Physiological Integrity Q 32
The nurse is caring for a neonate whose mother is diabetic. The nurse will expect the neonate to be:
A. Hypoglycemic, small for gestational age
B. Hyperglycemic, large for gestational age
C. Hypoglycemic, large for gestational age
D. Hyperglycemic, small for gestational age
Correct Answer: C. Hypoglycemic, large for gestational age
The infant of a diabetic mother is usually large for gestational age. After birth, glucose levels fall rapidly due to the absence of glucose from the mother. Hypoglycemia is caused by hyperinsulinemia due to hyperplasia of fetal pancreatic beta cells consequent to maternal-fetal hyperglycemia. Because the continuous supply of glucose is stopped after birth, the neonate develops hypoglycemia because of insufficient substrate.
Option A: The infant will not be small for gestational age. Fetal macrosomia (>90th percentile for gestational age or >4000 g in the term infant) occurs in 15-45% of diabetic pregnancies. It is most commonly observed as a consequence of maternal hyperglycemia. When macrosomia is present, the infant appears puffy, fat, ruddy, and often hypotonic.
Option B: The infant will not be hyperglycemic. Stimulation of fetal insulin release by maternal hyperglycemia during labor significantly increases the risk of early hypoglycemia in these infants. Perinatal stress may have an additive effect on hypoglycemia due to catecholamine release and glycogen depletion.
Option D: The infant will be large, not small, and will be hypoglycemic, not hyperglycemic. The overall risk of hypoglycemia is anywhere from 25-40%, with LGA and preterm infants at the highest risk. Fetal growth is assessed by plotting birth weight against gestational age on standard growth curves. Infants whose weight exceeds the 90th percentile for gestational age are classified as large for gestational age (LGA).