Which of the following is NOT a common problem of infants born to diabetic mothers?

AIIMS BBSR SNO - 2019

Child Health Nursing (Pediatrics)

Medium

Appeared in: AIIMS BBSR SNO - 2019

Explanation

Hyperglycemia (high blood sugar) is not a common problem in infants of diabetic mothers (IDMs).
The core issue is fetal hyperinsulinism, where the fetus produces excess insulin in response to high maternal glucose levels.
After birth, the maternal glucose supply is cut off, but the infant's high insulin levels persist, leading to rapid glucose uptake from the blood and causing neonatal hypoglycemia (low blood sugar).
Hypoglycemia typically develops within the first 1 to 3 hours of life and is a hallmark complication for IDMs.

Option B: Hypocalcemia (low serum calcium) is a known metabolic complication in infants of diabetic mothers, often appearing within 24-72 hours after birth.
Option C: Polycythemia (an abnormally high concentration of red blood cells) is a common hematologic problem in IDMs. It is thought to result from chronic fetal hypoxia, which stimulates erythropoietin production.
Option D: Macrosomia (large body size, birth weight greater than 4000g) is a classic and very common finding in IDMs. The excess insulin in the fetus acts as a growth hormone, leading to increased body fat and organ size.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Neonatal complications of maternal diabetes as background academic context rather than a clinical decision trigger.
The primary nursing responsibility for an infant of a diabetic mother is to monitor for and prevent hypoglycemia. This involves performing a heel-stick blood glucose test within the first hour of life and before feedings.
Early and frequent feedings (breast milk or formula) are crucial to provide a glucose source and prevent blood sugar from dropping to dangerous levels.
Nurses must also assess for other complications like respiratory distress, jitteriness (which can be a sign of hypoglycemia or hypocalcemia), and signs of birth trauma due to macrosomia.

How to Approach the Question

First, identify the negative keyword 'NOT' in the question stem. This means you are looking for the option that is the exception or is incorrect.
Recall the core pathophysiology for an infant of a diabetic mother: maternal hyperglycemia leads to fetal hyperinsulinism.
Think through the consequences of fetal hyperinsulinism after birth. The key event is the removal of the maternal glucose source while high insulin levels persist.
Evaluate each option: Does it logically follow from the pathophysiology of hyperinsulinism?
Hyperglycemia is the opposite of what would be expected from high insulin levels. Insulin lowers blood sugar.
Hypocalcemia, Polycythemia, and Macrosomia are all well-documented consequences of the intrauterine environment in maternal diabetes. Therefore, Hyperglycemia is the correct answer as it is NOT a common problem.

Concept Tested & Keywords

Concept Tested: Neonatal complications of maternal diabetes
Stem keywords: infants, diabetic mothers, common problem
Lead-in keywords: NOT
Negative lead-in flag: Question asks for the exception or the condition that is NOT a common problem.

QvyER1w0RN7tvYEpUovj1_

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1151-1153

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 6-8