How Long Will They Stay In The Nicu
All preterm babies must meet certain milestones before they can be safely discharged from the NICU. They must be able to eat, breathe, and stay warm on their own. Moderately preterm babies take several weeks to meet these milestones and are usually discharged at approximately 36 weeks gestational age.ï»¿ï»¿
Management: Healthy Behaviour Interventions
Weight gain. The 2009 IOM guidelines for weight gain during pregnancy were developed for a healthy population and little is known regarding optimal weight gain in women with GDM. Retrospective cohort studies of GDM pregnancies show that only 31.7% to 42% had GWG within IOM guidelines. Those gaining more than the IOM recommendations had an increased risk of preeclampsia , caesarean deliveries , macrosomia , LGA and GDM requiring pharmacological agents . Modification of IOM criteria, including more restrictive targets of weight gain, did not improve perinatal outcomes of interest . A large population-based study including women with GDM, concluded that while pre-pregnancy BMI, GDM and excessive GWG are all associated with LGA, preventing excessive GWG has the greatest potential of reducing LGA risk . These researchers suggest that, in contrast to obesity and GDM prevention, preventing excessive GWG may be a more viable option as women are closely followed in pregnancy.
Further studies are needed to develop weight gain guidelines for GDM patients and to determine whether weight gain less than the IOM guidelines or weight loss in pregnancy is safe. Until this data are available, women with GDM should be encouraged to gain weight as per the IOM guidelines for the BMI category to reduce adverse maternal and neonatal outcomes and postpartum weight retention.
Problems Relating To Early Delivery In Gestational Diabetes
There are various risks associated with the premature delivery of a child especially due to gestational diabetes.
Underweight- There is a maximum possibility of delivering an underweight child. the entire body of the premature baby is underdeveloped. It makes the baby weak. Respiratory problems- due to underdevelopment of the body, sometimes lungs also do not develop completely. This might cause respiratory problems and the child can face issues related to breathing. To cure it more oxygen is given to the newborn. Heart problem premature delivery might cause heart-related problems also. In severe cases, heart failure might also occur. It happens because the heart fails to get the blood that has oxygen. Jaundice- It is the most common health issue which most premature babies have to face. It can be treated easily by keeping the newborn under observation and doctors make use of light therapy to reduce the levels of bilirubin. Brain hemorrhage- In serious cases, the possibility of brain damage is also there. Such a problem might arise due to the tearing of blood vessels in the brain. Large baby- if diabetes is not under control at the time of delivery. Then it might result in extra growth of the baby.
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Will I Need To Be Induced
Induction of labour is the process of starting labour artificially. Induction of labour may be advised if your medical professionals feel it is necessary for the baby to be delivered earlier for medical reasons.
A diagnosis of gestational diabetes no longer = definite early induction of labour
Previous NICE guidelines recommended that all women with gestational diabetes should be offered induction of labour at 38 weeks. This meant the majority of women diagnosed with gestational diabetes were induced or had planned cesarean sections at around 38 weeks.
In Feb 2015, the NICE guidelines were updated, recommending that women with gestational diabetes should be advised to give birth no later than 40+6 weeks, but to consider elective birth before 40+6 weeks for women with gestational diabetes if there are maternal or fetal complications.
It should be noted that hospitals take time to roll out new procedures and so although NICE guidelines changed in 2015, some hospitals have taken some time to update their policies. It should also be noted that whilst there are recommended guidelines, hospitals do not have to follow them and may have their own protocols and policies which they follow instead.
Since the update in the NICE guidelines in 2015, we are seeing a decline in the amount of women being advised to have earlier inductions within our support group compared to earlier years, with an ever increasing amount of spontaneous births.
Tips For Women With Gestational Diabetes
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Labor Induction And Gestational Diabetes
It is common practice to induce labor prior to 40 weeks for women with gestational diabetes as a strategy to reduce complications, especially those related to macrosomia. Labor induction is often planned at 38 ½ to 39 weeks gestation and can occur when the babys lungs are mature, antepartum tests are normal, diabetes is under control, and the mother doesnt have vascular disease .
ACOG recommends consideration of C-section delivery in diabetic women when estimated fetal weight exceeds 4500 grams. Some researchers recommend considering C-section delivery when the estimated weight is between 4000 and 4500 grams, after evaluating obstetrical history and clinical measurements of the pelvis. Physicians should be alerted to the possibility of cephalopelvic disproportion if dilation or descent stops during labor, and the babys estimated weight exceeds 4000 grams. These researchers also suggest consideration of C-section delivery in diabetic women who demonstrate significant protracted labor and failure of descent .
Physicians have to consider a number of factors when caring for a woman with gestational diabetes and her baby. Due to the variety and complexity of these issues, it is essential that medical professionals monitor and treat the mother and baby very closely throughout the pregnancy, labor, and delivery.
Are Babies Born Earlier If The Mother Has Gestational Diabetes
Field: Typically, thats not the case. There are not standard recommendations when people with gestational diabetes should be delivered. If the patient is well-controlled, she doesnt have other complications and the baby isnt too big, my goal is to have her go into labor on her own and hopefully have a vaginal delivery. The data doesnt really support inducing labor early. I have criteria for who Im worried enough about that I might consider an early delivery.
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Treatment And Management For Gestational Diabetes
Once a patient is diagnosed with gestational diabetes, the physician will have her monitor her diabetes by testing her glucose level at home. The most common way involves obtaining a drop of blood from a finger and putting it on a device that will give a glucose reading. The goals of treatment are to keep blood glucose levels within normal limits during the pregnancy and to make sure the growing baby is healthy.
With gestational diabetes, frequent check-ups by the physician are essential, especially during the last three months of pregnancy. The physician will carefully monitor the patients blood glucose levels.
The medical team will also perform other teststo monitor the babys health. Tests used to monitor and protect the baby include:
In addition to close monitoring, it is recommended that mothers with gestational diabetes be treated with dietary counseling, oral hypoglycemic medications, or insulin .
What Is An Infant Of A Mother With Diabetes
An infant of a mother with diabetes is a baby who is born to a mother with diabetes. Because the mother has diabetes, the baby is at risk for problems.
People with diabetes have high levels of sugar in their blood . Over time, this can lead to serious health problems. Keeping your blood sugar under control lowers your risk for complications. You can manage diabetes by eating a nutritious diet, getting regular exercise, and taking medicine.
Two types of diabetes can happen in pregnancy. These are:
Gestational diabetes. In this condition, you dont have diabetes before pregnancy. You develop it during pregnancy. This type of diabetes goes away after your baby is born.
Pre-gestational diabetes. In this condition, you have diabetes before getting pregnant. You may have type 1 or type 2 diabetes.
People with type 1 diabetes dont make insulin. Your body needs insulin to use blood sugar. Youll need to take insulin shots.
People with type 2 diabetes cant use the insulin they make. Or their bodies dont make enough insulin. Youll need blood sugar-lowering medicine and possibly insulin.
Its important to manage your blood sugar during pregnancy. This can lower your babys risk for problems.
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Is Gestational Diabetes Considered A High Risk Pregnancy
Gestational diabetes may also increase your risk of: High blood pressure and preeclampsia. Gestational diabetes raises your risk of high blood pressure, as well as preeclampsia a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby.
Similarly, you may ask, what is considered a high risk pregnancy?
A “high–risk” pregnancy means a woman has one or more things that raise her or her baby’s chances for health problems or preterm delivery. A woman’s pregnancy might be considered high risk if she: is age 17 or younger. has high blood pressure, diabetes, depression, or another health problem.
Additionally, what increases the risk of gestational diabetes? Numerous factors raise a pregnant woman’s risk of developing gestational diabetes, including: Prediabetes High blood pressure. Being overweight, or gaining too much weight during pregnancy.
Also, how likely is it to have a stillbirth from gestational diabetes?
Diabetes affects 1-2% of pregnancies and is a major risk factor for many pregnancy complications. Women with diabetes are around five times more likely to have stillbirths, and three times more likely to have babies that don’t survive beyond their first few months.
How early do you deliver with gestational diabetes?
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What Causes Gestational Diabetes
Gestational diabetes occurs when your body cant make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.
During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your bodys cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your bodys need for insulin.
All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.
About 50% of women with gestational diabetes go on to develop type 2 diabetes, but there are steps you can take to prevent it. Talk to your doctor about how to lower your risk and how often to have your blood sugar checked to make sure youre on track.
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Are Bananas Good For Gestational Diabetes
Takeaway. Bananas are a safe and nutritious fruit for people with diabetes to eat in moderation as part of a balanced, individualized diet plan. A person with diabetes should include fresh, plant food options in the diet, such as fruits and vegetables. Bananas provide plenty of nutrition without adding many calories.
What Birth Defects Are Caused By Gestational Diabetes
Babies of diabetic mothers may have major birth defects in the heart and blood vessels, brain and spine, urinary system and kidneys, and digestive system. Macrosomia. This is the term for a baby that is much larger than normal. All of the nutrients the baby gets come directly from the mother’s blood.
Evidence On: Induction For Gestational Diabetes
Gestational diabetes mellitus is defined as high blood glucose that develops during pregnancy . We cover the evidence on diagnosing GDM in a separate Evidence Based Birth® article here. Two of the main questions that come up in caring for pregnant people with GDM are the following: Should labor be induced? And, if induction for gestational diabetes is chosen, when should it occur?
The main alternative to labor induction for gestational diabetes is expectant management. Choosing expectant management means you decline elective induction for gestational diabetes now, and instead plan to wait for labor to start on its own. With expectant management, you could also be induced later if complications develop, or you could be induced electively further along in the pregnancy.
What is gestational diabetes?
We encourage you to read the beginning of the Evidence Based Birth® Signature Article on Diagnosing GDM. There, we define several important terms and explain whats going on in the body when someone has GDM.
How Is Gestational Diabetes Diagnosed
Screening tests for gestational diabetes include:
Glucose ChallengeTest This test involves drinking a syrupy glucose solution, and then undergoing blood test to measure your blood sugar level one hour later. Generally, a blood sugar level is considered normal if it is below 140 milligrams per deciliter or 7.8 millimoles per liter , according to the Mayo Clinic. A blood sugar level of 190 mg/dL or 10.6 mg/dL indicates gestational diabetes.
Follow-Up Glucose Testing If your blood sugar level was higher than normal during the initial glucose challenge test, youll need to complete another one to determine if you have gestational diabetes. This test will be similar to the first screening except the glucose solution will be sweeter and your blood will be checked hourly for three hours. If two of these blood tests come back high, you will receive a gestational diabetes diagnosis.
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Use Your Brain To Make Informed Decisions Around Gestational Diabetes Birth
To help make informed decisions over your gestational diabetes birth, use your B R A I N
Remember it is your body, your baby and your birth. It is up to YOU to make the decisions, phrases such as you are not allowed should not be used and are not helpful.
Medical professionals will advise what they feel is best, but ultimately it is your CHOICE and you decide what is allowed.
The Nursing and Midwifery Council state that a midwife must support the birthing persons choices even if the midwife doesnt agree with them
Is There Anything I Should Be Afraid Of
If gestational diabetes is diagnosed and treated effectively, there is little risk of complications. In such cases, women with gestational diabetes can have healthy babies, and diabetes should disappear after delivery.
However, if it is not treated, effects on the mother and baby can include:
- Large birth weight -those who weigh 9 pounds or more are more likely to become wedged in the birth canal, have birth injuries or need a cesarean delivery.
- Premature delivery an early delivery may be recommended because the baby is large.
- Respiratory distress syndrome babies born early to mothers with gestational diabetes may experience Serious breathing difficulties.
- Low blood sugar sometimes babies of mothers with gestational diabetes have low blood sugar shortly after birth. Severe episodes of hypoglycemia may cause seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the babys blood sugar level to normal.
- Obesity and type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
- Stillbirth. Untreated gestational diabetes can result in a babys death either before or shortly after birth.
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Can Women Pass Gestational Diabetes On To Their Baby
Field: No, expecting mothers dont pass it on to their children. However, there is a higher risk if the mother has a family history of diabetes and develops gestational diabetes that she could pass it on to her baby. In addition, women who develop gestation diabetes in a pregnancy have a 20 to 60 percent risk of developing Type 2 diabetes themselves later on in life.
Diagnosing Gestational Diabetes Through Blood Tests
The American Congress of Obstetrics and Gynecologists recommends that all pregnant women receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for gestational diabetes. Women who have risk factors for it may have this test earlier in the pregnancy, typically around the 18th week of pregnancy .
Usually, to test for gestational diabetes the pregnant woman will drink a syrupy solution, and her blood will be tested to check glucose level an hour later. A follow-up test is then given, whereby the patient fasts overnight and then has her blood sugar tested the next morning. After the test, she will drink a solution that has an even higher level of glucose than the syrupy solution given during the initial test. The patients blood glucose level will then be checked every hour for a period of three hours. If at least two of the blood glucose readings are higher than normal, the patient will be diagnosed with gestational diabetes .
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