Diabetes in Pregnancy

Dr. Parang Mehta, MD.

Diabetes is a disease in which the body cannot handle carbohydrates appropriately.  This leads to, among other things, high levels of glucose in the bloodstream.  Almost all organs and systems of the body are affected in diabetes.  This includes the uterus, and the baby growing within, if pregnancy and diabetes coexist.

Pregnancy And Diabetes

Two situations are possible.  In one a woman with previously diagnosed diabetes plans and achieves a pregnancy.  In the other, pregnancy is first diagnosed after pregnancy becomes known.  The latter is known as Gestational Diabetes.  

About 3-7% of all pregnancies are complicated by diabetes, so it is not a rare occurrence.  The situation carries risks for both baby and mother.

Risks To The Baby

The diabetes and pregnancy combination has been known for several decades.  We now know that certain fetal conditions occur with an increased frequency when the mother has diabetes.

Fetal Macrosomia: In other words, large babies.  The increased blood levels of glucose in the mother's blood are carried across the placenta, and babies weighing over 4 Kg are common results of the pregnancy and diabetes combinaiton.

These large babies are difficult to deliver, and birth injuries are common (see sidebar).

Cesarean Sections: Large babies are more likely to need a cesarean section for delivery, of course.  However, even when compared to babies of similar size, those born to mothers with diabetes are more likely to require a cesarean section.

Hypoglycemia: or low blood glucose levels.  The mother's high blood glucose levels are transferred to the baby across the placenta.  Baby's pancreas responds by producing more insulin.  When the glucose transfusion stops abruptly when the cord is cut after birth, the high insulin levels cause a sudden fall in blood glucose levels in the baby.

Babies born to mothers with diabetes in pregnancy should be closely monitored for hypoglycemia.  Apart from immediate effects like lethargy, cyanosis, poor feeding, and seizures (fits), hypoglycemia can cause permanent brain damage.

Jaundice: or hyperbilirubinemia.  Neonatal jaundice is more common, and rises to higher levels, in children of women who had diabetes in pregnancy.  

Respiratotry Distress Syndrome: also called Hyaline Membrane Disease.  It is a serious disease of the respiratory system in babies, and is more frequent in babies when diabetes and pregnancy co existed.  

Long Term Problems: Babies born to women with diabetes during pregnancy are more likely than others to develop type 2 diabetes mellitus themselves when they grow up.  Obesity is also more common in these children.

Birth Injuries in Large Babies

Babies born to women with diabetes during pregnancy are often large.  These large babies are likely to suffer injuries during birth.

Most of these do not lead to a permanent disability.  Fractures heal quickly in children, and the nerve damage is usually of short duration.

Avoiding The Problems

Easier said than done.  While we know that the problems are caused by high glucose levels in the blood, it is difficult to achieve normal blood glucose levels.  Especially in pregnancy.  Many women with diabetes are not detected until a late stage of pregnancy, when the mischief has already been done.  However, the following measures help:

The Pregnancy - Diabetes combination is getting more frequent, because of the obesity epidemic.  Management of a pregnancy complicated by diabetes should be a joint effort of an obstetrician, a diabetologist, a dietitician, and other carers as needed.

Last Revision: July 2, 2020