Elevated blood sugar in pregnant women often has specific effects on their infants. Infants of diabetic mothers are generally larger and may have large organs and systems, particularly the liver, adrenal glands, and heart.

These infants may have a hypoglycemic episode (low blood sugar) shortly after birth because of the increased fetal production of insulin (a substance that moves glucose from the bloodstream into body tissues) in response to maternal high blood sugar. This requires close monitoring of blood sugar levels in these infants.

Overall, there is an increased chance that mothers with poorly-controlled diabetes will miscarry or have a stillborn child. If the mother was diagnosed with diabetes before the pregnancy, her infant also has an increased risk of having congenital malformations if her disease is not well controlled.

• Mother had previous large for gestational age (LGA) infant
• Infant is large for gestational age (LGA)
• Infant has
  • Reddish appearance (plethoric)
  • Puffy face
  • Tremors or shaking shortly after birth
  • Jaundice of the skin
  • Poor feeding, lethargy, weak cry (signs of severe low blood sugar)
  • Blue or mottled skin color, rapid heart rate, rapid breathing (signs of heart failure)

In the mother, signs include:

• History of diabetes or gestational diabetes
• Poor glucose control during pregnancy
• Ultrasound demonstrates LGA in late term

In the infant, signs include:

• Macrosomia (abnormally large body)
• Hypoglycemia - low blood sugar
• Hypocalcemia - low blood calcium
• Abnormally large heart causing heart failure

• Serial blood sugar levels
• Serum calcium
• Echocardiography

All infants of diabetic mothers should be tested for hypoglycemia, even if they have no apparent symptoms.

In an infant with an initial episode of low blood sugar (hypoglycemia), repeat blood sugars over several days will be required until the infant's blood sugar remains stable with normal feedings.

Early feeding may prevent hypoglycemia in mild cases. Low blood sugar is treated with intravenous glucose solutions until blood sugar levels are stable.

Rarely, heart medications (such as propranolol) are needed.

Better control of diabetes and early recognition of gestational diabetes has decreased both the incidence and severity of symptoms for infants of diabetic mothers. Early intervention helps ensure recovery.

In general, an infant's symptoms resolve within a few weeks. However, an enlarged heart may take several months to resolve.

• Stillbirth -- the incidence of stillbirth is higher in diabetic mothers (stillborn LGA infants are believed to have outgrown their oxygen supply prior to delivery)
• Cardiac failure
• Profound hypoglycemia -- blood sugar may be sufficiently low to cause permanent brain damage
• A 2- to 3-fold increase in congenital heart abnormalities
• Low-back and leg wasting
• Small left colon syndrome
• Polycythemia

If you are pregnant and receiving routine prenatal care, your physician will know by your history whether you have diabetes, and will discover through routine testing if you develop gestational diabetes.

However, if you are pregnant, have diabetes, and are having difficulty controlling your blood sugar, call your physician immediately.

If you are pregnant and not receiving prenatal care, make an appointment with your physician or call the State Board of Health for instructions on how to obtain state-assisted prenatal care.

Prevention of the complications associated with an infant of a diabetic mother requires supportive care of the mother throughout the pregnancy. Good control of glucose in existing diabetes and early recognition of gestational diabetes can prevent many of the problems associated with infants of diabetic mothers.

Careful monitoring of the infant in the first 24 hours following birth may prevent the complications of hypoglycemia.