A nurse is caring for a newborn who has macrosomia and whose mother has diabetes mellitus
There are two types of diabetes that occur in pregnancy: Show
With both types of diabetes, there can be complications for the baby. It is very important to keep tight control of blood sugar during pregnancy. The placenta supplies a growing fetus with nutrients and water. It also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can block insulin. This usually begins about 20 to 24 weeks into the pregnancy. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results. Pregnancy also may change the insulin needs of a woman with preexisting diabetes. Insulin-dependent mothers may require more insulin as pregnancy progresses. About 5 percent of all pregnant women in the U.S. are diagnosed with gestational diabetes. Gestational diabetics make up the vast majority of pregnancies with diabetes. Some pregnant women require insulin to treat their diabetes. The mother's excess amounts of blood glucose are transferred to the fetus during pregnancy. This causes the baby's body to secrete increased amounts of insulin, which results in increased tissue and fat deposits. The infant of a diabetic mother is often larger than expected for the gestational age. The infant of a diabetic mother may have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risk for birth defects and stillbirth. It also increases the risk for birth defects, including problems with the formation of the heart, brain, spinal cord, urinary tract, and gastrointestinal system. Unlike insulin-dependent diabetes, gestational diabetes generally does not cause birth defects. Women with gestational diabetes generally have normal blood glucose levels during the critical first trimester when baby's organs form. A newborn infant of a diabetic mother may develop one, or more, of the following:
Treatment of a baby born to a diabetic mother often depends upon the control of diabetes during the last part of pregnancy and during labor. Specific treatment will be determined by your baby's physician based on:
Treatment may include:
Prenatal care is essential to a healthy outcome when a mother has diabetes in pregnancy. Careful diet management, blood glucose monitoring, and insulin therapy can help keep a mother's blood glucose levels at normal levels and decrease many of the risks to her baby. Why fetal macrosomia develops in a pregnant woman who is having diabetes mellitus?In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called 'large for gestational age'.
Which factors are associated with the development of complications in infants of mothers with diabetes?Infants of diabetic mothers are prone to neurologic impairments, mainly due to perinatal asphyxia, birth traumas and metabolic disorders. Perinatal asphyxia: Increased risk of perinatal asphyxia has been reported in diabetic pregnancies in a number of studies.
What is macrosomia?The term "fetal macrosomia" is used to describe a newborn who's much larger than average. A baby who is diagnosed as having fetal macrosomia weighs more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age.
Which reason would the nurse provide to a new mother about neonatal weight loss in the first 3 days of life?Neonates receive only small amounts of fluids in the first days following birth,1 and they tend to lose weight before they begin to gain weight. Excessive weight loss or inadequate weight gain can be indications of low milk production or of insufficient milk transfer.
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