Another indication of immaturity resulting from maternal diabetes

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Maternal diabetes results in increased exposure of the fetus to high glucose levels that cause release of fetal insulin. Insulin promotes growth and delays differentiation in the fetus. The well-known clinical correlates are an increased risk of lung immaturity resulting in respiratory distress syndrome and decreased bilirubin conjugation associated with increased hyperbilirubinia. In this issue of The Journal, Bromiker et al demonstrate that infants born to insulin-dependent mothers have less well-developed sucking patterns, which suggests neurologic immaturity. This physiologic demonstration of poor feeding behavior is consistent with the general teaching that infants of mothers with diabetes often do not feed well over the first days of life.