Complications of Diabetes Mellitus: Complications for the Newborn

Because of the insulin antagonist effect of pregnancy, some women develop DM only during pregnancy (gestational diabetes). Although gestational diabetes is not associated with an increase in congenital anomalies, it can cause other difficulties, such as macrosomia, birth trauma, and an increased risk of cesarean section.

Nutritional Considerations

Avoidance of complications requires good glycemic control before most women recognize that they are pregnant. Women with diabetes can be counseled to plan their pregnancies, so that good control can be in place early.

Control of blood glucose has been shown to prevent macrosomia. Complications of delivery, including shoulder dystocia, increase with newborns that are more than 4000 grams (macrosomic). Elevated glucose contributes to macrosomia, and control of blood sugar (eg, with insulin) reduces this risk.^{48, 49}

Orders

See Diabetes.

What to Tell the Family

The best way to prevent diabetes complications is through aggressive control of blood glucose and cardiovascular risk factors. Diet plays an important role, along with exercise and appropriate medications. Encouraging the entire family to adopt a healthy diet is important, not only to support dietary adherence by the patient, but also to reduce the family's risk of disease.

All diabetes patients should be screened yearly for retinopathy by an ophthalmologist and have lab work done to monitor for nephropathy. Neuropathy is most likely to be discovered by the patient, but the family can help monitor for blisters or calluses. Special shoes may be needed to prevent infections.

It is important for the family and patient to understand that because diabetes complications can greatly reduce quality of life, aggressive prevention and/or treatment is imperative.