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Gestational diabetes

Gestational diabetes insipidus occurs during pregnancy. This is a type of diabetes and about 2-10 percent of expectant mothers develop this condition. When pregnant, hormonal changes make your cells less responsive to insulin. But during pregnancy, the pancreas cannot keep up with the increased insulin demand, and hence blood glucose levels rise resulting in gestational diabetes.

Significantly, most women with gestational diabetes do not remain diabetic after the baby is born. Once you've had gestational diabetes, though, you are at higher risk during a future pregnancy and for developing diabetes later in life.


Symptoms of gestational diabetes

There are no symptoms and that is perhaps why all pregnant women have to undergo a glucose screening test between 24 and 28 weeks. If you are at a high risk for diabetes and are showing signs of it, then the doctor would recommend this screening test at the first prenatal visit and then repeat at 24 weeks, the initial test being negative. Follow up tests are done to find out if the result on glucose screening is positive.

High risk factors for gestational diabetes

The American Diabetes Association prescribes the following condition for early screening, in case of high risk namely:

Obesity and BMI over 30
If you have had gestational diabetes in previous pregnancy
If the urine has sugar and
If you have a strong family history of diabetes.

Other risk factors

If earlier delivery was a big baby
If you have had a stillbirth
If you have high blood pressure and
If you are over 35.

An association between excessive weight gain during pregnancy, particularly in the first trimester and risk of gestational diabetes has been established.

Gestational diabetes: Pregnancy and baby

Poorly controlled diabetes may have short and long term consequences for you and your baby. If blood sugar levels are too high, the baby's blood may have too much glucose. The excess blood sugar and insulin can cause the baby to put on extra weight particularly in the upper body. This can lead to a condition called macrosomia. This baby may be too large to enter the birth canal or the baby's head may enter but shoulder may get stuck. This is a tricky condition called dystocia and the doctor has to use special procedures to deliver the baby.

Sometimes delivery of such babies may result in fractured bone or nerve damage which could become permanent in 99% of babies. It is better that babies of mothers with gestational diabetes, check their blood sugar regularly and breast feed the baby immediately after birth to prevent or correct hypoglycemia.

Such babies with hypoglycemia at birth are given IV glucose solution. Testing the baby's sugar and providing an IV if necessary can prevent serious problems such as coma, brain damage and seizures. The baby also exhibits high risk for breathing problems and newborn jaundice. In addition, the baby is also at risk for polycythemia or increase in the number of red cells in the blood and hypocalcaemia or low calcium in the blood. Women with gestational diabetes are at an increased risk of developing Preeclampsia, particularly those who are obese before pregnancy and blood sugar levels are uncontrolled.

Macrosomia

Macrosomia is a condition in which a baby is unusually large before birth. The baby's weight could be more than 8-9 pounds. Babies born with macrosomia might suffer from jaundice, low blood sugar, respiratory distress, etc. Pregnant women who gain weight rapidly and have a heavy stomach might be at risk for macrosomia. Women with large fundal height, the distance from top of the uterus to the pubic bone might indicate Macrosomia.


Managing Macrosomia

Gestational diabetes or diabetes mellitus is usually the main cause for macromasia. Obesity and genetic factors also play a role. Ultrasound during the third trimester to measure the child's head, femur and abdomen gives an indication of possible Macrosomia. A Leopold maneuver wherein the fetal weight is estimated by pushing the stomach through the abdomen is another diagnostic measure. Often a non-stress test is done to measure the baby's heart rate based on its movements. A cesarean delivery is usually conducted when macrosomia is noticed.


High Risk Pregnancy

A woman's medical status, lifestyle or external factors may be the cause for high risk pregnancy. Some complications are unavoidable, while the risk in some others can be minimized by the help of the gynecologist / physician. Many times complications can also occur without any warning signal. Sometimes causes and risk factors can be identified early and suitably treated.

Anemia in pregnancy: Anemia occurs when the red blood cells are too few in the body. This leads to a lowered ability of the red blood cells to carry oxygen. Since the fetus is dependant on the mother's blood anemia can cause poor fetal growth, pre term birth and low birth weight. Anemia of pregnancy, iron deficiency anemia, vitamin B 12 deficiency, anemia due to blood loss, folate deficiency anemia are some of the types of anemia during pregnancy.

Pre term labor: In high risk pregnancies more than 11% of the babies born are pre term. Pre term labor begins before completion of thirty seven weeks of pregnancy. Pre term labor may mean either uterine contractions, rupture of amniotic sac and/or cervical dilatation. Many factors can contribute to pre term labor. Some of the key factors are:

  • Maternal factors like preeclampsia, chronic medical illness, infection like urinary tract infections, vaginal infections, drug abuse, abnormal structure of the uterus, cervical incompetence, previous pre term birth.

  • Factors involving pregnancy like abnormal or decreased function of the placenta, placenta previa and abruption, premature rupture of membranes

  • Factors involving the fetus like behavior of intrauterine environment, multiple gestation and erythrobalstois fetalis which means Rh blood group incompatibility.


Intrauterine Growth Restriction (IUGR): This is a condition in which the fetus is smaller than expected for the number of weeks of pregnancy or there is fetal growth restriction. Newborn babies with IUGR are small for their gestational age. The baby's fetal weight is less than the 10th percentile. The fetus with IUGR may be born at term or prematurely. They appear thin, pale and have loose dry skin. Some have a wide eye look.

IUGR can begin at any time of pregnancy. While early onset of IUGR is due to chromosomal abnormality, late onset is due to other related problems. Although it is not possible to prevent IUGR, it can normally well managed by the doctor.

Generally the earlier and more severe the growth restriction, the greater the risk. Careful monitoring of the fetus growth is needed in all cases of IUGR. This is done by ultrasound and Doppler studies and mother's weight gain monitoring. Other ways to watch the potential high risk is by fetal movement counting, non stress testing, and biophysical profile examination.

Post term pregnancy: In contrast to pre term pregnancy, post term pregnancy lasts for more than forty two weeks. About 7% of babies are born at forty two weeks or later. Such post term pregnancies can cause longer hours of labor and operative delivery. Mothers are at increased risk for vaginal birth trauma due to large baby. Cesarean deliver is likely for post term babies.

Multiple pregnancy: Multiple pregnancy means two or more fetuses. A very small percentage (about 3%) of women experiences multiple pregnancy.

Post partum hemorrhage: This is when excessive bleeding follows the birth of the baby in the mother. About 4% of women have post partum hemorrhage. Immediate medical intervention is required to stop bleeding. Some women with placental abruption and placenta previa are more susceptible for post partum hemorrhage than others.

RH disease: This disease occurs when there is incompatibility between the blood of the mother and the baby. This again is a high risk factor in pregnancy.

Premature rupture of membranes: Premature rupture of membranes means breaking open of the membranes before labor begins, especially before thirty seven weeks of pregnancy. Nearly 10% of pregnancies suffer premature rupture of membranes.

Rupture or membranes is caused by natural weakening of membranes or from force of contractions. Low socioeconomic conditions, sexually transmitted infections, previous pre term birth, vaginal bleeding and cigarette smoking during pregnancy are some of the main causes for premature rupture of membranes. One third of the premature births suffer from premature rupture of membranes.

Gestational diabetes: Diabetes in pregnancy can have serious consequences for the mother and the fetus. The severity of the problem depends upon the degree of the mother's diabetic disease. In the US about 9 % if women have diabetes and one third of them do not know it. 2 to 3% of women develop diabetes during pregnancy called gestational diabetes. Here the mother who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy.

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Collection of Pages - Last revised Date: December 13, 2019