A fetus growing inside a woman who has diabetes may be exposed to high blood glucose levels during the pregnancy if the diabetes is not well controlled.
It is essential to ensure that diabetes is well controlled during pregnancy. Otherwise, the baby will be exposed to excess blood sugar levels that can affect it during pregnancy, during birth and after birth.
When diabetes is not adequately controlled, the excess blood glucose is transferred to the fetus during pregnancy, which causes the baby to produce extra insulin.
If a woman has insulin-dependent diabetes, there is also an increased risk of congenital disabilities that affect the heart, spinal cord, brain, gastrointestinal system, and urinary tract formation.
Unlike insulin-dependent diabetes, in gestational diabetes, the blood glucose levels are generally standard throughout the critical first three months of pregnancy, when the baby’s organs are forming.
What Is An Infant Of A Mother With Diabetes?
An infant of a mother with diabetes is a baby who is born to a mother with diabetes. Because the mother has diabetes, the baby is at risk for problems.
People with diabetes have high levels of sugar in their blood (hyperglycemia). Over time, this can lead to serious health problems.
Keeping your blood sugar under control lowers your risk for complications. In addition, you can manage diabetes by eating a nutritious diet, getting regular exercise, and taking medicine.
Two types of diabetes may put a baby at risk during pregnancy: gestational diabetes and pre-gestational diabetes.
Two types of diabetes can happen in pregnancy. These are:
In this condition, you don’t have diabetes before pregnancy. Instead, you develop it during pregnancy. This type of diabetes goes away after your baby is born.
Gestational diabetes is a condition that develops during pregnancy in women who did not previously have diabetes.
In this condition, you have diabetes before getting pregnant. You may have type 1 or type 2 diabetes. Pregestational diabetes refers to type 1 or types two diabetes that a woman already had before becoming pregnant and requires blood sugar lowering medications or insulin to treat it.
People with type 1 diabetes don’t make insulin. However, your body needs insulin to use blood sugar. So you’ll need to take insulin shots.
People with type 2 diabetes can’t use the insulin they make. Or their bodies don’t make enough insulin. So you’ll need blood sugar-lowering medicine and possibly insulin.
It’s essential to manage your blood sugar during pregnancy. This can lower your baby’s risk for problems.
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What Causes Problems For An Infant Of A Woman With Diabetes?
In pregnancy, the placenta gives the growing baby nutrients and water. It also makes hormones you need for a healthy pregnancy.
Some of these hormones can block insulin. This often starts at 20 to 24 weeks of pregnancy.
As the placenta grows, it makes more of these hormones. This means that the pancreas must produce more insulin.
Usually, the pancreas can make enough insulin. If it doesn’t, gestational diabetes occurs.
Pregnancy may also change the insulin needs of a woman who already has diabetes. If you have type 1 diabetes, you may need more insulin.
If you have type 2 diabetes, you may need to start using insulin or need more insulin.
An infant of a woman with diabetes is at risk for many problems. These issues can happen in pregnancy and after birth.
The problems happen when your blood sugar isn’t controlled well. For example, if diabetes is not well maintained during pregnancy, the baby is exposed to high blood sugar levels.
This can affect the baby and mother during pregnancy, at the time of birth, and after birth.
Infants of diabetic mothers (IDM) are often larger than other babies, especially if diabetes is not well-controlled.
This may make vaginal birth harder and increase the risk for nerve injuries and other trauma during delivery. Also, cesarean births are more likely.
An IDM is more likely to have periods of low blood sugar (hypoglycemia) shortly after birth and during the first few days of life.
This is because the baby has been used to getting more sugar than needed from the mother.
They have a higher insulin level than needed after birth. Insulin lowers blood sugar. It can take days for babies’ insulin levels to adjust after birth.
IDMs are more likely to have:
- Breathing difficulty due to less mature lungs
- High red blood cell count (polycythemia)
- High bilirubin level (newborn jaundice)
- Thickening of the heart muscle between the large chambers (ventricles)
If diabetes is not well-controlled, chances of miscarriage or a stillborn child are higher.
An IDM has a higher risk of congenital disabilities if the mother has pre-existing diabetes that is not well controlled from the very beginning.
Who Is At Risk For Gestational Diabetes?
The following factors increase your risk for gestational diabetes:
- Older than 25
- Overweight and obesity
- Gestational diabetes in past pregnancies
- Family history of diabetes
- Have given birth to a huge baby
- Have had a stillbirth
What Are The Symptoms In The Infant Of A Mother With Diabetes?
During pregnancy, the following can happen to your baby:
Birth (congenital) defects and miscarriage. These are more likely to occur in women who had diabetes before pregnancy.
- High blood sugar
- Low oxygen levels
- Low blood iron levels
- High blood pressure
- Enlarged heart
- Poor nervous system development
- Poor lung development
The following problems may happen to your baby after they are born:
- Large size (macrosomia). Big babies are more likely to get hurt during delivery. These include shoulder injuries.
- Low blood sugar (hypoglycemia)
- Low blood calcium
- Low blood iron
- High levels of red blood cells and thickened blood
- High levels of bilirubin from the breakdown of red blood cells
- Congenital disabilities. Most affect the heart, blood vessels, brain, and spinal cord.
- Premature birth
- Enlarged heart
- Breathing problems
Long-term problems. Babies born to mothers with diabetes are more likely to have diabetes and be obese later in life.
The infant is often larger than babies born after the same length in the mother’s womb (giant for gestational age). Conversely, in some cases, the baby may be smaller (tiny for gestational age).
Other symptoms may include:
- Blue skin colour, rapid heart rate, rapid breathing (signs of immature lungs or heart failure)
- Poor sucking, lethargy, weak cry
- Seizures (a sign of severe low blood sugar)
- Poor feeding
- Puffy face
- Tremors or shaking shortly after birth
- Jaundice (yellow skin colour)
How Is Diabetes During Pregnancy Diagnosed?
Your doctor will check you for diabetes during pregnancy.
If you have risk factors for type 2 diabetes, such as being overweight, your doctor will check you early in pregnancy. Your doctor may test you during your first checkup.
Exams And Tests
Before The Baby Is Born:
Ultrasound is performed on the mother in the last few months of pregnancy to monitor the size of the baby relative to the opening to the birth canal.
Lung maturity testing may be done on the amniotic fluid. This is rarely done but may be helpful if the due date was not determined early in pregnancy.
After The Baby Is Born:
The baby’s blood sugar will be checked within the first hour or two after birth and rechecked regularly until consistently normal. This may take a day or two or even longer.
The baby will be watched for signs of trouble with the heart or lungs.
The baby’s bilirubin will be checked before going home from the hospital and sooner if there are signs of jaundice.
An echocardiogram may be done to look at the size of the baby’s heart.
Your healthcare provider will screen you for gestational diabetes between 24 and 28 weeks of pregnancy.
This screening is done using an oral glucose tolerance test (OGTT). An OGTT checks a woman’s blood sugar levels after she has sugar (glucose). For example, you may have one of these tests:
After not eating (fasting), you’ll have 75 grams of glucose. Your healthcare provider will check your blood sugar after a set amount of time.
You’ll have 50 grams of glucose (you don’t need to fast). Your healthcare provider will check your blood sugar after a set amount of time.
If your blood sugar is high, you’ll do another OGTT with 100 grams of glucose.
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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. In addition, 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 baby’s risks. You’ll likely need to do the following to care for your diabetes:
Watch your blood sugar levels closely. Your healthcare provider may ask you to test your blood sugar at home.
Take insulin as prescribed. Your dose of insulin may change throughout pregnancy.
Watch your weight. Your doctor may tell you to gain less weight if you’re overweight or obese.
Your baby’s treatment depends on how well you controlled your blood sugar in the last part of pregnancy and during labour and delivery.
Treatment will also depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Your baby’s healthcare provider may draw their blood. This will check your baby’s blood sugar, blood calcium, and other levels.
This may be done through a heel stick, a needle in your baby’s arm, or an umbilical catheter (a tube placed in your baby’s umbilical cord).
Your baby may need a glucose and water mixture as an early feeding. Or your baby may need glucose given into a vein (intravenously or IV).
Your baby’s healthcare provider will closely watch their blood sugar levels. This is done in case your baby’s blood sugar levels drop too low.
Help With Breathing
Your baby may need oxygen or a breathing machine to breathe better.
Your child may need extra care if they have congenital disabilities or injuries. Your child may need to see a specialist. This depends on their condition.
Can Gestational Diabetes Be Prevented?
Caring for your diabetes well can lower your baby’s risks. Eating a nutritious diet, testing your blood sugar, and taking insulin can help you manage your condition.
Having gestational diabetes raises your risk for diabetes later in life. If you have gestational diabetes, your healthcare provider will test you for diabetes after you give birth.
This is often done 6 to 12 weeks after your baby is born. Your healthcare provider will continue to check you for diabetes because of your risk.
After birth, your child’s healthcare provider should also regularly check them for diabetes. An early diagnosis and treatment can lower their risk for problems.
Risks To The Baby
Some of the complications that diabetes can lead to if it is not carefully managed during pregnancy are described in more detail below.
Excessive Birth Weight
If there is an excess of glucose in the maternal blood, it crosses the placenta, and the baby’s pancreas senses the high glucose level.
This causes the baby to produce an excess of insulin to help use up the glucose.
This can lead to the baby developing large deposits of fat and growing excessively large. This is referred to as macrosomia.
Babies that have reached a considerable weight of 9 pounds or more are more likely to become stuck in the birth canal, which increases the risk of birth injury and the need for a caesarean section.
Babies born to mothers with diabetes are at an increased risk of developing low blood sugar or hypoglycemia shortly after birth and during the first few days of life since they are already producing an excess of insulin.
After birth, the baby continues to have an excess of insulin but is no longer being exposed to the mother’s excess glucose level, resulting in too much glucose being used up and the blood sugar level, therefore, becoming very low. If the hypoglycemia is severe, the baby is at an increased risk of seizure.
The baby’s blood sugar level is checked after birth, and if it is too low, an intravenous glucose solution may be administered to restore the blood sugar to an average level.
Early Or Preterm Birth
Having a high blood sugar level can increase the mother’s risk of going into labour early and having her baby delivered before the due date has been reached.
A doctor may also recommend an early delivery due to the baby has grown too big.
Respiratory Distress Syndrome
Babies born preterm are at an increased risk of respiratory distress, which is difficulty breathing.
The excess insulin in the baby’s body can delay the production of the surfactant required for lung maturation.
These babies require assistance to breathe until their lungs have matured and strengthened.
Babies born to mothers with poorly controlled diabetes are also at risk of respiratory distress even if they are not taken early.
Type 2 Diabetes Later In Life
Babies born to mothers with poorly controlled diabetes during pregnancy are also at an increased risk of becoming obese and developing type 2 diabetes later in life.
All infants born to mothers with diabetes should be tested for low blood sugar, even if they have no symptoms.
Efforts are made to ensure the baby has enough glucose in the blood:
Feeding soon after birth may prevent low blood sugar in mild cases. However, even if the plan is to breastfeed, the baby may need some formula during the first 8 to 24 hours if the blood sugar is low.
Many hospitals are now giving dextrose (sugar) gel inside the baby’s cheek instead of formula if there is not enough mother’s milk.
Low blood sugar that does not improve with feeding is treated with fluid containing sugar (glucose) and water given through a vein (IV).
In severe cases, if the baby needs large amounts of sugar, fluid containing glucose must be given through an umbilical (belly button) vein for several days.
Rarely, the infant may need breathing support or medicines to treat other effects of diabetes. For example, high bilirubin levels are treated with light therapy (phototherapy).
In most cases, an infant’s symptoms go away within hours, days, or a few weeks. However, an enlarged heart may take several months to get better.
Very rarely, blood sugar may be so low as to cause brain damage.
The risk of stillbirth is higher in women with diabetes that is not well controlled. There is also an increased risk for several birth defects or problems:
- Congenital heart defects.
- High bilirubin level (hyperbilirubinemia).
- Immature lungs.
- Neonatal polycythemia (more red blood cells than usual). This may cause a blockage in the blood vessels or hyperbilirubinemia.
- Small left colon syndrome. This causes symptoms of intestinal blockage.
When To Contact A Medical Professional
If you are pregnant and getting regular prenatal care, routine testing will show if you develop gestational diabetes.
If you are pregnant and have diabetes that is not under control, call your provider right away.
If you are pregnant and are not receiving prenatal care, call a provider for an appointment.
Women with diabetes need special care during pregnancy to prevent problems. Controlling blood sugar can prevent many problems.
Carefully monitoring the infant in the first hours and days after birth may prevent health problems due to low blood sugar.
Awareness of the problem may promote some preventive behaviours. For example, if diabetic mothers breastfeed, their children may be less likely to develop type 2 diabetes later.
One study found that among mothers who did not have gestational diabetes, the children exclusively breastfed as infants were less than half as likely to become obese as those solely bottle-fed.
For babies whose mothers had diabetes during pregnancy, the health problems can be lifelong.
These children are at serious risk of obesity, glucose-tolerance problems, and, eventually, type 2 diabetes.
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