Fetal and neonatal mortality rates were as high as 65% before the development of specialized maternal, fetal, and

neonatal care. Since then, infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates. Today, 3-10% of pregnancies are affected by abnormal glucose regulation and control. Of these, 80% are related to abnormal glucose control of pregnancy or gestational diabetes mellitus. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following:

Respiratory distress Growth abnormalities (large for gestational age [LGA], small for gestational age [SGA]) Hyperviscosity secondary to polycythemia Hypoglycemia Congenital malformations Hypocalcemia, hypomagnesemia, and iron abnormalities

These infants are likely to be born by cesarean section for many reasons, among which are such complications as shoulder dystocia with potential brachial plexus injury related to the infant's large size. It is important for these mothers to be monitored closely throughout pregnancy. If optimal care is provided, the perinatal mortality rate, excluding congenital malformations, is nearly equivalent to that observed in normal pregnancies. Mortality/Morbidity:

Birth defects in infants of diabetic mothers have risen from 1-2% to 8-15% as a consequence of increased perinatal survival. Major congenital malformations are found in 5-9% of affected infants and account for 3050% of perinatal deaths of infants of mothers with gestational diabetes. In mothers with insulin-dependent diabetes, the stillbirth and perinatal mortality rate is 5 times the rate in the general population, and neonatal and infant mortality rates are 15 and 3 times the rate in the general population, respectively. These infants are 3 times more likely to be born by cesarean delivery, twice as likely to suffer serious birth injury, and 4 times as likely to be admitted to a neonatal intensive care unit. Major causes of morbidity include the following: o LGA or SGA infants o Hypoglycemia o Prematurity o Respiratory distress syndrome

Intrapartum asphyxia

Race: Incidence is higher in Latinos and African-Americans than in whites. Diabetes occurs more frequently in persons of American Indian descent, particularly among the Pimas of the southwestern United States. Sex: Frequency of involvement in boy and girl IDMs is equal. Age: Generally, the first 1-3 hours after birth are the most critical for the development of hypoglycemia. (Cordero)