Gestational Diabetes in Primary Care

Paul Hicks, MD

In This Article

Neonatal Complications

In many cases, the physician who provides prenatal care will become the baby's caregiver as well. As such, the neonatal complications of GDM are important to consider. The potential sequelae of shoulder dystocia are Erb's palsy, a stretch injury to the brachial plexus, and intrapartum fetal hypoxia, with the possibility of a hypoxic ischemic event or death if the hypoxia is extreme or prolonged. The flaccid paralysis of Erb's palsy usually resolves in the first few days to weeks but occasionally is lifelong.

Other neonatal complications of GDM are hypoglycemia, polycythemia, and respiratory distress. Secondary to fetal hyperinsulinemia, hypoglycemia is defined as a heel-stick blood sugar < 35 mg/dL in a full-term neonate and < 25 mg/dL in one born preterm. The hypoglycemia typically resolves with feeding of either milk or a glucose solution. If the baby is symptomatic or the hypoglycemia profound, an IV bolus of 10% dextrose is recommended -- 0.25 mg/kg followed by 4-6 mg glucose/kg/min with gradual titration. Blood sugar monitoring is continued every hour until it has stabilized. Polycythemia is a result of chronic intrauterine hypoxemia and placental insufficiency secondary to poor glycemic control. Hypoxemia causes increased fetal erythropoietin release and subsequent polycythemia.[52] When these extra red blood cells break down, there is increased incidence of hyperbilirubinemia at days to weeks after birth. Respiratory distress is the most serious complication for the neonate. Fetuses affected by GDM are at elevated risk (perhaps 5- to 6-fold greater) of lung immaturity compared with age-matched controls.[53] Oxygen supplementation, ventilatory support, and surfactant replacement are among the treatments available, and care may require consultation with a neonatologist.


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