Maternal diabetes and neonatal metabolic complications
THE CONTEXT
Maternal diabetes is associated with fetal and neonatal complications. The target passage also classifies common causes of neonatal hypoglycemia and describes early- and late-onset hypocalcemia.
Complications of maternal diabetes
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Sudden fetal death may occur during the last trimester of pregnancy.
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Macrosomia increases the chances of birth trauma, asphyxia, and cesarean section.
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Neonatal complications include respiratory distress, hypoglycemia, hypocalcemia, polycythemia, increased blood viscosity, and hyperbilirubinemia.
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The risk of congenital anomalies is increased.
Common causes of neonatal hypoglycemia
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Inadequate substrate is associated with small-for-gestational-age infants below the 3rd weight percentile, gestation below 35 weeks, and birth weight below 2000 g.
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Relative hyperinsulinemia is associated with infants of diabetic mothers and large-for-date infants above the 97th weight percentile.
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Illness-related causes include hypothermia, sepsis, and asphyxia.
Early-onset hypocalcemia
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Early-onset hypocalcemia occurs in the first 3 days. Risk factors include prematurity, perinatal asphyxia, and being an infant of a diabetic mother.
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It is usually asymptomatic and is managed with intravenous and oral calcium.
Late-onset hypocalcemia
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Late-onset hypocalcemia occurs after seven days. Risk factors include increased phosphate load from cow milk feeds or renal insufficiency, vitamin D deficiency in the mother and neonate, hypomagnesemia, and hypoparathyroidism.
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Clinical features include tetany, seizures, tachycardia, prolonged QTc interval, apnea, tachypnea, and cyanosis.
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Management includes intravenous and oral calcium; establishing the etiological diagnosis is vital to treating the cause.