetes. High bilirubin levels are treated with light therapy (phototherapy), or rarely, by replacing the baby's blood with blood from a donor (exchange transfusion).

Outlook (Prognosis)

Better control of diabetes and early recognition of gestational diabetes has decreased the number and severity of problems in infants born to mothers with diabetes. Usually, an infant's symptoms go away within a few weeks. However, an enlarged heart may take several months to get better.

Possible Complications

• Congenital heart defects
• Heart failure
• High bilirubin level (hyperbilirubinemia) -- may cause permanent brain damage if it is not treated
• Immature lungs
• Neonatal polycythemia (more red blood cells than normal) -- this may cause a blockage in the blood vessels or hyperbilirubinemia
• Severe low blood sugar - may cause permanent brain damage
• Small left colon syndrome - causes symptoms of intestinal blockage
• Stillbirth

When to Contact a Medical Professional

If you are pregnant and receiving regular prenatal care, routine testing will show if you develop gestational diabetes.

If you are pregnant and have diabetes that is difficult to control, call your doctor immediately.

If you are pregnant and are not receiving prenatal care, make an appointment with your health care provider or call the State Board of Health for instructions on how to obtain state-assisted prenatal care.

Prevention

To prevent complications, the mother needs care throughout her pregnancy. Controlling blood sugar and getting diagnosed with gestational diabetes early can prevent many of the problems that can occur with this condition.

Lung maturity testing may help prevent breathing complications due to immature lungs if the baby is being delivered more than a week before the due date.

Carefully monitoring the infant in the first hours after birth may prevent complications due to low blood sugar. Monitoring and treatment in the first few days may prevent complications due to high bilirubin levels.

Alternative Names

IDM

Updated: 4/14/2012

Reviewed by: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.