Infants of Diabetic Mothers
Anatomy, Pathophysiology, and Etiology
Diabetic mothers have glucose intolerance of different levels, which they may have been living with, or occurs in the course of pregnancy. Approximately 20-50% of the infants of diabetic mothers develop macrosomia, characteristically described as a birth weight that exceeds the 90th percentile, 4 kg. Infants with macrosomia have an exceptional overgrowth pattern that entails the central disposal of subcutaneous fat around the abdomen and interscapular regions. Such infants have larger shoulders as well as extremity perimeters, a reduced shoulder-to-head proportion, considerably higher body fat, in addition to thicker upper-extremity skinfolds (Kamana, Shakya, & Zhang, 2015). Since the size of the infant’s head is considerably small and the abdominal and shoulder girth noticeably enlarged, there is a risk of fetal death and Erb-Duchenne palsy with traumatic brachial plexus injuries and shoulder dystocia being more frequent. Nevertheless, skeletal development is mostly not affected.
Macrosomia’s pathophysiology is linked to the status of the fetus and condition of the mother that is responsible for its occurrence. Inadequately managed diabetes, mother’s obesity, and undue weight gain by the mother account for macrosomia with irregular incidents of high blood sugar being widespread. High blood sugar in the fetus leads to the prompt of insulinlike growth aspects, hormones, and insulin, which spurs development and accumulation of glycogen and fat (Kamana et al., 2015). Higher gestational age leads to a greater weight at parturition as it facilitates the practice of growth in the uterus. Increased fat mass in infants of diabetic mothers does not rely on maternal BMI.
Contrary to maternal high blood sugar, the obesity of the mother has a powerful impact on the likely occurrence of macrosomia. Gestational age at the point of giving birth, the mother’s BMI when pregnant, increased weight in the course of pregnancy, short height of the mother, cigarette smoking, and high blood pressure are causal factors of macrosomia. Comparing obese mothers with their normal-weight counterparts shows that women with obesity have a two-fold higher risk of macrosomia than their other colleagues (Kamana et al., 2015). A wide pool of studies affirms that the birth weight of the fetus is strongly associated with second and third-trimester postprandial glucose rates; if the sugar values are roughly 120 mg/dl, about 25% of infants may be anticipated to develop macrosomia.
Diagnosis, Treatments, and Services
It may be hard to obtain a sense of the accurate weight of the fetus while in the uterus though there are approaches that a mother and the health professional may get indications of the size of the unborn baby. To start with, the health professional will assess the mother’s fundal height and measure the distance from the top of the uterus and pubic bone; a greater than the anticipated size insinuates a larger than normal baby. The caregiver can as well feel the abdomen by hand to have a sense of the size of the fetus (Mardani, Rossta, & Rezapour, 2014). Though this might make the mother feel some discomfort, it does not hurt the baby in any way. A different means of having a notion of the weight of the baby is via regular ultrasound scans that will offer rough extent of the weight of the baby and the amount of amniotic fluid. The amount of amniotic fluid shows the size of the baby as too much of amniotic fluid is linked to macrosomia since larger babies result in a higher level of urine that translates to an increased amniotic fluid. The measurements coupled with the history of the mother provide a strong diagnosis of whether the unborn baby has a probability of developing macrosomia. Nonetheless, a sure diagnosis is achieved the moment that the weight of the baby is confirmed following delivery.
For babies that are found to have a likelihood of developing macrosomia, the mother should be prepared for the possibility of undergoing caesarean section (especially when the weight of the baby is expected to be over nine pounds), although at times giving birth normally may be possible. After delivery, health professionals should examine and/or treat the infants of diabetic mothers for hypoglycemia, jaundice, breathing difficulties, and injuries in the course of parturition, for example, shoulder dystocia (Mardani et al., 2014). The mother should be made aware that her baby might require having a short period of hospitalization in the neonatal critical care unit for enhanced treatment in case it has developed severe indicators. Gladly, with effective diagnosis and treatment, most of the infants of diabetic mothers do not develop complications and are allowed to go home a short period after delivery; the mother is only certain of stocking up some large-sized diapers.
If a mother has diabetes, macrosomia may be prevented by suitably addressing the level of blood sugar. The health professional can seek the services of a nutritionist who will advise the mother on the excellent approaches to managing diabetes in the course of pregnancy; for instance, the consumption of a diet that is rich in nutritional fiber and complex carbohydrates with decreased levels of sugars, fat, and cholesterol. If a mother gains a lot of weight in the course of pregnancy or has fears of adding weight, she can seek advice from a doctor and nutritionist who will enlighten her on the means of checking weight (Mardani et al., 2014). Many pregnant women are expected to have thirty minutes of non-vigorous physical activities (for instance, swimming and taking a walk) as a minimum every day and consume healthy diets containing fruits, vegetables, low fats and proteins, and lots of whole grains.
Nursing Management of Macrosomia in the Acute Care and Home Care Setting
If macrosomia results in pregnancy being high-risk, the welfare of the fetus and the mother might become compromised. At such a point, nurses are in the best position of offering timely and fundamental care while supporting the mother in the course of the potentially hard times (Cruz et al., 2015). Nursing care of mothers carrying a macrosomic fetus demands close monitoring of the condition of both the mother and an unborn baby in the acute care and home care setting. The diabetic mothers might require hospitalization for some weeks before birth and necessitate a multidisciplinary care approach. Moreover, the nurses ought to provide education and support to ease the stress in such mothers.
In the acute care and home care settings, infants of diabetic mothers go through a comprehensive physical assessment from toe to head, and health practitioners ought to address the arising congenital problems and birth trauma effectively. Diabetic mothers ought to obtain thorough care and examination while being assessed for hyperbilirubinemia, electrolyte problems, polycythemia, and low blood sugar (Cruz et al., 2015). For the infants of diabetic mothers, the level of blood sugar must be checked within one hour of life and after each hour for eight consecutive hours before proceeding as the need arises. Oral feeding, preferably breastfeeding is advocated as much as achievable, and when inadequate, glucose ought to be administered intravenously.
Cruz, J., Grandía, R., Padilla, L., Rodríguez, S., Hernández, P., Lang, J., & Márquez-Guillén, A. (2015). Macrosomia predictors in infants born to Cuban mothers with Gestational Diabetes. MEDICC Review, 17(3), 27-32. Retrieved from http://www.medigraphic.com/pdfs/medicreview/mrw-2015/mrw153f.pdf
Kamana, K. C., Shakya, S., & Zhang, H. (2015). Gestational diabetes mellitus and macrosomia: A literature review. Annals of Nutrition and Metabolism, 66(2), 14-20. Retrieved from https://www.karger.com/Article/FullText/371628
Mardani, M., Rossta, S., & Rezapour, P. (2014). Evaluation of the prevalence of macrosomia and the maternal risk factors. Iranian Journal of Neonatology IJN, 5(3), 5-9. Retrieved from http://ijn.mums.ac.ir/article_4141_2eea5da05c11dfc90bbc15858a127f50.pdf