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Maternal Diabetes Syndrome

IDM


Presentation

  • Metabolic and electrolyte abnormalities Hypoglycemia may present within the first few hours of life.[emedicine.medscape.com]
  • Renal vein thrombosis presents with hematuria and a flank mass. The etiology is unknown. Small left colon syndrome presents with abdominal distension. Contrast enema shows a small left colon.[utmb.edu]
  • Written by an esteemed list of international authors, Gestational Diabetes: Origins, Complications, and Treatment presents timely reviews relating to some of the most important aspects of gestational diabetes, specifically its causes, consequences, and[books.google.com]
  • Obesity (BMI 85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring.[pediatrics.aappublications.org]
  • This is supported by the present study results showing that the greater the number of MetS components, the greater the increase in risk of GDM.[em-consulte.com]
Crying
  • Brief resolved unexplained event -- BRUE (Medical Encyclopedia) Crying - excessive (0-6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical[icdlist.com]
  • Although the infant is generally asymptomatic, symptoms may include jitteriness, irritability, apathy, poor feeding, high-pitched or weak cry, hypotonia, or frank seizure activity.[emedicine.medscape.com]
  • Other symptoms may include: Blue skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure) Poor sucking, lethargy, weak cry, seizures (signs of severe low blood sugar) Poor feeding Puffy face Tremors or shaking shortly after[medlineplus.gov]
  • Sudden moodiness or behavior changes, such as crying for no apparent reason. Pale skin color. Difficulty in paying attention. Confusion. Tingling sensations around the mouth. Hyperglycemia High blood sugar.[the-diabetic-voice.com]
  • In his evening presentation, he had us all laughing, crying, connecting with each other, and thinking deeply about what Hauora and wellbeing really mean.[theyogalunchbox.co.nz]
Poor Feeding
  • Poor feeding is a common problem that affects up to 37% of IDMs, often prolonging the hospital stay.[pediatricweb.com]
  • Although the infant is generally asymptomatic, symptoms may include jitteriness, irritability, apathy, poor feeding, high-pitched or weak cry, hypotonia, or frank seizure activity.[emedicine.medscape.com]
  • Other symptoms may include: Blue skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure) Poor sucking, lethargy, weak cry, seizures (signs of severe low blood sugar) Poor feeding Puffy face Tremors or shaking shortly after[medlineplus.gov]
Feeding Difficulties
  • An abnormally high red blood cell count (polycythemia) can occur in IDMs, increasing their risk of jaundice (yellow skin color), feeding difficulties, respiratory distress, or lethargy.[pediatricweb.com]
  • difficulties, respiratory distress, hypoglycemia, and hyperbilirubinemia. 31 Less commonly, necrotising enterocolitis, thrombocytopenia, and venous thrombosis (for example, renal vein thrombosis) may result. 31 In the HAPO study, there was a weak association[dovepress.com]
Sepsis
  • 6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical Encyclopedia) Neonatal respiratory distress syndrome (Medical Encyclopedia) Neonatal sepsis[icdlist.com]
Flank Mass
  • Renal vein thrombosis presents with hematuria and a flank mass. The etiology is unknown. Small left colon syndrome presents with abdominal distension. Contrast enema shows a small left colon.[utmb.edu]
Pneumonia
  • Initially, the differential diagnosis includes transient tachypnea of the newborn, respiratory distress syndrome, pneumonia, and persistent pulmonary hypertension.[emedicine.medscape.com]
Nasal Flaring
  • Pulmonary disease These infants are at an increased risk of respiratory distress syndrome and may present within the first few hours after birth with tachypnea, nasal flaring, intercostal retractions, and hypoxia.[emedicine.medscape.com]
Failure to Thrive
  • Brief resolved unexplained event -- BRUE (Medical Encyclopedia) Crying - excessive (0-6 months) (Medical Encyclopedia) Failure to thrive (Medical Encyclopedia) Hemorrhagic disease of the newborn (Medical Encyclopedia) Hyperglycemia - infants (Medical[icdlist.com]
Abdominal Distension
  • Small left colon syndrome presents with abdominal distension. Contrast enema shows a small left colon. Meconium passage following the enema usually resolves the symptoms.[utmb.edu]
Thrombosis
  • Hyperviscosity due to polycythemia increases the IDM’s risk for stroke, seizure, necrotizing enterocolitis, and renal vein thrombosis.[emedicine.medscape.com]
  • Renal vein thrombosis presents with hematuria and a flank mass. The etiology is unknown. Small left colon syndrome presents with abdominal distension. Contrast enema shows a small left colon.[utmb.edu]
  • Renal vein thrombosis or clotting of the vessel draining blood from the kidney, causing the kidney to swell, is rare; however, it can occur before or after birth in IDMs.[pediatricweb.com]
  • (for example, renal vein thrombosis) may result. 31 In the HAPO study, there was a weak association between hyperbilirubinemia and maternal blood glucose levels on the OGTT, 10 but the risk of severe hyperbilirubinemia, such as seen in hemolysis, is[dovepress.com]
  • Women assessed as being at high risk should be referred to a specialist service, for example a trust-nominated thrombosis in pregnancy expert or team.[pathways.nice.org.uk]
Cardiomegaly
  • When cardiomegaly or poor perfusion and hypotension are present, performing echocardiography to differentiate between these processes is important.[emedicine.medscape.com]
  • CVS :ASD/VSD, CoA :Transposition, :Cardiomegaly CNS :Anencephaly, :NTD, :Microcephaly GI : duodenal atresia, anorectal atresia, situs inversus GU : renal agenesis :Polycystic kidneys MSK :caudal regression :siren Preexisting Diabetes Congenital anomalies[slideshare.net]
Diastolic Hypertension
  • To evaluate the prevalence of MS in the cohort on the basis of the conventional criteria established by NCEP, we examined the proportion of subjects 6 to 11 years of age in each of the 4 groups with 1 component (obesity, systolic or diastolic hypertension[pediatrics.aappublications.org]
Heart Murmur
  • A thorough physical examination will be performed to look for any physical abnormalities and to listen to the heart for any evidence of a heart murmur.[pediatricweb.com]
Apathy
  • Although the infant is generally asymptomatic, symptoms may include jitteriness, irritability, apathy, poor feeding, high-pitched or weak cry, hypotonia, or frank seizure activity.[emedicine.medscape.com]
Intracranial Hemorrhage
  • The risk for brachial plexus injury, facial palsy, intracranial hemorrhage (subdural), clavicular fractures, phrenic nerve paralysis, hemorrhage into abdominal organs (especially liver and adrenals) is increased.[utmb.edu]

Workup

Insulin Increased
  • As pregnancy advances -Progressive increase in tissue resistance to insulin Increase insulin secretion to maintain euglycemia Suppressed glucagon response Inc. prolactin, cortisol HPL has GH like effects 9. CHO Metabolism 10.[slideshare.net]
Ventricular Hypertrophy
  • Cardiovascular anomalies Cardiomyopathy with ventricular hypertrophy and outflow tract obstruction may occur in as many as 30% of IDMs. [7] The cardiomyopathy may be associated with congestive failure with a weakly functioning myocardium or may be related[emedicine.medscape.com]
  • Pathological ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J. 2007;28:1319–1325. 47. Chu C, Gui Y, Ren Y. The impacts of maternal gestational diabetes mellitus on fetal hearts.[dovepress.com]

Treatment

  • Treatment for infants of diabetic mothers 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.[stanfordchildrens.org]
  • Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if your child is having problems.[myhealth.alberta.ca]
  • What special treatments may be required for the infant after birth? If the baby is well after birth, he/she should be nursed or given formula in the first hour.[pediatricweb.com]
  • Treatment Results from various studies have concluded that proper treatment has a significant impact on the health of both mother and child.[pharmacytimes.com]

Prognosis

  • Prognosis DKA represents an acute emergency to both maternal and fetal well-being. Prompt initiation of treatment will correct the associated maternal and fetal metabolic acidosis, hyperglycemia, ketosis, and volume depletion..[clinicaladvisor.com]
  • HbA1c for diagnosis and prognosis of gestational diabetes mellitus. Diabetes Res Clin Pract 110, 38-43, 2015. Lacroix M, Battista MC, Doyon M, Houde G, Menard J, Ardilouze JL, Hivert MF, Perron P.[degruyter.com]
  • […] with the drug, there remains a possibility of long-term complications from metformin therapy. [3] Babies born to women treated with metformin have been found to develop less visceral fat, making them less prone to insulin resistance in later life. [73] Prognosis[en.wikipedia.org]

Etiology

  • Etiology is islet cell hyperplasia due to maternal hyperglycemia with subsequent hyperinsulinemia. Much less frequent with good maternal prenatal diabetic control. Respiratory Distress Syndrome.[utmb.edu]
  • Cushing’s syndrome Treatment will depend on the etiology of the cortoisol excess and may include surgery, radiotherapy, chemotherapy, and/or cortisol-inhibiting medications, such as metyrapone, ketoconazole, or aminoglutethimide.[clinicaladvisor.com]
  • PubMed Google Scholar Kjos SL, Walther F: Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of lung maturation tests. Am J Obstet Gynecol. 1990, 163 (3): 898-903.[dmsjournal.biomedcentral.com]
  • Although the etiology and diagnostic criteria of MS is still a subject of debate, the condition shares common features with GDM, including insulin resistance, dyslipidemia, and endothelial dysfunction [10].[journals.plos.org]

Epidemiology

  • Unlike previous epidemiological studies, BP, and lipid, glucose and insulin concentrations in early pregnancy, were precisely measured and not self-reported.[em-consulte.com]
  • Epidemiological studies confirmed that the prevalence of GDM is in direct proportion to the prevalence of type 2 diabetes mellitus (T2DM) [4].[omicsonline.org]
  • Epidemiology Diabetic ketoacidosis Incidence of DKA is approximately 2% to 3% in pregnancy with an associated 10% perinatal mortality rate.[clinicaladvisor.com]
  • Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84. 29. Hedderson M, Ferrara A, Sacks D. Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth.[dovepress.com]
  • American Journal of Epidemiology. 160 (12): 1168–76. doi : 10.1093/aje/kwh345. PMID 15583369. Toulis KA, Goulis DG, Kolibianakis EM, Venetis CA, Tarlatzis BC, Papadimas I (August 2009).[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • The final section discusses future prospects in screening, diagnosis, prevention, pathophysiology, and treatment of gestational diabetes.[books.google.com]
  • Pathophysiology Changes in glucose metabolism Variable glucose and insulin levels are seen in pregnancy depending upon the mother’s nutritional state. Fasting glucose levels can decrease by 10% to 20%.[clinicaladvisor.com]
  • Inflammatory and Other Biomarkers: Role in Pathophysiology and Prediction of Gestational Diabetes Mellitus. Int J Mol Sci 16, 13442‒13473, 2015. Aktun HL, Uyan D, Yorgunlar B, Acet M. Gestational diabetes mellitus screening and outcomes.[degruyter.com]
  • Diabetic-associated stillbirth: incidence, pathophysiology, prevention. Obstet Gynecol Clin North Am. 2007;34:293–307. 25. Mathiesen E, Ringholm L, Damm P. Stillbirth in diabetic pregnancies. Best Pract Res Clin Obstet Gynaecol. 2011;25:105–111. 26.[dovepress.com]
  • Pathophysiology [ edit ] Effect of insulin on glucose uptake and metabolism. Insulin binds to its receptor (1) on the cell membrane which in turn starts many protein activation cascades (2).[en.wikipedia.org]

Prevention

  • Women with diabetes need special care during pregnancy to prevent problems. Controlling blood sugar can prevent many problems.[medlineplus.gov]
  • The final section discusses future prospects in screening, diagnosis, prevention, pathophysiology, and treatment of gestational diabetes.[books.google.com]
  • Later in the pregnancy, glucose control is important to prevent macrosomia, hypoglycemia (after birth), and ventricular septal hypertrophy of the baby's heart.[pediatricweb.com]
  • Checking for hypocalcemia (low calcium levels) Giving oxygen or using a breathing machine (if respiratory distress occurs) Care for any problems arising from a birth injury Care for any problems that occur with a birth defect Prevention of problems associated[stanfordchildrens.org]
  • Public health strategies are urgently needed to prevent obesity and to treat it effectively.[pediatrics.aappublications.org]

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