Diabetes in Pregnancy

Elevated maternal blood glucose concentrations during pregnancy are a risk factor for a variety of maternal and child complications. From an orthopedic perspective, the most common complication seen in infants of diabetic mothers (IDMs) is macrosomia, which increases the child’s risk for shoulder dystocia, clavicular fracture, and brachial plexus injury at the time of birth. Fetal hyperglycemia and hyperinsulinemia also put the fetus at risk of developing a range of congenital abnormalities. The infant complication most classically associated with maternal diabetes is caudal regression syndrome (CRS). CRS is a spectrum of lumbar and sacral agenesis that may be accompanied by kyphosis, scoliosis, hip and knee dislocations, flexion contractures, femoral hypoplasia, and foot anomalies. Depending on the degree of functionality, management of CRS ranges from supportive care and muscle strengthening exercises with physical therapy to surgical hip stabilization, limb amputation, and the correction of severe scoliosis. With rising rates of diabetes worldwide, education surrounding the complications associated with this diagnosis is needed, with emphasis placed on primary prevention through the tight control of maternal blood glucose concentrations during pregnancy.