Diabetes Effects on the Baby
Diabetes makes a pregnancy high risk. This is because diabetes can cause many potentially negative effects on the baby as well as the mother. Blood sugar is the baby’s food source and it passes fron the mother through the placenta to the baby.
When a woman has diabetes and her blood sugars are poorly controlled (too high), excess amounts of sugar are transported to the baby. Since the baby does not have diabetes, he/she is able to increase the production of insulin substantially in order to use this extra sugar. This abnormal cycle of events can result in several complications including:
Macrosomia
Macrosomia refers to a baby born weighing more than 4,000g (8.8 pounds) or born at greater than the 90 percentile for the gestational age. In response to the excess amounts of sugar that the baby receives, large amounts of insulin are produced by the baby in order to convert the sugar into body fat. That is, the baby is being “overfed” while inside the uterus.
As a result, the delivery can be more difficult for the baby and the mother with increased risk for injury to both. In addition, the odds of requiring a cesarean delivery can be much greater when the baby is too large. Most obstetricians perform an ultrasound to estimate the fetal weight before delivery and to determine if it is safe to attempt a vaginal delivery. Trying to deliver a very large baby vaginally, particularly when the mother has diabetes, can result in one of the most frightening obstetrical emergencies, a shoulder dystocia, where the baby’s head delivers but the shoulders are too large to fit through the birth canal.
Neonatal hypoglycemia
Neonatal hypoglycemia is defined as low blood sugars in the baby after birth. If the baby’s pancreas is making large amounts of insulin in response to the mother’s high blood sugars, it will continue to do so for a time after delivery. Since the sugar supply fron the mother is no longer present once the baby has delivered, blood sugar can drop too low (hypoglycemia, blood sugar < 40 mg/dl). The baby can become fussy, jittery or may even have a seizure or breathing problems.
Because of these possible complications, most babies born to women with diabetes will be monitored very closely for the first few hours of life with frequent heel sticks to check their blood sugars. These babies may require more frequent breast or bottle-feeding to maintain their blood sugars at a normal range and in some cases will require intravenous fluids with glucose.
Other metabolic problems
In addition to hypoglycemia, the excess insulin can also infrequently be responsible for other metabolic complications such as jaundice (yellowing of the skin) and imbalances of calcium or magnesium. The chances of a baby being born with diabetes are extremely rare particularly in cases where the mother has gestational diabetes.
Type 2 diabetes tends to run in families and offspring may be at increased risk for developing it in adulthood. Children of mothers with Type 1 diabetes have less than a 5% chance of developing diabetes during childhood. In fact, the baby has a greater risk if his/her father has Type 1 diabetes.
Stillbirth
When blood sugars are persistently high, blood vessel damage in the placenta and poor oxygen and nutrient supply to the baby can occur. This decrease in oxygen may cause health damage to the baby including death or stillbirth. This rarely occurs in pregnancies complicated by gestational diabetes and is more likely to occur if the mother had diabetes (either Type 1 or 2) before the pregnancy (pre-gestational diabetes). Because of this, women with pre-gestational diabetes should be monitored more closely toward the end of pregnancy.
Respiratory distress syndrome
RDS, respiratory distress syndrome is a condition which the newborn has trouble breathing and may require supplemental oxygen. Poor blood sugar control during pregnancy can slow the maturity of your baby’s lungs. Even having a baby at term (after 37 weeks gestation) with poor blood sugar control can put your baby at risk for RDS. By keeping your blood sugars in the normal range you decrease your baby’s chance of being born with RDS.
Birth Defects
In the general population, there is about a 2 to 3% risk for having a baby with a major birth defect. Babies born to mothers with gestational diabetes do not have a greater risk of birth defects than the general population.
In women with pre-gestational diabetes, this risk is increased about three to fourfold particularly if blood sugars are high during the early weeks of pregnancy. This is the developmental time period when the baby is forming its vital organs. The risk for having a baby with one of these birth defects is directly correlated with how poorly the blood sugar was controlled during the first few weeks of pregnancy.
The most common birth defects are those of the brain, spinal cord and heart. The majority of these birth defects can be detected during the first half of the pregnancy with ultrasound studies and prenatal diagnostic tests. Having diabetes does not increase the risk for having a baby with a chromosome problem such as Down syndrome over the age-related risk. The key to minimizing the risks for having a baby with a birth defect is to seek preconception medical care in order to optimize blood sugar control before becoming pregnant.
Diabetes Guidelines :
Try to eat a variety of foods everyday. All foods can be fit into your meal plan in moderation. Remember portions are very important. The American Diabetes Association recommends that you eat three small-to-moderate-sized meals and two to four snacks every day, including an after-dinner snack
Don’t skip meals! Try to eat the same amount of food and try to eat at the same time each day. This will help keep your blood sugar under control.
CHECK YOUR BLOOD SUGARS! You should check your blood sugar first thing in the morning (fasting) and 2 hours after a meal. Record these and give them to your doctor on each visit.
Your fasting blood sugar should be 60-90 and 2 hours after meals should be 90-120.
Be as physically active as possible. Exercise will help your body use insulin and help keep blood sugar under control. Every movement counts, park a little further fron stores, take the stairs. Try to accumulate 30 minutes of activity a day. It does not have to be vigorous activity to see the benefits.
Where exercise can help lower your blood sugar, stress can raise your blood sugar. If you have a high blood sugar look back and see what was going on around that time.
Do your “kick count” sheet. This type of monitoring is something you can do at home to help make sure your baby is healthy. If you believe your baby is not moving as much or is just “not right” please go straight to Labor and Delivery at Arrowhead Hospital for monitoring. The RN there will call your doctor, you do not have to call him.
If you have any questions or concerns please call your doctor’s office phone number at (623) 561-7250.
Fetal kick counts
Instructions:
Your baby’s movements can provide useful information to your health care provider. Select a different hour each day to count you baby’s movements. Drink something cold and sweet (juice, sports drinks, etc.), if you are diabetic just ice water. Lay down on your side and count your baby’s movements for one hour. Your baby should move at least 4 times in one hour. If you do not have 4 distinct movements after doing the above instruction please go to Labor and Delivery for further testing.