There are two types of diabetes that occur in pregnancy:
With both types of diabetes, there can be complications for the baby. It is very important for a mother to maintain very close control of her diabetes during pregnancy.
The placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.
As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.
Pregnancy also may change the insulin needs of a woman with existing diabetes as a medical condition. Insulin-dependent mothers may require more insulin as pregnancy progresses, sometimes as much as 30 percent over the pre-pregnancy dose.
About 5 percent of all pregnant women in the US are diagnosed with gestational diabetes. Gestational diabetics make up the vast majority of pregnancies with diabetes. Some pregnant women require insulin to treat their diabetes, according to the American Diabetes Association.
The mother's excess amounts of blood glucose are transferred to the fetus during pregnancy. This causes the baby's body to secrete increased amounts of insulin, which results in increased tissue and fat deposits. The infant of a diabetic mother (IDM) is often larger than expected for the gestational age.
The infant of a diabetic mother may have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risk of birth defects and stillbirth. It is thought that poor control of blood glucose is linked to the development of congenital abnormalities. These may include abnormalities in the formation of the heart, brain spinal cord, urinary tract, and gastrointestinal system.
Unlike insulin-dependent diabetes, gestational diabetes generally does not cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. But, the insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes generally have normal blood glucose levels during the critical first trimester.
A newborn infant of a diabetic mother may develop one, or more, of the following:
Treatment of a baby born to a diabetic mother often depends upon the control of diabetes during the last part of pregnancy and during labor. Specific treatment will be determined by your baby's physician based on:
Treatment may include:
Prenatal care is essential to a healthy outcome when a mother has diabetes in pregnancy. Careful diet management, blood glucose monitoring, and insulin therapy can help keep a mother's blood glucose levels at normal levels and decrease many of the risks to her baby.