Infants of diabetic mothers

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The Pedersen hypothesis and diabetic fetopathy

Most, but not all, of the fetal and neonatal sequelae of diabetes during gestation are a function of maternal glycemic control (Fig. 1). This concept had its ontogeny in the Pedersen hypothesis, which states that maternal hyperglycemia results in fetal hyperglycemia because glucose readily traverses the placenta [3]. Before 20 weeks' gestation, the fetal islet cells are not capable of responsive insulin secretion, and the main pathologic condition to which the embryo and early fetus are

Diabetes during the periconceptional period

Several well-done epidemiologic studies have demonstrated a strong association between maternal glycemic control at the time of conception and during early gestation and the incidence of congenital anomalies [1], [4], [5]. These studies demonstrated a fourfold higher rate of congenital anomalies of the brain, heart, kidneys, intestine, and skeleton in IDM [4]. The rate of major congenital anomalies for IDM can be predicted from maternal hemoglobin A1c values at 14 weeks' gestation. Mothers with

The effect of maternal diabetes on the developing fetus

Uncontrolled maternal diabetes has an effect on fetal growth, glucose metabolism, oxygenation, iron metabolism, and preparation for extrauterine life.

Neonatal complications in infants of mothers with diabetes

Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequelae, including abnormalities of neonatal body habitus, glucose, calcium and magnesium metabolism, hematologic status, cardiorespiratory function, bilirubin metabolism, and neurologic functioning [5]. A general approach to screening for common derangements is outlined in Table 1 [5], [22], [23].

Long-term sequelae in offspring of mothers with diabetes

The long-term health of IDMs can be affected by the periconceptional, fetal, and neonatal pathologies discussed previously. The major issues revolve around long-term risks of obesity and diabetes, neurologic outcome, and iron status. There is no strong evidence that large-for-date newborn infants grow up to be fat children and adults. Most seem to return to a genetically programmed growth curve well within the population standards. Diabetes mellitus clearly has a genetic component; thus, it is

Prenatal diagnosis and management of diabetes during gestation

Strict maternal glycemic control during a pregnancy complicated by diabetes mellitus reduces neonatal morbidity and mortality. Periconceptional glucose control seems to reduce the incidence of congenital anomalies. Fetal hyperinsulinemia and its associated metabolic abnormalities can be reduced by maintaining tight glycemic control after 28 weeks' gestation [5]. Similarly, fetal macrosomia can be prevented by appropriate glycemic control from 32 weeks' gestation until term.

Controversy has

Summary

Advances in the management of mothers with diabetes have reduced the rate of morbidity and mortality for their infants. Aggressive control of maternal glycemic status is warranted because most morbidities are epidemiologically and pathophysiologically closely linked to fetal hyperglycemia and hyperinsulinemia. Although rates of complications are lower than in previous eras, there may be a resurgence of IDMs within the next 10 years. The burgeoning public health problem of overweight and obesity

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    This article was supported in part by grants HD-29421 and NS-32755 to Michael K. Georgieff.

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