APPENDIX 20

INFANTS OF MOTHERS WITH DIABETES MELLITUS

For a successful pregnancy, there should be no insulin reactions. No ketosis. No acidosis. As normal as possible blood sugar. No infections. Careful prenatal care. All are important. It may not be possible to attain these objectives completely, but every effort should be made.

THE BABY
Most information suggests that the newborn baby does best if delivered between the 36th and 37th weeks of pregnancy. Regardless of the time of birth, about 40% to 60% of the infants of diabetic mothers have no more problems than do other infants. Most doctors consider all infants of diabetic mothers to be very fragile, even when the newborn weighs 9 or 10 pounds. These infants are usually kept in incubators, unclothed for careful observation, in a special nursery.

The most common complication is respiratory distress or difficulty in breathing. This sometimes requires that the baby be given oxygen, fluids administered intravenously, and (less frequently) assisted ventilation of the lungs or artificial respiration. Diagnostic procedures such as X-rays and repeated blood and urine samples for ordinary and special analyses are often necessary. Some infants may have very low blood sugars. Others may develop jaundice, kidney complications, or muscle spasms from low calcium levels. Many have too much blood and occasionally may require the removal of blood.

Some of the babies may become jaundiced (too yellow) and may require an exchange transfusion to reduce the jaundice, as is done in the Rh-incompatible baby. Others may develop heart failure and may require oxygen, digitalis, and diuretics (medicines which promote the loss of water and salt by the kidneys). For these reasons, the baby should be under the care of a pediatrician familiar with the special problems that may develop during the first hours and days after birth. The causes of many of the complications occurring in a small percentage of these infants are not yet known.

The baby is not diabetic at birth and usually does not develop diabetes mellitus. Once beyond the first days and weeks of life, most will do as well as any infant.
If the baby's father is diabetic and the mother is not, the new-born will have no more problems than any other infant. Diabetes in the father alone requires no special care for the mother or the newborn baby.