Gestational Diabetes during Pregnancy
Pregnancy management – complications
My second son was born with multiple defects and has subsequently died. I have been on insulin for 14 years (since the age of 10). Are women with diabetes more likely to have an abnormal baby?
The secret to a successful pregnancy is perfect blood glucose control starting before conception and continuing throughout pregnancy. There is good scientific evidence to suggest that multiple developmental defects are caused by poor control in the first few weeks of pregnancy and that the risk of this can be avoided by ensuring immaculate control at the time that the baby is conceived. The risks in terms of multiple congenital defects seem to be confined to the very early stages of the pregnancy. This is hardly surprising because this is the stage when the various components of the baby’s body are beginning to develop and when other illnesses such as German measles (rubella) also affect development.
Good control is also needed for the rest of the pregnancy because the gradual development and growth of the baby can be disturbed by poor control. In particular, with poor control, the baby grows rather faster than normal and is large in size, although the development of the organs remains relatively immature in terms of their function. This does not happen with well-controlled diabetes. Because the baby is large, the mother has to be delivered early and, because the baby is immature, it is susceptible to a number of added risks immediately after birth.
I have read that the babies of mothers with diabetes tend to be fat and have lung trouble shortly after birth and also there is a risk of hypoglycaemia. Is this true, and if so why does it happen?
We know that, if the mother runs a high blood glucose through-out pregnancy, glucose gets across the placenta into the baby’s circulation and causes the baby to become fat. This is because the baby’s pancreas is still capable of producing insulin even though the mother’s cannot. As a result of this, the baby grows bigger during pregnancy and delivery has to be carried out earlier to avoid a difficult labour. This used to be carried out most commonly by caesarean section at about 36 weeks of pregnancy. One of the complications of this method of delivery is lung trouble in these babies, known as the respiratory distress syndrome (RDS), caused by the fact that the babies were born before their lungs were properly developed.
If the mother’s blood glucose levels are kept strictly within normal limits during pregnancy, babies do not grow faster than they should and pregnancy can be allowed to continue for the normal period of 40 weeks. This avoids the risk of caesarean section in the majority of women and RDS is rarely seen because the babies are fully mature when they are born.
Low blood glucose (hypoglycaemia) during the first few hours after birth is a result of the fact that the baby’s pancreas has been producing a lot of insulin during the pregnancy to cover the mother’s high blood glucose, which was passed across the placenta to the baby. If the mother’s blood glucose is strictly controlled during pregnancy and delivery, hypoglycaemia in the baby is much less of a problem.
My baby was born with jaundice. Are babies of mothers with diabetes more likely to have this?
Babies born to mothers with diabetes are more likely to be jaundiced. This is partly because they tend to be born early, but we do not know why a mature baby is jaundiced, though the problem is usually mild and clears without treatment.
I developed toxaemia during my last pregnancy and had to spend several weeks in hospital even though control of my diabetes was immaculate. Luckily everything turned out all right and I now have a beautiful healthy son. Was the toxaemia related to me having diabetes? Is it likely to recur in future pregnancies?
Women with diabetes are more prone to toxaemia. You are not more likely to develop toxaemia in your future pregnancies – indeed the risk is less.
During my last pregnancy I had ‘hydramnios’ and my obstetrician said that this was because I had diabetes. Is this true? And is there anything that I can do to avoid it happening in future pregnancies?
Hydramnios is an excessive amount of fluid surrounding the fetus and it is, unfortunately, more common in mothers with diabetes. It does appear to be related to how strictly you control your diabetes throughout your pregnancy. Our advice is that you can reduce the risk to an absolute minimum in future pregnancies by aiming to keep your HbA1c and blood glucose levels completely normal from the day of conception.
During the recent delivery of my fourth child (which went quite smoothly) I had an insulin pump into a vein during labour. I had not had this in my previous three pregnancies, despite having diabetes. Why did I need the pump this time?
We now know that it is very important to keep your blood glucose within normal limits during labour to minimize the risk of your baby developing low blood glucose (hypoglycaemia) in the first few hours after birth. This is most effectively and easily done using an intravenous insulin infusion combined with some glucose given as an intravenous drip. This means that your blood glucose can be kept strictly regulated at the normal level until your baby has been delivered. It also ensures that should any complications arise and something like a caesarean section be required, you are all ready immediately for an anaesthetic and operation.
My first child was delivered by caesarean section. Do I have to have a caesarean section with my next pregnancy?
It all depends on why you had the caesarean section. If it was performed for an obstetric reason that is likely to be present in this pregnancy, then the answer is yes. If it was performed because the first baby was large or just because you have diabetes, the answer could be no.
Some doctors do consider it safer to deliver a woman by caesarean section if she has had a caesarean section before. Others would allow you a ‘trial of labour’. In other words, you would start labour and, if everything was satisfactory, you would be able to deliver your baby vaginally in the normal way.
My doctor tells me that I will have to have a caesarean section because my baby is in a bad position and a little large. What sort of anaesthetic is best?
Nowadays approximately 50% of women who have caesarean sections have them under epidural anaesthetic rather than under general anaesthetic. If you have an epidural anaesthetic your legs and abdomen are made completely numb by injecting local anaesthetic solution through a needle into the epidural space in your spine. You remain awake for the birth of your baby and therefore remember this event. In most cases an epidural is preferred because your baby receives none of the anaesthetic and therefore is not sleepy.
If you are interested in having your baby this way, you should discuss it with your obstetrician.
My baby had difficulty with breathing in his first few days in the Special Care Unit. They said this was because my control of my diabetes was poor – why was this?
It sounds as if your baby had what is called respiratory distress syndrome (RDS) which occurs most commonly in premature babies and was discussed in an earlier question. It occurs in babies of mothers with diabetes where the baby has grown too quickly because of the mother’s poor blood glucose control, and so the baby is born before it has become fully mature. It used to be a relatively common cause of death in the babies of mothers with diabetes but now, because of stricter control and super-vision, the mother does not have to be delivered early, so the baby is fully mature when it is born. It is now uncommon and indeed you can probably completely prevent it if you control your blood glucose throughout your pregnancy, thus allowing it to proceed for the normal 40 weeks.
