It seems like the baby from Indonesia who weighed 19.2 lbs at birth has become world famous. The press needs some feel good items once in a while to lighten all the bad news. For people who work in obstetrics, however, this is actually a rather tragic situation. This is a baby who could very easily have died in utero from the effects of out of control blood sugars in a diabetic mother. Then, the world would never have heard of him. This happens every day around the world. Even after being born alive, any pediatrician will tell you that these babies who look so big and strong are alarmingly vulnerable. Most pediatricians would rather look after a tiny premature baby any day than a macrosomic (large) infant of a diabetic mother (IDM).
WHAT IS THE CONCERN?
The growth and maturation of the fetus are closely associated with the delivery of maternal nutrients, particularly glucose. This is most crucial in the third trimester when the baby and the placenta are both making demands on the mother’s insulin-producing capabilities.
Pregnancy problems associated with maternal diabetes include a higher risk of pregnancy induced hypertension (PIH), urinary tract infections, cesarean section, and worsening diabetes. Remember the role that Julia Roberts played in “Steel Magnolias”? The character was a diabetic who had a precarious pregnancy. She did carry to term but, in the movie, her diabetes took her life when her son was just a toddler. Problems associated with diabetic pregnancies for the baby are: macrosomia (large baby), neural tube defects, polyhydramnios, neonatal hypoglycemia (low blood sugar), hypocalcemia, hypomagnesemia, jaundice (hyperbilirubinemia), birth trauma, prematurity syndromes, and subsequent childhood and adolescent obesity.In addition to careful monitoring of insulin needs, diabetic women are given the following diet guidelines:What foods to avoid?
• sugar (white or brown)
• honey, molasses, syrup, jams, jellies, marmalade
• chocolate, candy
• puddings, Jell-O, fruit yogurts
• desserts—cakes, pies, pastries, iced cookies, etc.
• soft drinks, tonic water
• sweetened condensed milk
• sweet sauces—oyster sauce, teriyaki, plum, sweet & sour, ketchup
Caffeine has been shown to make the body more resistant to the effects of insulin so tea, coffee and all soda pop should be avoided.
Fruit sugar should only be consumed in small portions. ½ a banana, 10 grapes, a small apple are the serving sizes. Milk products are also high in sugar and should be used in moderation according to the advice of a diabetic nutritionist. For more information on Infant of a Diabetic Mother, seehttp://www.nlm.nih.gov/medlineplus/ency/article/001597.htm