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Post Delivery

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Post Delivery

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At birth infants of diabetic mothers are at risk of hypoglycaemia secondary to hyperinsulinaemia, which persists after delivery. Despite the above recommendations, a recent retrospective review from Shrewsbury (presented at the forum) revealed 64% of babies born to gestational and pregestational diabetic mothers to have hypoglycaemia (Reference1). This was not related to glycaemic control in pregnancy or labour, onset of diabetes, need for insulin or size of the infant and was therefore difficult to predict. Although infants of diabetic mothers are no longer routinely admitted to SCBU in most units, it emphasises the need for careful nutritional management and regular blood glucose monitoring in these infants.

There is also a risk of neonatal hypocalcaemia because hyperglycaemia results in glycosylated albumin, which displaces bound calcium. This results in suppression of parathyroid hormone. This functional hypoparathyroidism  persists temporarily post delivery.

Fetal hyperinsulinaemia also suppresses phosphotydyl glycerol, which is a major component of surfactant. Thus neonates are at increased risk of respiratory distress syndrome, particularly at premature gestations.

Maternal insulin requirements are markedly reduced post delivery; they usually return to pre pregnancy levels and should be adjusted by the medical team.

Breast feeding should be encouraged although insulin requirements and calorific intake may need further adjustments for this.

Post pregnancy management should include contraceptive advice and the chance to reinforce pre pregnancy management for subsequent pregnancies.

1 -Cansick JC, Deshpande SA. How common is hypoglycaemia in infants of diabetic mothers?, Abstract

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