From the Guidelines
Newborns of mothers with gestational diabetes should be closely monitored for hypoglycemia, macrosomia, and other complications, and long-term follow-up is crucial to screen for the development of obesity and type 2 diabetes later in life. According to the most recent evidence [ 1 ], it is essential to monitor these infants for potential complications. The monitoring should include blood glucose levels within 1-2 hours after birth and continue every 2-4 hours until glucose levels stabilize above 45 mg/dL for at least two consecutive readings. If hypoglycemia occurs, early feeding with breast milk or formula should be initiated, and in severe cases (glucose <25 mg/dL or symptomatic), intravenous glucose (2 mL/kg of 10% dextrose) may be necessary.
Key Considerations
- Monitoring for hypoglycemia and other complications such as macrosomia, birth injuries, respiratory distress syndrome, jaundice, and polycythemia is crucial [ 1 ].
- Long-term follow-up is important to screen for the development of obesity and type 2 diabetes later in life, with regular well-child visits including monitoring of growth parameters, developmental milestones, and screening for metabolic disorders [ 1 ].
- Women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years [ 1 ].
Recommendations
- Breast-feeding should be encouraged in women with GDM [ 1 ].
- Regular well-child visits should include monitoring of growth parameters, developmental milestones, and screening for metabolic disorders as they grow [ 1 ].
- Women with GDM should be screened for diabetes 6–12 weeks postpartum and should be followed up with subsequent screening for the development of diabetes or pre-diabetes [ 1 ].
From the Research
Gestational Diabetes Newborn Follow-up
- Newborns of mothers with gestational diabetes are at increased risk of abnormal nutritional status at birth, which can lead to metabolic disorders 2.
- The management of newborns of mothers with gestational diabetes, particularly in the prevention, detection, and management of hypoglycaemia, is improved through the existence of a written protocol 3.
- Systematic blood glucose monitoring is recommended for newborns of mothers with insulin-treated gestational diabetes, or infants considered large or small for gestational age 3.
- Newborns should undergo routine neonatal icterus monitoring, and measurement of calcium levels and a complete blood count (CBC) should be carried out when clinically appropriate 3.
- Complementary testing for the detection of heart, bone, or brain defects should be performed according to clinical signs 3.
- Maternal prepregnancy diabetes and gestational diabetes mellitus are associated with an increased risk of congenital anomalies of the newborn, including cyanotic congenital heart disease and hypospadias 4.
Follow-up Care
- Newborns can be cared for in general maternity wards, except in cases of premature birth, major malformations, or severe fetal growth abnormalities 3.
- The indications for transferring infants of mothers with gestational diabetes to a neonatal intensive care unit are the same as for all other newborns 3.
- Long-term complications of mothers with gestational diabetes include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance 5.
Screening and Diagnosis
- Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes 6.
- The one-step approach for the diagnosis of gestational diabetes, using a 75 g oral glucose tolerance test, has more than doubled the incidence of gestational diabetes, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial 5.
- Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes 6.