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Gestational Diabetes and Pregnancy

Diabetes mellitus (diabetes) has become a major health concern in this country, with diagnoses continuing to skyrocket, and a significant proportion of the population suffering from it.  In fact, according to Medscape, 21 million people, or 7% of the country’s populace, currently carry a diagnosis of some form of diabetes.  This means that obstetricians have become very familiar with treating pregnant women suffering from the disease, and generally have a solid protocol for successfully dealing with it throughout the length of the pregnancy.  Again, this success absolutely hinges on vigilant patient compliance with dietary, testing and treatment guidelines; but if such instructions are followed and any problems reported early, you and your baby have decidedly better odds than in years past for a smooth and uncomplicated pregnancy.

However, as with any serious condition during pregnancy – but particularly diabetes and several others – there are certain risks and potential complications of which you should be aware.  The subject of gestational diabetes during pregnancy is a fairly vast one, so while not comprehensive, this article will serve to offer you some key information about the major concerns and complications that may arise during your diabetic pregnancy.

What are the most common complications during pregnancy related to gestational diabetes?

As noted above, the list of possible pregnancy complications related to gestational diabetes is quite extensive, but UpToDate lists the following five common conditions seen in gestational diabetes:

  • Macrosomia:  “large body”; mothers with poor sugar control during pregnancy tend to have larger babies at term, which can lead to various labor and delivery issues, such as C-section, shoulder and clavicle problems, and nerve damage.
  • Preeclampsia:  a relatively common syndrome (in gestational diabetes and otherwise) of pregnancy, consisting of rapidly elevated blood pressure and dumping of protein into the urine, among other parameters.
  • Hydramnios:  too much amniotic fluid; commonly seen in gestational diabetes, but not known to significantly contribute to maternal or fetal morbidity or mortality.
  • Stillbirth:  appears to be heavily correlated to glycemic (glucose/sugar) control, and thus amenable to treatment and prevention, to a certain degree.
  • Neonatal Morbidity:  a host of other potential issues, including electrolyte and glucose disturbances, respiratory problems, and various birth defects.

What is the treatment, and how high-risk are the complications to the baby?

It may come as no surprise that the single biggest factor in predicting complications, and therefore the main focus of prevention and treatment, is poor sugar control while pregnant.  As to the risk for the fetus/baby, it is quite varied, but it can be very broadly stated that the less regulated a woman’s glucose and insulin levels, the more trouble her child might experience during its time in the womb and afterward.

To some extent, the treatments will depend on the specific problems and how serious they are.  But in general, there are several major recommendations all obstetricians will offer, and these of course concern proper sugar control.  Towards this end, the pregnant mother must be extremely vigilant in eating a nutritious diet, exercising regularly, closely monitoring blood sugar levels, and reporting fluctuation promptly, so that insulin or other therapy may be initiated/modified if necessary.

Beyond this, particular treatments might include C-section (for macrosomia), hypertension and kidney medication/management (preeclampsia), and any number of interventions on behalf of the mother, fetus or both, depending on the given complication and overall scenario.  Finally, the mother with gestational diabetes should be seen more often (versus normal pregnancies) by their physician for certain maternal and fetal screenings, to ensure that things are progressing smoothly.

Diabetes is tricky, and there are no guarantees of a worry-free pregnancy, even with the best compliance and diligence.  However, heeding the information and guidelines above, in addition to the much more extensive guidance offered by your clinician, will absolutely reduce the chances of complications, and turn the odds in your and your child’s favor.

Questions for your doctor:

  • Am I at particular risk for developing diabetes during my pregnancy?  If yes, how can I avoid it?
  • Are some diabetes treatments/medications safer than others during pregnancy?  Which ones and why?
  • When do we decide whether to deliver by C-section and/or involve maternal-fetal medicine (MFM – high risk birth doctors) specialists?
  • What specific tests or imaging studies are necessary for me that might not be routine for normal pregnancies?  When should these occur?
  • How can I get more information about proper nutrition tailored to the diabetic mother-to-be?  Should I see a dietitian?

References
http://www.uptodate.com/contents/obstetrical-management-of-pregnancy-complicated-by-pregestational-diabetes-mellitus?source=search_result&search=diabetes+in+pregnancy&selectedTitle=3~150

About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians.  After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time.  He may be reached at [email protected].

This post contains opinions of the author.  AutoimmuneMom.com is not a medical practice and does not provide medical advice, diagnosis, or treatment.  It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances.  Camino Real Ventures, Inc., the company that makes AutoimmuneMom.com available to you, does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website.  Your use of the website is subject to our Terms of Use and Privacy Policy

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