20.7 Maternal Diabetes

Neonates born to a mother with type 1, type 2, or gestational diabetes are more likely to have congenital cardiac and central nervous system anomalies and are at greater risk for birth injury due to increased neonatal size. Classic signs of an infant born to a diabetic mother include being large for gestational age (LGA) and being heavily coated with vernix at birth. However, infants born to mothers with uncontrolled diabetes may have the opposite presentation and be small for gestational age (SGA) due to intrauterine growth restriction (IUGR).^[1]

All newborns of mothers with diabetes have an increased risk of hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and hypomagnesemia after birth. Nursing management includes close monitoring of serum blood glucose levels and frequent assessments for hypothermia, respiratory distress, and bilirubin levels. If the infant is otherwise stable, feeding by mouth within the first hour of life is important for glycemic control and thermoregulation. Additional formula feedings may be required for glycemic control, according to agency policy.^[2]