[The child of the diabetic mother]

The prevalence of infants of diabetic mothers is estimated at 2-3% of all pregnancies in the Italy, with 60-90% of gestational diabetes. The perinatal mortality rate has decreased ten-fold over the past four decades; at present it is 2% mainly for congenital anomalies. The effects on the fetus and newborns depend on the degree of maternal diabetes. Macrosomia has served as a marker for evaluating morbidity and may be defined as occurring in an infant whose weight with reference gestation, exceeds the 97.5 percentile. This is mainly due to fetal hyperinsulinism secondary to hyperglycemia from inadequate maternal metabolic control. Insulin-requiring diabetes during organogenesis doubles or triples a woman's risk of producing a malformed infant (major risk for sacral dysgenesis). Hypoglycemia is a common complication of fetal hyperinsulinemia but is also caused by lower systemic glucose production rate. Hypocalcemia is recognized in these infants but the major problem and principal cause of death is respiratory distress syndrome which is identical to that found in premature infants and it comes from hyperinsulinemia retarding lung maturation through cortisol inhibition. Cardiomyopathy complicating the infants of diabetic mothers, shows a characteristic pattern with thickened intraventricular septum producing obstruction to flow.