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664700 
Journal Article 
Metabolic abnormalities in infants of diabetic mothers 
Barr, SM; Hawdon, JM 
2001 
1 
Pediatric Research
ISSN: 0031-3998
EISSN: 1530-0447 
49 
4 Pt 2 Suppl 
295A 
BACKGROUND: All newborn infants must undergo metabolic adaptation after birth. However, IDMs are at high risk of failure of metabolic adaptation as they may be hyperinsulinaemic and thus are at risk of hypoglycaemia without the protective ketone body response. OBJECTIVE: To investigate metabolic adaptation in infants of diabetic mothers (IDMs). DESIGN/METHODS: Seven mothers requiring insulin therapy during pregnancy were recruited antenatally. After delivery, enteral feeds were offered early and breast feeding encouraged. Feed frequency was adjusted according to pre-feed total blood glucose. Intravenous dextrose was only given if neonates had persistently low blood glucose concentrations and were symptomatic. Pre-feed neonatal blood samples were collected and assayed for blood concentrations of glucose, and intermediary metabolites, including ketone bodies, and plasma concentrations of insulin. A feeding history was documented. RESULTS: Glycaemic control was good in 6/7 mothers. 50 blood samples were obtained. Blood glucose concentrations fell from a mean of 3.3 mmol/L (range 1.6-5.8 mmol/L) before the first feed to a nadir of 2.1 mmol/L (range 1.4-3.3 mmol/L) at 6 hours of age. By 24 hours of age, mean glucose levels had normalised to 3.2 mmol/L (range 2.0-4.2 mmol/L). Initial plasma insulin levels were elevated in all neonates, median value 269 pmol (range 83-548 pmol/L). However by 24 hours of age plasma insulin levels had fallen to normal neonatal range in 6/7 neonates (less than 60 pmol/L). In 38/50 samples ketone body levels were lower than those reported for non-IDMs of the same postnatal age. Three neonates had episodes of hypoglycaemia (blood glucose less than 2 mmol/L) with plasma insulin levels that were inappropriately elevated (median 116 pmol/L, range 80-600 pmol/L). Two of these cases failed to mount a ketone body response. The neonate with ketgenesis in response to low blood glucose level was breastfed whilst the other two were formula fed. In this small study no antenatal factor predicted postnatal insulin levels, or postnatal blood glucose or ketone body concentrations. CONCLUSIONS: IDMs have high insulin levels, impaired ketogenesis and low blood glucose levels in the early neonatal period. These abnormalities resolve within 48 hours. Early formula feeding may also impair metabolic adaptation in IDMs. These findings have implications for the feeding management of IDMs and warrant further study. 
Pregnancy; Infant; Newborn; Human; Female; Adaptation; Physiological; Pregnancy in Diabetics; Insulin ADMINISTRATION & DOSAGE; Ketone Bodies BIOSYNTHESIS; Blood Glucose ANALYSIS; 11061-68-0; No cas rn