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102: Infant of a Diabetic Mother

INTRODUCTION

Maternal diabetic control is a key factor in determining fetal outcome for the infant of a diabetic mother (IDM). Data indicate that perinatal morbidity and mortality rates in the offspring of women with diabetes mellitus have improved with dietary management and insulin therapy. However, complications may still arise in the infant, including hypoglycemia, hypocalcemia, hypomagnesemia, perinatal asphyxia, respiratory distress syndrome (RDS), other respiratory illnesses, hypertrophic cardiomyopathy, hyperbilirubinemia, polycythemia, renal vein thrombosis, macrosomia, birth injuries, and congenital malformations. Because of better current understanding of the pathophysiology of diabetic pregnancies, these complications can be recognized and treated.

I. CLASSIFICATION

  1. White's classification. White's classification system is based on the age at onset, duration of the disorder, and complications. It is currently used to group women with diabetes during pregnancy and provide a method to compare groups of infants. The original table was revised (Table 102–1).

  2. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Table 102–2 presents the nomenclature of the Expert Committee for the classification diabetes mellitus.

Table 102–1.WHITE'S MODIFIED CLASSIFICATION OF DIABETES IN PREGNANCY
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Table 102–1.WHITE'S MODIFIED CLASSIFICATION OF DIABETES IN PREGNANCY
White's Class Description
Gestational diabetes A1 Diet-controlled gestational diabetesa (fasting glucose <105 mg/dL 2 hours postprandial glucose <120 mg/dL)
Gestational diabetes A2 Insulin-treated gestational diabetesa (fasting glucose >105 mg/dL 2 hours postprandial glucose >120 mg/dL)
A Abnormal GTT at any age or of any duration; treated only by diet therapy
B Onset at age ≥20 years and duration <10 years
C Onset at age 10–19 years or duration of 10–19 years
D Onset before 10 years of age, duration >20 years, benign retinopathy, or hypertension (not pregnancy induced)
 D1 Onset before age 10 years
 D2 Duration >20 years
 D3 Calcification of vessels of the leg (macrovascular disease), formerly called Class E
 D4 Benign retinopathy (microvascular disease)
 D5 Hypertension (not pregnancy induced)
R Proliferative retinopathy or vitreous hemorrhage
F Nephropathy with >500 mg/d proteinuria
RF Criteria for both classes R and F
G Many pregnancy failures
H Evidence of arteriosclerotic heart disease
T Prior renal transplantation

GTT, glucose tolerance test.

aAny degree of glucose intolerance with onset or first recognition during pregnancy.

Classes B through T require insulin treatment. Classes R, F, RF, H, and T have no onset or duration criterion, but usually occur with long-standing diabetes.

Modified and reproduced, with permission, from Brown FM, Hare JW. Diabetes Complicating Pregnancy: The Joslin Clinic Method. 2nd ed. New York: Wiley-Liss; 1995.

Table 102–2.NOMENCLATURE OF THE EXPERT COMMITTEE ON THE DIAGNOSIS AND CLASSIFICATION OF DIABETES MELLITUS
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Table 102–2.NOMENCLATURE OF THE EXPERT COMMITTEE ON THE DIAGNOSIS AND CLASSIFICATION OF DIABETES MELLITUS
Class Description
I. Type 1 diabetes β-Cell destruction usually leading to absolute insulin deficiency (immune or idiopathic)
II. Type ...

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