Delivery in Diabetic Mothers

March 4, 2020

Having a healthy pregnancy with type 1 diabetes can be hard, but possible. For this, you need to have control over your blood sugar levels before, during and after pregnancy. If you have a constant high level of blood glucose, it can harm your baby. Also, there are several complications during delivery. Also, before you finalize the delivery mode, it is important that you take into consideration the status of your as well as your baby’s health.

Complications that can affect the baby

Babies that are born to diabetic mothers are at an increased risk of breathing difficulties, jaundice and low blood sugar at birth. Apart from this, the following complications can arise in babies born to diabetic mothers:

Excess birth weight – The extra glucose present in the mother’s bloodstream can cross the placenta. This triggers the pancreas of the baby to produce more insulin. This can lead to macrosomia where the baby grows too large. Very large babies that weigh more than 4 kg can get wedged in the birth canal, have birth injuries and might need a C-section delivery.
Preterm birth – The high blood sugar level in the mother can increase the risk of premature delivery. Also, in some cases, when the baby is large, an early might be recommended.
Respiratory distress syndrome – This is a condition that leads to breathing difficulties in babies. Such babies will need help with breathing until their lungs become strong and mature. Kids born from diabetic mothers can have respiratory distress syndrome, even if they are not premature.
Hypoglycemia (low blood sugar) – In some cases, babies born to diabetic mothers can develop hypoglycemia shortly after the delivery. This is because the insulin production in their body is high. Severe hypoglycemia can trigger seizures in the baby. In some cases, an IV glucose solution and early feedings can return the blood sugar level of the baby back to normal.
Type 2 diabetes – This will happen to babies born to diabetic mothers later in life. Also, they have a higher chance of becoming obese. If gestational diabetes is left untreated, it can lead to the death of the baby before or after birth.
Birth defects – Caused by unhealthy blood sugar levels in the mother, infants can have some birth defects like the cardiovascular issues and problems of the spine, brain, limbs, mouth, gastrointestinal tract, and kidneys.
Shoulder dystocia – A baby who is large in size is at the risk of shoulder dystocia. This is a condition in which the baby’s anterior shoulders are unable to pass the pubic symphysis or fail to do so without manipulation.

Complications that can affect the mother

Diabetes in a mother can increase the risk of certain complications. So, it is important that you get follow-ups and antepartum care.

1. Preeclampsia – This is a condition causing gestational high blood pressure and hypertension. Women with type 1 diabetes already have a high BP which can get worse as the pregnancy moves forward.

2. Insulin resistance – When a woman gets pregnant, the placenta supplies water and nutrients to the growing fetus. It is also responsible for making the hormones required for maintaining the pregnancy. In the early weeks of pregnancy, these hormones can increase insulin secretion and decrease glucose production by the liver. This can lead to low blood sugar levels or hypoglycemia. In later weeks of pregnancy, these hormones (cortisol, estrogen and human placental lactogen) can block the insulin leading to a condition named insulin resistance. As the placenta keeps growing and producing more hormones, insulin resistance becomes stronger.

3. Diabetes complications get worse – If you are pregnant and some glands, organs, or nervous system of your body is not healthy, this can lead to some complications. The diabetes management will become increasingly difficult and it will be harder for you to keep your blood glucose level in the right range.

4. Difficult delivery – Babies with diabetic mothers are usually large in size. This makes the delivery difficult. In fact, sometimes, doctors might recommend an early inducement of labor or cesarean delivery.

5. Miscarriage or stillbirth – When the baby is lost before 24 weeks, it is termed as miscarriage. Stillbirth is when the baby dies after 24 weeks in the womb. Excessive sugar in the blood can lead to this.

For lowering the complications’ risk and deliver successfully, mothers need to keep the levels of blood glucose in range. Also, regular follow-ups with the doctor will ensure that you and your baby are safe.

 

Blog Written By:

Dr. Asmita Podtar

Consultant – Obstetrics & Gynaecology

Apollo Spectra Hospitals, Pune