If you are having gestational diabetes and are able to control your blood sugar levels within the normal range then you are avoiding harm to yourself and your baby and can deliver a healthy baby. It’s important to keep your blood sugar levels in check because poorly controlled GDM can cause serious short-term and long-term complications for you and your baby. Complications are particularly more in those whose blood sugar levels are not well controlled and who are obese before pregnancy.
The main problem with having too much sugar in your blood is that it crosses the placenta to your baby.
How gestational diabetes affects your baby
Untreated or uncontrolled high blood sugar levels means problems for your baby, your baby may be at increased risk of:
• Excessive birth weight, Macrosomia:
Infants born to mothers with GDM are at risk of being large for gestational age. This condition is called as macrosomia.
When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Insulin does not cross placenta although glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat, causing your baby to put on extra weight, particularly in the upper body. This can lead to macrosomia, or a “fat baby”.
A macrosomic baby may be too large to enter the birth canal. This in turn increases the risk of instrumental deliveries (e.g. forceps, ventouse and caesarean section). Or the baby’s head may enter the canal but then his shoulders may get stuck. This situation is called shoulder dystocia, and your practitioner will have to use special maneuvers to deliver your baby.
The development of macrosomia can be evaluated during pregnancy by using sonography. When you are having gestational diabetes your doctor will advice more frequent visits to the hospital to monitor you and your baby.
• Delivery-related complications due to the infant’s large size include:
Birth injury (trauma) because of the baby’s large size : It leads to an increased risk of shoulder dystocia. This is when your baby’s head has been born but one of his or her shoulders is stuck behind your pelvic bone, preventing his or her body being delivered. This in turn can damage nerves in your baby’s neck or result in a fracture of one of his or her arms or shoulders. Very rarely, it can cause brain damage if the blood supply to your baby’s brain is blocked off for too long.
Delivery by c-section: To prevent the risks involved in delivery through vagina delivery by cesarean section is recommended for women with gestational diabetes.
• Early (preterm) birth and respiratory distress syndrome:
A mother’s high blood sugar may increase her risk of going into labor early and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is growing large. Babies born early may experience respiratory distress syndrome; a condition that makes breathing difficult. The baby’s lungs haven’t developed as they should hence the baby has problem in breathing. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they’re not born early. As GDM also interferes with maturation, causing dysmature babies prone to respiratory distress syndrome due to incomplete lung maturation and impaired surfactant synthesis.
• Your baby is more likely to have periods of low blood sugar (hypoglycemia):
After birth during the first few days of life your baby may have low blood sugar. As the high glucose environment disappears, your baby may continue to make extra insulin causing his or her blood glucose levels to drop, condition called as hypoglycemia.
Severe episodes of hypoglycemia may provoke seizures in the baby. Hence, it’s recommended that you breastfeed your baby within 30 minutes of delivery to return the baby’s blood sugar level to normal. Otherwise, your baby may be given a sugar solution orally or through a drip directly into a vein. Midwives will check your baby’s blood sugar level regularly.
• Jaundice
If you have gestational diabetes there is an increased risk of your new born developing jaundice. Jaundice is yellowish discoloration of the skin and the whites of the eyes. Jaundice occurs when bilirubin is present in your baby’s blood. Bilirubin normally forms when the body recycles old or damaged red blood cells. If a baby’s liver isn’t mature enough to break down bilirubin then it stays in blood. Although jaundice usually isn’t a cause for concern, however careful monitoring is important. This usually fades without the need for medical treatment. depending on the severity your baby may need
treatment with a special ultraviolet light after being born.
• Development of diabetes later in life :
Babies have excessive fat stores as a result of high maternal sugar levels during pregnancy. They often continue to be overweight in childhood and adulthood. Babies are at a higher risk of developing obesity and type 2 diabetes later in life.
• Gestational diabetes and birth defects:
Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy, whereas GDM gradually develops and is least pronounced during the first trimester. Gestational diabetes affects the mother in late pregnancy, after the baby’s body has been formed. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy. Gestational diabetes has not clearly shown to be an independent risk factor for birth defects. But studies have shown that the offspring of women with GDM are at a higher risk for congenital malformations.
• Chemical imbalances after birth:
Chemical imbalances which may require admission to a neonatal intensive care unit. If your blood sugar control is especially poor, your baby is at risk for polycythemia (an increase in the number of red cells in the blood) and hypocalcemia (low calcium in the blood), and your baby’s heart function could be affected as well. Neonates are also at an increased risk of low
magnesium (hypomagnesemia).
• Still birth
Untreated gestational diabetes can result in a baby’s death either before (still birth) or shortly after birth. Controlling blood sugar levels reduces this risk.
Complications that may effect you
Gestational diabetes isn’t an immediate threat to your health. However, poorly controlled diabetes in pregnancy puts you at a higher risk of various problems.
• High blood pressure, preeclampsia and eclampsia.
Gestational diabetes increases your risk of developing two serious complications of pregnancy: preeclampsia and eclampsia.
Preeclampsia is a toxic condition that develops in late pregnancy and causes a sudden rise in blood pressure, excessive weight gain, fluid build-up, albumin in your urine, severe headache, and visual disturbances. Mothers with gestational diabetes have an increased risk for high blood pressure during pregnancy.
Eclampsia is a toxic condition characterized by convulsions and possibly coma during or immediately after pregnancy.
• Future diabetes, diabetes during subsequent pregnancy and later in life.
If you have gestational diabetes, it’s more likely that you will have gestational diabetes during a future pregnancy too. You’re also more likely to develop type 2 diabetes as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes. If women with a history of gestational diabetes reach their ideal body weight after delivery, then their chances of developing type 2 diabetes is less.
The punch line is if your diagnosed with gestational diabetes take care that your blood glucose levels are maintained within the normal range through out your pregnancy for your baby’s and your good health.