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Are all infants of diabetic mothers "macrosomic"?

Case report A 44 year old man presented in July 1987 with a one year history of progressive numbness of his feet, paraesthesia of his hands, a tendency to trip, and urgency of micturition. His mother suffered from pernicious anaemia. On examination he had ataxic nystagmus on right lateral gaze and bilateral pyramidal signs in the legs, consisting of increased tone, exaggerated knee jerks, and extensor plantar responses. Ankle jerks were unobtainable, and there was mild proprioceptive loss in the toes. Recording of visual evoked responses, examination of cerebrospinal fluid (including oligoclonal bands), cervical myelography, and magnetic resonance imaging all yielded normal results. Haemoglobin concentration was 158 g/l with a mean corpuscular volume of 106 fl. A blood film showed a macrocytic, normochromic picture with hypersegmentation of neutrophils. Serum concentration of vitamin B12 was 19 ng/l (normal 170-900), and serum folate concentration was normal. Antibodies to gastric intrinsic factor were absent. Results of a Schilling test were consistent with a diagnosis of pernicious anaemia. Subacute combined degeneration of the cord was diagnosed, and the patient was treated with intramuscular hydroxocobalamin, 1 mg daily for five days and three monthly thereafter. The ataxic nystagmus had completely resolved two months after treatment started, but the myelopathy persisted with little change in its severity.