a small ascending left colon.
So here’s an infant
of a diabetic mother,
what we worried about is any
infant whose mother has had
persistently high blood
sugars during the pregnancy.
This is about 3-10% of infants
in the United States.
About 1/3 are type 1 diabetes,
but 2/3 are type 2 diabetes
and the rate is on the rise because of our
worsening obesity epidemic in the U.S.
So the pathology of infants of
diabetic mothers is as follows.
Mom has a high blood sugar,
that’s running unchecked.
This, in turn, results in
a high fetal blood sugar.
The problem is, is that high
sugars have direct effects
on a variety of tissues
throughout the fetus.
So we need to look at what are all
the various problems that can happen
as a result of developing inside the uterus
where there is a high sugar environment.
So the first is size alone.
Because sugar is such a
great growing substrate,
these infants are usually
large for gestational age.
They are too big.
About 30% of infants of diabetic mothers
are going to be large for gestational age.
This can lead to problems.
For example, they may develop
failure to progress.
I’m talking about the delivery now.
As the baby starts coming out, baby
stops, baby can’t go any further.
This can result in fetal distress,
difficulty with breathing,
difficulty with blood perfusion.
Infants can get strokes, all
kinds of problems can happen.
Another one for example
is shoulder dystocia
and that’s the classic
one you read about.
Where because the child is having a
hard time getting out of the vagina,
that shoulder gets injured.
Infants can also be small
for gestational age.
This happens in 20% of
infants of diabetic mothers.
It doesn’t seem to make
sense but it’s true.
This stems from basically a poor
uterine growth environment.
This can lead to poor
outcomes after birth.
So, here’s our graph where we would
see what is the appropriate weight
of an infant based on how premature
they are or what week they're born on.
So you could plot an infant
on a graph such as this.
So let’s do it together.
If an infant is 1,000 grams
and they’re born at 28 weeks,
they’re about appropriate.
But if they are above the
line, they are large
or if they are below
line, they are small.
Infants of diabetic mothers
are at increased risk
for other problems such as
respiratory distress syndrome.
This is more common in these babies,
but I talked a little bit about
that in another lecture.
They can also get polycythemia.
Basically that sugar substrate is so good
that they have too many red blood cells.
That, in turn, can result in a
hypertension in the lung of the infant,
which is called persistent pulmonary
hypertension of the newborn.
Infants with PPHN can be at grave
distress when they’re born
because basically the blood is having a
hard time getting through their lungs.
Additionally, infants may
become hypoglycemic at birth.
Think about as simply this way,
that infant has been exposed
to high amounts of sugar
while they were in utero, so their
pancreas is really ramped up.
They are born, they are not getting
that sugar from their mom anymore
and there is a transient period of
time when suddenly they get too low.
And the problem is that low sugar can
cause seizure or even frank brain damage.
So we have to watch these
kids carefully after birth
to make sure they don’t have
a rebound hypoglycemia.
They may get plethora.
This is a red color to the skin
and this is because of those
increasing red blood cells.
That in itself can cause not
only problems in the lungs
but can cause
In fact, they can get strokes.
So infants of diabetic mothers
because of too many red blood cells
and sludging of the blood can actually
have an ischemic stroke of the brain.
Because those red cells then breakdown,
they can also get hyperbilirubinemia
and bad hyperbilirubinemia can lead
to brain damage through kernicterus.
Lastly, they can get thrombocytopenia.
That’s because of inhibited thrombopoiesis
in utero from chronic hypoxia.
So these infants may have
low platelet counts.
Additionally, infants may have
structural organ disease.
A common one is cardiomyopathy.
This can even happen so significantly
they have ventricular hypertrophy
and thus an outflow
This is really common.
It happens in about a third of babies
with exposure to diabetic
mothers while in utero.
Also, these infants can be at risk
for ventricular septal defects,
transposition of the great vessels
and a variety of other problems.
So the heart can structurally
be wrong as a result
of being in a high sugar
environment in utero.
Also, these infants are at increased
risk for significant CNS malformations.
So they are 16 times more likely than
regular infants of diabetic mothers
and especially the one we
think of is anencephaly.
This is when the infant is
actually born without a brain.
This is not
consistent with life.
Also, they may have renal
malformation of a variety of types
and they may have
The classic gastrointestinal
complication that you will see
is an atresia or a poor
growth of an intestine.
This may happen in duodenal atresia.
For duodenal atresia, we can expect
to see the double bubble sign
which you can see
in this x-ray here.
They may have anorectal atresia
which is an inability to form the anus and
the rectum. That’s a surgical emergency.
Or they may have small left colon syndrome,
a small ascending left colon.
So just remember that the
intestine may be atretic
as a result of exposure
to high sugar in utero.
So that’s my review of the basic problems
of infants born to diabetic mothers.
Thanks for your time.