From the Guidelines
Newborns of mothers with gestational diabetes should be closely monitored for hypoglycemia, jaundice, respiratory distress, and polycythemia, and have a follow-up appointment with the pediatrician within 3-5 days after discharge, with long-term follow-up focusing on monitoring the child's growth and development due to increased risk of obesity and type 2 diabetes later in life. The monitoring of blood glucose levels should begin within 1-2 hours after delivery and continue every 2-4 hours for the first 24-48 hours after birth, with a target blood glucose level above 45 mg/dL (2.5 mmol/L) 1. If hypoglycemia is detected, immediate feeding with breast milk or formula should be initiated, and if glucose levels remain low, intravenous glucose may be necessary.
Key Considerations
- Infants of mothers with gestational diabetes often have higher birth weights and increased fat stores, which can lead to hypoglycemia after birth when the constant maternal glucose supply is removed but their insulin production remains high 1.
- The child’s primary care provider should be aware that the child of a mother with GDM has inherent risks of future obesity and diabetes, and measures aimed at reducing or preventing obesity by modification of lifestyle may also decrease the risk of obesity and diabetes in the offspring 1.
- Long-term follow-up is crucial, as these infants have an increased risk of developing obesity and type 2 diabetes later in life, and close monitoring is essential to optimize their growth and development 1.
Recommendations
- Breast-feeding should be encouraged in women with GDM, as it has beneficial effects on the infant's health and development 1.
- Reclassification of maternal glycemic status should be performed at least 6 weeks after delivery, and women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years 1.
- The frequency of follow-up and blood glucose monitoring for newborns of mothers with GDM is not yet clear, but likely to be less intensive than for women diagnosed with GDM by older criteria 1.
From the Research
Newborn Follow-up for Mothers with Gestational Diabetes
- The newborns of mothers with gestational diabetes are at a higher risk of postnatal hypoglycemia, which can lead to severe neurological lesions and even death if left unrecognized and undiagnosed 2.
- Screening for post-natal hypoglycemia in the early hours after birth is crucial, and management strategies are still a topic of debate 2.
- A study found that 45% of full-term singleton neonates born to mothers with gestational diabetes developed hypoglycemia, and factors such as gestational weight gain, HbA1c at 1st trimester, and insulin therapy during pregnancy were significant predictors of hypoglycemia 3.
- Fetal macrosomia, defined as a birth weight ≥ 4,000 g, is a common adverse infant outcome of gestational diabetes, and it increases the risk of shoulder dystocia, clavicle fractures, and brachial plexus injury, as well as admissions to the neonatal intensive care unit 4.
- Infants of women with gestational diabetes are also at an increased risk of becoming overweight or obese at a young age and developing type II diabetes later in life 4, 5.
- Premature birth, hypoglycemia at birth, and shoulder dystocia are some of the fetal problems that can result from gestational diabetes 5.
- The placenta is a compromised target that largely suffers the impact of maternal diabetes, and the degree of fetal damage and placental dysfunction can lead to the induction of macrosomia or intrauterine growth restriction 6.