An infant of a diabetic mother is a baby born to a mother who has diabetes. The phrase specifically refers to a baby who is born to a mother who had persistently high blood sugar (glucose) levels during pregnancy.

High blood sugar levels in pregnant women often have specific effects on their infants. Infants born to mothers who have diabetes are generally larger than other babies. They may have large organs, particularly the liver, adrenal glands, and heart.

These infants may have a hypoglycemic episode (low blood sugar) shortly after birth because of the increased insulin in the baby. Insulin is a substance that moves glucose from the blood into body tissues. This requires close monitoring of blood sugar levels in the infant.

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

Symptoms in the infant:

• Infant is large for gestational age (LGA)
• 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 control of blood sugar levels during pregnancy
• Ultrasound in the last few months of pregnancy shows a LGA baby
• Previously having a LGA infant

In the infant, signs include:

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

• Blood tests to check glucose and serum calcium
• Echocardiography

All infants born to mothers with diabetes should be tested for hypoglycemia, even if they have no symptoms.

If an infant had an initial episode of low blood sugar (hypoglycemia), tests to check blood sugars will be done over several days. This will continue 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 glucose given through an IV. Rarely, heart medications (such as propranolol) are needed.

Better control of diabetes and early recognition of gestational diabetes has decreased the number and severity of problems in infants born to mothers with diabetes. Usually, an infant's symptoms go away within a few weeks. However, an enlarged heart may take several months to get better.

• Stillbirth (stillborn LGA infants are believed to have outgrown their oxygen supply before being born)
• Cardiac failure
• Serious hypoglycemia (blood sugar may be low enough to cause permanent brain damage)
• Low back and leg wasting
• Small left colon syndrome
• Polycythemia
• Congenital heart defects

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.