WOMEN'S HEALTH
Monitor your sugar
DR. DEEPA HARIHARAN
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Gestational diabetes can cause complications for both the mother and the newborn. Here’s what you need to know.
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PHOTO: AP
Uma had delivered a chubby baby weighing four kg. However, she panicked when doctors informed her that the baby had to be admitted to a neonatal intensive care unit for low blood sugar. Further tests showed Uma had gestational diabetes, which had res
ulted in low blood sugar in the baby.
What is gestational diabetes?
Gestational diabetes occurs only during pregnancy. If a woman develops high blood sugar when pregnant, but has never had it before, then she has gestational diabetes. If not treated, it can cause problems for mother and baby, some of which can be serious.
How does it happen?
Insulin, a hormone secreted by the pancreas, prevents high blood sugar and diabetes. The effect of insulin is blocked by hormones produced in the placenta during pregnancy causing insulin resistance. Insulin resistance increases as the placenta grows during the last few months of pregnancy, so the pancreas is unable to make additional insulin to overcome the resistance. This results in gestational diabetes. The risk is higher in older or obese women, those with a family history of diabetes, and those who had stillbirths or very large babies earlier. Also, the relative risk of Indian women developing gestational diabetes is 11 times compared to Caucasian women.
Does the baby being “too big” have anything to do with it?
Diabetes during pregnancy results in macrosomia or large body. High blood sugar in the mother leads to high blood sugar in the foetus. The foetus’ pancreas perceives this as foetal diabetes and secretes insulin in high quantities to lower blood sugars. However, insulin is a growth hormone for the foetus and the increased insulin causes excessive growth. Macrosomic babies may have difficulty being born because of their size and may develop birth injuries.
Why does the baby need to be admitted in a neonatal intensive care unit?
The two most common problems in such babies are: Hypoglycemia and respiratory distress. Hypoglycemia or low blood sugar occurs if the mother’s blood sugar levels have been consistently high, causing the foetus to have a high secretion of insulin. After delivery, the baby continues to have a high insulin level, but no longer has abnormally high levels of sugar from its mother. This results in the blood sugar level becoming very low. Untreated hypoglycemia can result in poor activity or irregular breathing or even convulsions. So, blood sugar must be tested soon after birth and at frequent intervals for three to five days. Early feeding is recommended to prevent low blood sugar.
The excess insulin in the baby, while promoting physical growth, delays lung maturity, especially if the baby is born before 38 weeks. This can result in difficulty in breathing. To prevent this, the baby should be monitored carefully and supplemental oxygen given if necessary. In severe cases, ventilator support and injections to promote lung maturity may be needed.
In addition, these babies should be monitored for low calcium levels, sluggish blood flow due to too much haemoglobin (thick blood) and birth defects or injuries. This is better done in a neonatal intensive care unit.
Will the baby’s life be in danger or is there a risk of the baby developing diabetes?
With careful monitoring and early treatment, these babies do well. With modern neonatal intensive care, the mortality is almost nil, unless the baby is very premature or asphyxiated at birth from a very difficult delivery. Also, with gestational diabetes, unlike diabetes that was present before pregnancy, the chance of the baby having birth defects in the heart, kidneys, brain are very low. Babies born to mothers with gestational diabetes do not generally develop diabetes in childhood.
Can this problem be avoided in the next pregnancy?
Planning for the next pregnancy should start even now. Being as close to ideal body weight as possible prior to pregnancy and going for regular check ups decreases the risk. During the next pregnancy, it is better to undergo glucose tolerance test (measuring blood glucose levels at specific times after taking oral glucose) rather than measuring blood sugar level at random to avoid missing the diagnosis of diabetes. In fact, glucose challenge or tolerance tests are recommended in all Indian women during pregnancy. If diabetes is detected, optimal control of blood sugar starting early in pregnancy may result in a normal weight and outcome for the baby and prevent long-term complications.
The writer is a Chennai-based neonatologist.
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