Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%.
We don’t know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother’s body to use insulin. She may need up to three times as much insulin.
2. What is Gestational Diabetes?
Pregnant women who
have never had
diabetes before but
who have high blood
glucose (sugar) levels
during pregnancy are
said to have
gestational diabetes.
According to a 2014
analysis by the Centers
for Disease Control
and Prevention, the
prevalence of
gestational diabetes is
as high as 9.2%.
We don’t know what
causes gestational
diabetes, but we have
some clues. The placenta
supports the baby as it
grows. Hormones from
the placenta help the
baby develop. But these
hormones also block the
action of the mother’s
insulin in her body. This
problem is called insulin
resistance. Insulin
resistance makes it hard
for the mother’s body to
use insulin. She may
need up to three times as
much insulin.
Gestational diabetes
starts when your body
is not able to make and
use all the insulin it
needs for pregnancy.
Without enough insulin,
glucose cannot leave
the blood and be
changed to energy.
Glucose builds up in
the blood to high
levels. This is called
hyperglycemia.
4. Risk factors for Gestational Diabetes
Age greater than 25.
Women older than age 25 are
more likely to develop
gestational diabetes.
Family or personal health
history.
Your risk of developing
gestational diabetes increases
if you have prediabetes —
slightly elevated blood sugar
that may be a precursor to
type 2 diabetes — or if a close
family member, such as a
parent or sibling, has type 2
diabetes. You’re also more
likely to develop gestational
diabetes if you had it during a
previous pregnancy, if you
delivered a baby who weighed
more than 9 pounds (4.1
kilograms), or if you had an
unexplained stillbirth.
Excess weight.
You’re more likely to
develop gestational
diabetes if you’re
significantly overweight
with a body mass index
(BMI) of 30 or higher.
Nonwhite race.
For reasons that aren’t
clear, women who are
black, Hispanic,
American Indian or
Asian are more likely to
develop gestational
diabetes.
5. How Will Gestational Diabetes Affect My Baby?
Because your baby may
be larger than normal, he
or she is at higher risk for
some complications.
Remember, these are just
possible complications.
Your baby might have
none of them. They
include:
Injuries during delivery
because of the baby’s
size
The greatest impact of
gestational diabetes on
delivery is related to fetal
size. When gestational
diabetes is undiagnosed
or poorly managed during
pregnancy the fetus
responds to the high
maternal glucose levels
by secreting insulin.
These high levels of
fetal insulin result in
excessive fetal growth.
At term these infant
may weigh in the range
of 9 to 12 pounds.
These macrosomic
infants are more likely
to become wedged in
the birth canal, to
cause laterations of the
maternal perineal
tissue, to sustain birth
injuries and to
necessitate a
cesaream delivery.
Low blood sugar and mineral
levels at birth
Low blood glucose
(hypoglycemia): Right after
the baby is born, the blood
glucose level may drop very
low (hypoglycemia) because
they have so much insulin in
their bodies.
The extra glucose in your
body actually stimulates the
baby’s body to make more
insulin, so when the baby is
out the womb, the extra
insulin can cause problems.
Hypoglycemia in babies is
easily treated by giving the
baby a glucose solution to
quickly raise the blood
glucose level.
Feeding the baby should also
raise the blood glucose level.
6. Jaundice, a treatable condition that makes the skin yellowish
Most parents panic when they
hear their baby has jaundice
as they think it’s the same
ailment which affects adults.
Jaundice in healthy infants,
unlike in adults, is not due to
problems in the liver.
Jaundice develops in a
healthy baby when her blood
contains an excess of bilirubin
– a chemical produced during
the normal breakdown of old
red blood cells.
Newborns tend to have higher
levels because they have
extra oxygencarrying red
blood cells and their young
livers can’t metabolise the
excess bilirubin.
As the baby’s bilirubin
level rises above normal,
the yellowness spreads
downwards from the head
to the neck, to the chest,
and in severe cases, to
the toes. Unless it’s a
serious case, your baby’s
jaundice will usually not
cause any damage.
In severe but rare cases
of jaundice caused by
liver disease or maternal
blood incompatibility,
newborns may suffer
damage to the nervous
system.
How common is jaundice in
newborns?
60 per cent of fullterm infants
develop jaundice on the second or
third day after birth. It usually
peaks by around the fifth or sixth
day and then starts to decrease. In
most babies it disappears after one
week, though some babies may
take about a fortnight to recover
completely.
80 per cent of premature babies
develop it between the fifth and
seventh days after delivery. It
usually disappears within a month
of birth.
Some studies suggest that
mothers with gestational diabetes
may have a higher risk of giving
birth to babies with jaundice.
Some studies also suggest that the
male child is more likely to have
jaundice than a female.
Babies of mothers with blood
group O have a higher chance of
developing jaundice
7. How can Jaundice in my baby be treated?
If your baby looks jaundiced,
your doctor may suggest tests
to measure the bilirubin level in
her blood. If your baby was
born at term and is otherwise
healthy, most doctors will not
begin treatment, unless the
bilirubin level is over 16
milligrams per decilitre of blood
but it also depends on the age
of the baby.
Since the early 1970s, jaundice
has been treated with
phototherapy, a process in
which infants are exposed to
fluorescenttype lights which
break down excess bilirubin.
The baby usually lies naked
under the lights for a day or
two, with his/ her eyes covered
by a protective mask.
If the level of bilirubin doesn’t
require phototherapy, you can
still help your baby by taking
her out into the sunlight in the
early morning or late
afternoon. Take care not to
expose your baby for too long
since her delicate skin is
prone to sunburns.
In the rare case of bloodtype
incompatibility where the
bilirubin level can rise to
dangerously high levels, your
baby may need a blood
transfusion. The Rh blood test
you have when you are
pregnant should alert you in
advance about any
incompatibility with your baby,
and you will be given antiD
injections to avoid this
problem.
10. How Will Gestational Diabetes Affect Me?
Gestational diabetes increases the
chances of certain pregnancy
complications. Your doctor or
midwife will want to watch your
health and your baby’s health
closely for the rest of your
pregnancy.
Possible risks include:
Higher chance of needing a C
section
Gestational diabetes can
sometimes affect whether you are
able to deliver your baby vaginally
or by cesearean delivery.
Your healthcare provider, once you
have been diagnosed with
gestational diabetes, will follow you
closely, and monitor your baby. In
monitoring you and your baby
closely, your healthcare provider will
monitor the baby’s growth.
Babies born to mothers with
gestational diabetes are often
large for their gestational age —
meaning that they are bigger than
most babies at the same time in
their mother’s pregnancy. Large
babies, sometimes referred to as
macrosomic infants, are at risk for
not fitting through the mother’s
boney pelvis.
This may lead to a failure to dilate
in labor, or an ability to dilate in
labor to 10 centimeters, but an
innability to push the baby out
safely.
As your healthcare provider
measures your baby’s growth in
the last weeks of your pregnancy,
he/she will be able to determine
the safest route of delivery for you
and your baby.
11. Miscarriage
Women with pre-existing
diabetes have a higher risk
of miscarrying. Those with
type 2 often need to adjust
their medication early in
pregnancy; many switch
from tablets to insulin
injections.
Women with type 1 diabetes
are risk having severe
‘hypos’ (episodes of low
blood glucose). Often, the
usual warning signs, such
as feeling sweaty or
shaking, change or
disappear during
pregnancy.
To avoid unexpected hypos,
you should be careful not to
skip meals. You should also
always carry foods to
quickly treat hypos, such as
jelly beans, carbohydrate
snacks and glucose tablets.
12. High blood pressure or Preeclampsia
Like gestational diabetes,
preeclampsia is a condition
that only appears during
pregnancy. Gestational
diabetes causes elevated
blood sugar levels and can
result in preeclampsia which
involves type of high blood
pressure.
Sometimes pregnancy
hormones can disrupt your
body’s ability to use insulin.
Insulin is the hormone that
converts blood sugar into
usable energy. When it can’t
perform effectively, blood
glucose (sugar) levels rise.
Insulin resistance can cause
high blood glucose levels and
can eventually lead to
gestational diabetes.
15. How can I protect Myself and my Baby?
Women with diabetes can
have healthy pregnancies
and babies. It is important
to try to establish healthy
blood glucose levels
before pregnancy. If you
have an unplanned
pregnancy, stabilising
your blood glucose as
soon as you find out
you’re pregnant is critical
because your baby’s
major organs develop
during the first eight
weeks. Paying careful
attention to nutrition and
maintaining general
fitness can help you
control your blood glucose
levels.
Before you conceive, or as soon as
possible afterwards, your doctor
will want to test you for diabetes
related complications. You may
undergo a physical exam to check
for nerve damage; you will be
asked to provide a urine sample so
your kidney function can be
assessed and your doctor will
recommend that you visit an
ophthalmologist to have your eyes
assessed.
During pregnancy, your diabetes
medication will need to be carefully
monitored. If you have type 2
diabetes and are taking tablets
prior to pregnancy, your doctor
may advise that you convert to
insulin in order to better control
your glucose levels. During labour
and delivery, your endocrinologist
will keep an eye on your levels.
They will adjust your insulin
dosage directly after your baby is
born to safeguard you against
hypoglycaemia.
If your baby is producing high levels of
insulin during your pregnancy in response
to your high glucose levels, their blood
sugars could be low following birth.
If left untreated, this could lead to
seizures. Your baby’s blood glucose levels
will be tested (by heel prick) every four
hours for the first 24 hours of their life. If
their glucose levels are very low, they may
need to have supplementary feeds.
Insulin does not pass into your breastmilk,
so it is safe for mothers to breastfeed their
babies. Breastfeeding within 30 to 60
minutes of birth can reduce the risk of your
baby having low blood sugar. Regular
feeds (every three to four hours) can help
them to maintain blood glucose levels.
Mothers with gestational diabetes are at
risk of developing type 2 diabetes later in
life. You will typically be offered an oral
glucose tolerance test about 68 weeks
after giving birth. This test assesses
whether your blood glucose levels are
within the normal range. The test should be
repeated every three years.
16. After delivery, you
and your baby Will
need to be
monitored closely
(a)For the first few hours, your
blood sugar level may be tested
every hour. Usually blood sugar
levels quickly return to normal.
(b)Your baby’s blood sugar level
will also be watched. If your blood
sugar levels were high during
pregnancy, your baby’s body will
make extra insulin for several
hours after birth. This extra insulin
may cause your baby’s blood
sugar to drop too low
(hypoglycemia). If your baby’s
blood sugar level drops too low, he
or she may need extra sugar, such
as a sugar water drink or glucose
given intravenously.
(c)Your baby’s blood may also be
checked for low calcium, high
bilirubin, and extra red blood cells.
Most of the time, the blood sugar
levels of women who have
gestational diabetes return to
normal in a few hours or days after
delivery.
Most doctors will
recommend that you
breastfeed, if possible,
for the health benefits for
you and your baby. For
example, breastfeeding
can help keep your child
at a healthy weight, which
may reduce his or her
chances of developing
diabetes. It provides
antibodies to strengthen
your baby’s immune
system. And it lowers your
baby’s risk for many types
of infections. Also, it may
lower your chances of
developing diabetes later
in life.