Gestational Diabetes and Your Baby
Most women who develop gestational diabetes go on to have healthy babies. You will be asked to keep your gestational diabetes blood sugar in control with a special low carbohydrate diet and daily exercise. Only some women will be required to take insulin shots.
Due to gestational diabetes, you can be at high risk of having a baby that is a bit larger than average. If this happens, it can lead to a more difficult birth due to the size. If the baby is too large for vaginal delivery, a C-section will be performed. After the birth, it’s actually highly recommended for moms to breastfeed the baby to maintain their sugar levels. Pregnancy is an excellent opportunity to discover if you are genetically programmed to develop diabetes later in life. It’s a good idea to keep up with good eating habits, exercise and keeping your weight at healthy levels to avoid getting the disease altogether.
Your doctor may watch the baby more closely during the last 2 to 3 months of pregnancy if you have a severe case of gestational diabetes. Your doctor may ask you to count your baby’s movements during the last trimester. If the baby becomes less active, you will need to alert your doctor immediately.
If your blood sugar cannot be controlled or it is high enough to require insulin shots, you may begin to have fetal heart monitoring. The monitoring will include non-stress tests or periodic ultrasounds around 32 weeks to check on the baby which is otherwise called a biophysical profile. If you can control the diabetes without insulin shots and no other problems are present, these tests may not be required until the last few weeks or until your delivery due date.
Poorly controlled diabetes can have serious consequences for you and the baby as too much glucose will end up in the baby’s blood. When this happens, the baby’s pancreas will need to produce more insulin to process the additional glucose and can end up making your baby fat, particularly in the upper body. The baby’s weight gain can lead to macrosomia.
An ultrasound may be requested around 29 to 33 weeks to measure the baby and get an estimate on the weight. If the baby is already too big, then you may begin taking insulin. Another ultrasound may be ordered closer to labor if the doctor suspects the baby is large, although ultrasounds are not very accurate in determining a baby’s size at this late stage in pregnancy. You may or may not be induced early or your doctor may recommend delivering the baby by C-section.
A marcosomic baby may be too large to be delivered vaginally as the baby’s head or the shoulders may get stuck. If this happens, the doctor will have to use special techniques to deliver the baby. It can result in a fractured bone or nerve damage, both that can heal without permanent problems in about 99 percent of babies. (In very rare cases, the baby may suffer brain damage from the lack of oxygen during the delivery process). Unfortunately, the maneuvers to deliver a broad-shouldered baby can lead to possible injuries in the vaginal area or require a cut (episotomy).
If your doctor suspects that baby will be too large, he/she may recommend delivering by C-Section, which only a small amount of women with well controlled gestational diabetes will end up having to do.
After delivery, the baby may end up having low blood sugar due to his body continuing to produce extra insulin. The nurses will test the baby’s blood sugar at birth by taking a drop at the heel. If they find the blood sugar is low, they will want you to feed him as soon as possible either by breastfeeding or by giving some sugar water or formula.
Some babies may be a higher risk of jaundice, hypocalcemia (low calcium in the blood), or polycythemia (increase of red blood cells in blood). If your blood sugar was controlled poorly, your baby’s heart function may have been affected. There are some studies that have found a link between severe gestational diabetes and an increased risk for stillbirth during the last 2 months of pregnancy. In addition, having gestational diabetes puts the mother at higher risk (twice as high) to develop preeclampsia as other pregnant women.
A number of factors can contribute to creating a large baby, but the most influential factors are genetics or high blood sugar not properly managed from gestational diabetes or diabetes mellitus. Factors that increase the risk include: obesity, gaining a lot of weight, going past your due date and even the sex of the baby. Typically male babies weigh more than females. If you have already had a large baby, you stand a good chance to having larger babies in future pregnancies.
“Big parents” will often have bigger babies, but babies can be larger due to the mother being obese or leaving her gestational diabetes untreated. Even if you don’t fit any of these risk factors, there are big babies born to women that have none of these risks.
There is a great chance that the delivery will be more difficult due to increased chances of perineal tearing, damage to your tailbone, or blood loss. The baby may have a small chance of having his/her shoulder caught behind your pubic bone, in which case he/she would get stuck. Your doctor will have to do some fancy maneuvering with your help to get your baby out and you may need to get an episiotomy. This situation is rare.
A large baby will also increase your chances of needing a cesarean and are performed only for when you are measuring large.
There is another possibility that your doctor may induce you early.
To avoid these complications, it is important to control your food intake as soon as you receive your diagnosis.
What Happens After the Baby is Born?
Most women with gestational diabetes will go on to have healthy babies, especially when they take control of their blood sugar, exercise lightly and eat a healthy balanced diet.
For many women their blood sugar levels will return to normal quickly after the baby is born. You should get your blood tested six weeks after the baby is born. The test will also check for your risk of developing diabetes in the future. If you plan on getting pregnant again, make sure to have your blood sugar tested 3 months prior to becoming pregnant to make sure your blood sugar has returned to normal.
Children who have been born to mothers with gestational diabetes will have a higher risk for obesity, diabetes or abnormal glucose tolerance.
Women who have had gestational diabetes are at a higher risk for obesity later in their lifetime and obtaining type 2 diabetes. Making lifestyle changes now will minimize the risk of getting type 2 diabetes and gain control of your future health.
Boosting Diabetes Screening After Pregnancy
Sending a reminder note to all new mothers with gestational diabetes may just be the right way to get mothers back to the doctor’s office for diabetes screening after pregnancy. Even though gestational diabetes typically ends after pregnancy, there is still a higher risk of developing another type of diabetes later.
Some hospitals have started a reminder system to send letters to new mothers and their doctors about 3 months after birth. Since less family physicians are delivering babies, it greatly helps to have information regarding the mother’s gestational diabetes history sent to the family physician.
The goal of retesting is to identity the women who are at greatest risk and make early changes to their diet and lifestyle to prevent the future onset of diabetes. Close monitoring of the children are important as well, as they will be at greater risk of obesity and adult-onset diabetes.
See also: Gestational Diabetes Studies
Page maintained by Susan Suarez
Page maintained by Susan Suarez