Maternal Diabetes Mellitus – Risk Factor for Fetus and Infant

Abstract

Diabetes during pregnancy may occur as pregestational or gestational diabetes mellitus. Throughout gestation there is a close relationship between maternal and fetal blood glucose concentrations. Maternal hyperglycemia leads to hyperglycemia of the fetus, stimulating the fetal pancreas to synthesize excessive amounts of insulin. At the time of delivery, after separation of the placenta, the flow of glucose to the newborn that is appropriate for hyperglycemia is suddenly interrupted. Excessive insulin production in the fetus in response to maternal hyperglycemia can cause severe hypoglycaemia during the neonatal period. It is a very common complication of maternal diabetes. In healthy children during the first 4-6 postnatal hours there is a physiological decrease in glucose level from the mother’s blood level to about 2.5 mmol / l (45 mg / dl). This is related to still not fully developed adaptive mechanisms. There is strong evidence that good glycemic control is essential for an optimal outcome of pregnancy in diabetic women. Despite advances in perinatal care, infants of diabetic mothers remain at risk for a multitude of physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, hypertrophic cardiomyopathy, and congenital anomalies, particularly of the central nervous system.