Nursing care of the infant of a diabetic mother: an antenatal, intrapartal, and neonatal challenge.

An understanding of the metabolic alterations seen in normal and diabetic pregnancies can lead to an optimal plan of care for the diabetic patient and her infant. The problems facing the infant of a diabetic mother antenatally, intrapartally, and neonatally relate directly to the sequence of maternal hyperglycemia, fetal hyperglycemia, and subsequent fetal hyperinsulinemia. Antenatally, intervention is aimed at identifying and preventing macrosomia and sudden fetal demise. Intrapartally, screening and monitoring are used to identify cephalopelvic disproportion and shoulder dystocia to prevent birth trauma and fetal asphyxia. During the neonatal period, a thorough assessment should be made to identify respiratory distress, birth trauma, problems with metabolic transition, and congenital anomalies.