Because your baby may be larger than normal, he or she is at higher risk for some complications. Remember, these are just possible complications. Your baby might have none of them. They include:
1.Injuries during delivery because of the baby’s size
The greatest impact of gestational diabetes on delivery is related to fetal size. When gestational diabetes is undiagnosed or poorly managed during pregnancy the fetus responds to the high maternal glucose levels by secreting insulin.
These high levels of fetal insulin result in excessive fetal growth. At term these infant may weigh in the range of 9 to 12 pounds.
These macrosomic infants are more likely to become wedged in the birth canal, to cause laterations of the maternal perineal tissue, to sustain birth injuries and to necessitate a cesaream delivery.
2.Low blood sugar and mineral levels at birth
Low blood glucose (hypoglycemia): Right after the baby is born, the blood glucose level may drop very low (hypoglycemia) because they have so much insulin in their bodies. The extra glucose in your body actually stimulates the baby’s body to make more insulin, so when the baby is out the womb, the extra insulin can cause problems. Hypoglycemia in babies is easily treated by giving the baby a glucose solution to quickly raise the blood glucose level. Feeding the baby should also raise the blood glucose level.
3.Jaundice, a treatable condition that makes the skin yellowish
Most parents panic when they hear their baby has jaundice as they think it’s the same ailment which affects adults. Jaundice in healthy infants, unlike in adults, is not due to problems in the liver.
Jaundice develops in a healthy baby when her blood contains an excess of bilirubin – a chemical produced during the normal breakdown of old red blood cells.
Newborns tend to have higher levels because they have extra oxygen-carrying red blood cells and their young livers can’t metabolise the excess bilirubin.
As the baby’s bilirubin level rises above normal, the yellowness spreads downwards from the head to the neck, to the chest, and in severe cases, to the toes. Unless it’s a serious case, your baby’s jaundice will usually not cause any damage.
In severe but rare cases of jaundice caused by liver disease or maternal blood incompatibility, newborns may suffer damage to the nervous system.
How common is jaundice in newborns?
60 per cent of full-term infants develop jaundice on the second or third day after birth. It usually peaks by around the fifth or sixth day and then starts to decrease. In most babies it disappears after one week, though some babies may take about a fortnight to recover completely.
80 per cent of premature babies develop it between the fifth and seventh days after delivery. It usually disappears within a month of birth.
Some studies suggest that mothers with gestational diabetes may have a higher risk of giving birth to babies with jaundice.
Some studies also suggest that the male child is more likely to have jaundice than a female.
Babies of mothers with blood group O have a higher chance of developing jaundice.
How can jaundice in my baby be treated?
If your baby looks jaundiced, your doctor may suggest tests to measure the bilirubin level in her blood. If your baby was born at term and is otherwise healthy, most doctors will not begin treatment, unless the bilirubin level is over 16 milligrams per decilitre of blood but it also depends on the age of the baby.
Since the early 1970s, jaundice has been treated with phototherapy, a process in which infants are exposed to fluorescent-type lights which break down excess bilirubin. The baby usually lies naked under the lights for a day or two, with her eyes covered by a protective mask.
If the level of bilirubin doesn’t require phototherapy, you can still help your baby by taking her out into the sunlight in the early morning or late afternoon. Take care not to expose your baby for too long since her delicate skin is prone to sunburns.
In the rare case of blood-type incompatibility where the bilirubin level can rise to dangerously high levels, your baby may need a blood transfusion. The Rh blood test you have when you are pregnant should alert you in advance about any incompatibility with your baby, and you will be given anti-D injections to avoid this problem.
If your baby is born early – also called ‘premature’ or ‘preterm’ – he may need special care.
The definition of a ‘premature’ or ‘preterm’ baby is one that is born before 37 weeks. There are different levels of prematurity and these carry their own risks. Very premature babies, born before week 26, are at most risk and are sometimes known as micro preemies. A baby born at 37 weeks or more is known as a ‘term’ baby. Generally the earlier your baby is born the higher the risk of health problems.
5.Temporary breathing problems
Sometimes, babies have trouble breathing on their own right after they’re born, and this breathing difficulty is more likely in babies whose mother has gestational diabetes. This should go away after the lungs become stronger.
Researchers have noticed that children whose mothers had gestational diabetes are at a higher risk for developmental problems, such as language development and motor skill development.
Later in life, your baby might have higher risks of obesity and diabetes. So help your child live a healthy lifestyle — it can lower his/her chances of developing obesity and diabetes.
How Will Gestational Diabetes Affect Me?
Gestational diabetes increases the chances of certain pregnancy complications. Your doctor or midwife will want to watch your health and your baby’s health closely for the rest of your pregnancy.
Possible risks include:
1.Higher chance of needing a C-section
Gestational diabetes can sometimes affect whether you are able to deliver your baby vaginally or by cesearean delivery.
Your healthcare provider, once you have been diagnosed with gestational diabetes, will follow you closely, and monitor your baby. In monitoring you and your baby closely, your healthcare provider will monitor the baby’s growth.
Babies born to mothers with gestational diabetes are often large for their gestational age — meaning that they are bigger than most babies at the same time in their mother’s pregnancy. Large babies, sometimes referred to as macrosomic infants, are at risk for not fitting through the mother’s boney pelvis.
This may lead to a failure to dilate in labor, or an ability to dilate in labor to 10 centimeters, but an innability to push the baby out safely.
As your healthcare provider measures your baby’s growth in the last weeks of your pregnancy, he/she will be able to determine the safest route of delivery for you and your baby.
Women with pre-existing diabetes have a higher risk of miscarrying. Those with type 2 often need to adjust their medication early in pregnancy; many switch from tablets to insulin injections.
Women with type 1 diabetes are risk having severe ‘hypos’ (episodes of low blood glucose). Often, the usual warning signs, such as feeling sweaty or shaking, change or disappear during pregnancy. To avoid unexpected hypos, you should be careful not to skip meals. You should also always carry foods to quickly treat hypos, such as jelly beans, carbohydrate snacks and glucose tablets.
3.High blood pressure or preeclampsia
Like gestational diabetes, preeclampsia is a condition that only appears during pregnancy. Gestational diabetes causes elevated blood sugar levels and can result in preeclampsia which involves type of high blood pressure.
Sometimes pregnancy hormones can disrupt your body’s ability to use insulin. Insulin is the hormone that converts blood sugar into usable energy. When it can’t perform effectively, blood glucose (sugar) levels rise.
Insulin resistance can cause high blood glucose levels and can eventually lead to gestational diabetes.
Gestational diabetes is a risk factor for preeclampsia. Your risk for gestational diabetes is highest if you already have preeclampsia.
Preeclampsia results in an escalation in blood pressure, as well as high levels of protein in the urine or blood, as well as swelling in the face, feet and hands. Preeclampsia is more prevalent among women with gestational diabetes, and among overweight women.
There are many factors that can increase the risk for preeclampsia.
Periodontal disease or urinary tract infections may leave a woman more vulnerable to preeclampsia. If you have been subject to chronic high blood pressure, kidney disease, lupus, migraines or rheumatoid arthritis or other chronic conditions you are at high risk for preeclampsia.
Women at risk for preeclampsia may have a family history of preeclampsia, or may have had it in an earlier pregnancy. Women pregnant for the first time are at highest risk for preeclampsia.
Women who have become pregnant by a new partner will be at higher risk for preeclampsia than women who are pregnant a second time by the same partner. A multiple pregnancy (carrying twins, triplets or more) brings with it a higher risk for preeclampsia than a single pregnancy.
Women between the ages of 20 and 40 years of age are at lower risk for preeclampsia than women who are younger or older.
Preeclampsia must be carefully monitored to prevent serious complications such as seizures. Once preeclampsia is on the scene, the only way to end it is by delivering the baby.
If the pregnancy is at less than approximately 37 weeks, and if the preeclampsia is mild, you may be able to buy some time by resting in bed at home. You can help things by drinking more water and eating less salt. Your doctor will want frequent appointments with you to monitor the situation.
At or beyond 37 weeks, your doctor may recommend induction of labor or a cesarean section.
Generally delivering the baby begins the resolution of preeclampsia. In most cases within six weeks of delivering the baby will see the disappearance of high blood pressure, protein in the urine and all other symptoms of preeclampsia.
Mothers with pre-existing or gestational diabetes are more likely to have a pre-term (prior to 37 weeks), or very pre-term (before 32 weeks) birth. On average, one-in-five women with type 1 or 2 diabetes and almost one-in-ten mothers with gestational diabetes give birth at 32-36 weeks. Women with diabetes are more likely to have an induced labour, an instrumental birth (delivery with forceps or ventouse) or a caesarean section.
After birth, you will have a higher risk of developing type 2 diabetes. Lifestyle changes can lower the odds of that happening. Just as you can help your child, you can lower your own risk of developing obesity and diabetes.
How can I protect myself and my baby?
Women with diabetes can have healthy pregnancies and babies. It is important to try to establish healthy blood glucose levels before pregnancy. If you have an unplanned pregnancy, stabilising your blood glucose as soon as you find out you’re pregnant is critical because your baby’s major organs develop during the first eight weeks. Paying careful attention to nutrition and maintaining general fitness can help you control your blood glucose levels.
Before you conceive, or as soon as possible afterwards, your doctor will want to test you for diabetes-related complications. You may undergo a physical exam to check for nerve damage; you will be asked to provide a urine sample so your kidney function can be assessed and your doctor will recommend that you visit an ophthalmologist to have your eyes assessed.
During pregnancy, your diabetes medication will need to be carefully monitored. If you have type 2 diabetes and are taking tablets prior to pregnancy, your doctor may advise that you convert to insulin in order to better control your glucose levels. During labour and delivery, your endocrinologist will keep an eye on your levels. They will adjust your insulin dosage directly after your baby is born to safeguard you against hypoglycaemia.
If your baby is producing high levels of insulin during your pregnancy in response to your high glucose levels, their blood sugars could be low following birth. If left untreated, this could lead to seizures. Your baby’s blood glucose levels will be tested (by heel prick) every four hours for the first 24 hours of their life. If their glucose levels are very low, they may need to have supplementary feeds. Insulin does not pass into your breastmilk, so it is safe for mothers to breastfeed their babies. Breastfeeding within 30 to 60 minutes of birth can reduce the risk of your baby having low blood sugar. Regular feeds (every three to four hours) can help them to maintain blood glucose levels.
Mothers with gestational diabetes are at risk of developing type 2 diabetes later in life. You will typically be offered an oral glucose tolerance test about 6-8 weeks after giving birth. This test assesses whether your blood glucose levels are within the normal range. The test should be repeated every three years.
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