Infants of diabetic mothers

Historically, infants born to mothers with diabetes have been at significantly greater risk for spontaneous abortion, stillbirth, congenital malformations, and perinatal morbidity and mortality. Fetal and neonatal mortality rates were as high as 65% before the development of specialized maternal and neonatal care. Over the past three decades, practitioners have sought to improve the outcome of diabetic pregnancies so that the results approach those of nondiabetic pregnancies [1]. Subsequently, advances in maternal and fetal care have improved the outlook of the infant of a diabetic mother (IDM) to the point at which most pregnant women with diabetes can expect to deliver a healthy child when they have received appropriate prenatal care. Currently, 3% to 10% of pregnancies are complicated by abnormal glycemic control. Of these, 80% are caused by gestational diabetes mellitus as opposed to pregestational diabetes mellitus. This number may rise significantly in the next decade as the current significantly overweight pediatric population heads into their child-bearing years. The IDM is at increased risk for periconceptional, fetal, neonatal, and long-term morbidities [1,2]. The causes of the fetal and neonatal sequelae of maternal diabetes are likely multifactorial; however, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus [2] and can be prevented by appropriate periconceptional and prenatal care. This article focuses on the complications associated with diabetes in pregnancy as they occur in the periconceptional, fetal, neonatal, and postnatal time period. Obstetric and pediatric management strategies to prevent morbidity in IDM are discussed at the end of the article.