How Diabetes May Affect Your Baby
Babies born to women with diabetes are often much bigger, a condition called “macrosomia.”
Because their mothers have high blood sugar levels, they get too much sugar through the placenta. The baby’s pancreas senses it and makes more insulin to use it up. That extra sugar gets converted to fat, making a large baby.
Many hospitals keep an eye on babies of mothers with diabetes for several hours after birth. If you regularly have high blood sugar levels while you’re pregnant , your baby may get dangerously low blood sugar right after they’re born. Their insulin is based on your high sugar, and when it’s suddenly taken away, their blood sugar level drops quickly and they’ll need glucose to balance it out.
Their calcium and magnesium levels may be off, too. Those can be fixed with medication.
Some babies are too big to be delivered vaginally, and you’ll need a cesarean delivery or c-section. Your doctor will keep an eye on your baby’s size so you can plan for the safest way to give birth.
Who Is Most At Risk For Gestational Diabetes
While researchers aren’t certain why some women get gestational diabetes while others dont, they do know that you may be at an increased risk if:
In the U.S., about 90 percent of pregnant women have at least one risk factor for gestational diabetes, which is why universal screening is thought to be the most practical approach.
What Is Gestational Diabetes Mellitus
Gestational diabetes mellitus is a type of diabetes that occurs during pregnancy and usually goes away after the baby is born. About 12-14% of pregnant women will develop gestational diabetes mellitus.
During pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also block the action of the womans insulin. This is called insulin resistance. When the body cannot cope with the extra demand for insulin production it results in high blood glucose levels and gestational diabetes.
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What Happens Once Youre Diagnosed With Gestational Diabetes
Its important that blood glucose levels are controlled during pregnancy to reduce long-term effects for mother and baby.
A monitor is used to check glucose levels, usually each morning and 1-2 hours after each main meal. Stephs GP taught her how to monitor her blood glucose levels using a finger prick test. I tested first thing every morning and then an hour after each main meal, says Steph. At first, I was told just to record what I ate and what my blood glucose levels were, and not worry too much about the numbers.
A team of health care providers will help manage GDM and an Accredited Practicing Dietitian will be able to provide information on what to eat and physical activity that will help keep blood glucose levels in the target range.
Steph had a group appointment at the hospital with a Diabetes Educator and a Dietitian where they talked a small group of expecting mums through more detailed recommendations. They talked in more detail about exactly what types of foods we should eat and when, and what should be avoided, says Steph.
A diabetes management plan is personalised for each pregnancy. Steph monitored and recorded her blood glucose levels and food intake for a week before meeting with a specialist who looked at the data and gave her personalised advice on what worked for her body.
What If I Need To Be Induced
Despite your best attempts to avoid it, induction might become medically necessary if you have gestational diabetes. This can challenge your attempts to have a natural birth, but you might avoid further interventions and a c-section. Theres a number of ways labour can be induced and, depending on the urgency of your situation, you might be able to negotiate as little intervention as possible.
During labour, your blood glucose will be monitored every hour to ensure it stays within safe levels. If your gestational diabetes has remained under control during pregnancy, through diet and exercise, its unlikely your blood glucose levels will rise. If you have been treated with insulin its more likely your blood glucose will increase during labour and, if that happens, you might need to have insulin and glucose administered through a drip.
Your baby will need continuous monitoring if medical forms of induction such as Pitocin or Syntocinon are used. This is because artificial oxytocin can cause your uterus to contract strongly and cause your baby to become distressed. Continuous monitoring will limit your ability to move, and might make it harder for you to cope with contractions. You can request an epidural, which might lead to further interventions and c-section.
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Hormonal And Inflammatory Markers
In the present study, we found that leptin levels decreased shortly after delivery but increased again 6 months post partum. Highman et al evaluated the longitudinal changes in maternal serum leptin concentrations before pregnancy, in early pregnancy and in late pregnancy in 10 women and reported that leptin levels increased with 66% from prepregnancy to late pregnancy and found a positive correlation between leptin and body fat. In our study, we found leptin levels late in pregnancy comparable to those in the study by Highman et al and that leptin levels almost halved post partum and were significantly negatively correlated with insulin sensitivity, supporting that leptin play a role in insulin resistance in pregnancy. It is well known that leptin is produced by adipocytes why the correlation between fat mass and leptin is strongly positive. Unfortunately, we were not able to obtain fat mass estimates from the participants and therefore this association remains unexplored in our study.
Our finding that leptin is negatively correlated with insulin sensitivity is in line with the findings of Kirwan et al, who performed a study including 5 women with GDM and 10 women with NGT where HEC was carried out before pregnancy, early in pregnancy and in late pregnancy . Insulin sensitivity was here strongly negatively associated with leptin levels late in pregnancy.
What Is Preterm Labor
Preterm labor occurs when you start having contractions that cause cervical changes before youre 37 weeks pregnant.
Some women are at greater risk for preterm labor, including those who:
- are pregnant with multiples
- have an infection of the amniotic sac
- have excess amniotic fluid
- have had a previous preterm birth
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How Are Pregnant Women With Diabetes And Their Infants Treated
During pregnancy, your healthcare provider will watch you and your baby closely. You may be treated by a specialist who cares for pregnant women with diabetes.
Controlling your blood sugar levels is a must. This is the best way to reduce your babys risks. Youll likely need to do the following to care for your diabetes:
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Watch your blood sugar levels closely. Your healthcare provider may ask you to test your blood sugar at home.
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Take insulin as prescribed. Your dose of insulin may change throughout pregnancy.
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Watch your weight. Your doctor may tell you to gain less weight if youre overweight or obese.
Your babys treatment depends on how well you controlled your blood sugar in the last part of pregnancy and during labor and delivery. Treatment will also depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
Risk Of Preterm Labor
The complications caused by elevated blood sugar levels can increase the risk of premature birth. Studies show that the risk of premature delivery due to gestational diabetes is greater if a mother develops diabetes before the 24th week of pregnancy. After the 24th week, the chances of preterm birth go down.
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What Happens If Placenta Deterioration Is Suspected
If you suspect placenta deterioration then you should contact a medical professional immediately. Most women will be asked to go to hospital for assessment and depending on the gestation, if following monitoring, dopplers or scans there is any cause of concern you may be admitted for care or assessed daily. A plan of care will be discussed which may involve you having steroid injections to help mature your babys lungs and you may be advised to have an induction or earlier than planned caesarean section.
It can be an extremely scary time, but your health care professionals should answer any questions you have and will help you work on the best plan of action for your baby and you.
How Does Gd Affect Your Baby After Birth
Babies who are born to mothers with gestational diabetes should be tested for low blood sugar , even if they have no symptoms, with a simple blood test after birth. This happens immediately after delivery, while you and baby are still in the hospital.
After birth, its essential to keep the focus you had during pregnancy on a healthy lifestyle for your whole family you may find that it helps you stick to your resolutions as well.
Teach your child good eating and exercise habits early on: If you had gestational diabetes, your baby could be at a higher risk for health problems, including obesity as a child or teen and an increased risk for type 2 diabetes later in life, according to the CDC.
To help avoid a type 2 diabetes diagnosis for your child, aim to ensure that he or she:
- Eats nutritious meals. The same diet you follow during pregnancy and beyond is good for your child, too. When he gets old enough, have him help you in the kitchen children who help prepare dishes are more likely to eat them.
- Gets plenty of exercise as he grows. Start by taking walks. As he gets older, toddler soccer and other activities are a great way to get him interested in healthy movement.
- Maintains a healthy weight. Talk to his pediatrician to make sure his BMI is on target, and talk openly to him about healthy weight and the increase in obesity he might notice in school.
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How Long Will Blood Glucose Checks Or Additional Treatments Be Needed
Blood glucose levels usually get back to normal within 12 hours to 72 hours of birth, especially once your baby is feeding regularly.
Its rare for full-term babies to continue having trouble with their blood glucose levels. If this happens beyond 24 hours, your babys doctor may want to do more tests.
Gestational Diabetes Is A Progressive Condition
Gestational diabetes typically presents itself between 24 28 weeks. It is for this reason that it is around this time where screening for gestational diabetes typically takes place. It should be noted that insulin resistance can be detected much earlier than this time also, especially in subsequent pregnancies where the mother previously had gestational diabetes. Many ladies are told that earlier diagnosis means that they may have undiagnosed Type 1 or Type 2 diabetes. We have found that this is not the case when ladies are tested following the birth of their baby and so we advise not panicking and waiting until you have your post birth diabetes testing before causing yourself too much distress. Further information on post birth diabetes testing can be found here.
Gestational diabetes is caused by increased hormones levels from the placenta that cause insulin resistance. Those diagnosed with gestational diabetes are not able to increase insulin production to meet the additional requirement, or they cannot use the insulin which has been made effectively and so blood sugar levels remain too high. For further information on diagnosis, see this page.
At around 26 weeks large amounts of cortisol are released and cortisol is a hormone which causes high insulin resistance, meaning there is a raise in blood glucose levels and is where most will be diagnosed. If you were diagnosed earlier than 26 weeks, then you may see a big raise in insulin resistance at around this time.
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What If I Have Gestational Diabetes
GD is increasingly common, with about 7% of women having the condition. If you are found to have GD, you will work closely with your health care provider to keep your blood glucose levels in a healthy range. This involves choosing a healthy diet, gaining the recommended weight during your pregnancy, getting exercise, and if needed, taking insulin or pills to lower your blood sugar. Your babys wellbeing will be carefully monitored by regular measurements of growth and amniotic fluid volume. If you have GD you will be offered a repeat glucose tolerance test between 6 weeks and 6 months postpartum to detect prediabetes and diabetes. You may also be offered induction between 38-40 weeks of pregnancy. Finally, it is strongly recommended that women with GD breastfeed their infants.
Being Tested For Diabetes Following Birth
After giving birth, in the majority of cases, blood sugar levels will return to normal . If levels do not return to normal it can indicate that the mother has Type 1 or Type 2 diabetes.
At 6 weeks post-partum the mother should be tested for diabetes by having a fasting blood test, or a HbA1c blood test at 13 weeks. A HbA1c blood test requires no fasting and is one simple blood test that can be taken at any time of day. It shows an average of blood glucose levels over a 3-month period.
The HbA1c may be more beneficial to new mothers, especially if breastfeeding as there is no need to fast for this test.
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How Can I Control Gestational Diabetes In My Third Trimester
Gestational diabetes can be treated with diet, lifestyle changes, and medicines, in some instances. Your doctor will recommend dietary changes, such as decreasing your carbohydrate intake and increasing fruits and veggies. Adding low-impact exercise can also help. In some instances, your doctor may prescribe insulin.
Planning For Labour And Delivery
Your diabetes in pregnancy team will work with you towards the ultimate goal of having a healthy baby. They will discuss what to expect during labour and birth, including a plan for managing blood glucose levels, insulin adjustment and who to contact if you go into labour earlier than expected.
Your diabetes in pregnancy team will work with you to aim for a natural birth close to your due date. It is usually recommended, that a woman with diabetes has her baby at around 3738 weeks gestation . If you do not come into spontaneous labour by then, your labour will be induced, or possibly an elective caesarean section will be suggested. The obstetrician in your diabetes in pregnancy team will discuss delivery options with you, with the goal usually being a vaginal birth. It is important that you feel comfortable discussing these birthing options with your team of health professionals.
If you go into labour spontaneously, it is best to go to hospital early for close monitoring of your diabetes and the babys well-being.
Sometimes, an earlier birth may be recommended if there are concerns during your pregnancy, such as:
- high blood pressure
- your baby becoming too big or not growing enough
- a substantial fall in your insulin requirements
- change in your babys patterns of movement.
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How Can I Prevent Low Blood Glucose In My Baby
The most natural way to feed your baby and to keep a normal blood glucose level is early and frequent breastfeeding. Talk to your health care provider before you start using breast milk substitutes .
Its also important to know if your baby is at risk for low blood glucose .
Do not smoke during pregnancy. Babies who are exposed to tobacco dont grow well.
What Is Blood Glucose
Blood glucose is a sugar that moves through the bloodstream and provides energy to all the cells in the body. It is one of your babys most important sources of energy.
Babies with normal blood glucose levels have all the energy they need for healthy growth and development. However, in rare cases, blood glucose levels can fall too low and cause a baby to become sick.
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Will Gdm Harm Me And My Baby
Gestational diabetes does pose some risks for the mother and her baby if it is not well managed. For instance, a mother with GDM is at a higher risk of preeclampsia and her baby might get too big making delivery difficult or earlier than expected. But if the advice of the doctor and the health team is followed, this would help reduce the risk of complications and increase the likelihood of a straightforward pregnancy and birth.
Tips For Women With Gestational Diabetes
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