How does Diabetes in the mother affect the baby before birth?
When a mother has diabetes, her body does not control blood sugar normally. Blood sugar is controlled mainly by insulin. Normally, blood sugar rises after meals. The body responds by putting insulin into the blood stream. The insulin helps the sugar get into the body's cells that use the sugar for energy and growth. With diabetes, there is not enough insulin released by the body causing the blood sugar rise abnormally high. When a mother's blood sugar is high, so is her baby's inside her because sugar travels across the placenta to the baby. The baby's body can and does make insulin. If the blood sugar is high, the baby makes extra insulin to keep its own blood sugar normal.
Diabetes may be present before pregnancy, or it may appear during pregnancy. Diabetes which occurs only during pregnancy is called "gestational diabetes" and appears after the first few months of pregnancy. In gestational diabetes, diet alone often controls the blood sugar level, but sometimes the body needs extra insulin. Diabetes which exists before pregnancy usually requires insulin and often gets worse during pregnancy. Keeping blood sugar in the normal range is very important in pregnancy.
If a woman has diabetes for several years, the blood vessels in her body may be more narrow or show changes of aging. These same changes can occur in the blood vessels to the placenta.
Problems of the developing baby can include:
Large size. The high sugar and high insulin together may make the baby grow larger than normal.
Small size. Usually when the mother has had diabetes for several years and has changes in her blood vessels.
Increased risk for malformations or birth defects. This is more common when diabetes started before pregnancy and/or when there was poor control of blood sugar before and during the first two months of pregnancy. Good control of blood sugar before and during pregnancy can reduce this risk to almost that of non- diabetics.
Unexplained death in-utero. Doctors monitor diabetic women more closely during pregnancy. If the fetus shows signs of problems or there is concern, the doctor may decide to deliver the baby early.
What problems are more common in infants of diabetics during birth? Delivery may be difficult due to the large size of the baby. Normally the head is the largest part of the baby and the head comes first. So, if the head gets through, the rest of the body slips through easily. In the IDM, the shoulders may be large, making them the largest part of the baby. With delivery there may be:
Injury to the nerves to the arm called brachial plexus palsy
The collar bone may break, called fractured clavicle
The baby may need more help breathing at birth because it took longer for the head and shoulders to come out.
The doctors may need to use forceps or a suction cup (vacuum) to help with delivery
The doctors may need to do a cesarean section if the baby is too big for a normal vaginal delivery
What problems do IDM's have after birth? Common problems include:
Low blood sugar - After delivery, the infant no longer is getting sugar from its mother. The IDM may have too much insulin for the amount of sugar that it can make. This causes the blood sugar level to fall.
Breathing problems, both Respiratory Distress Syndrome and Transient Tachypnea of the Newborn
Polycythemia - This is too many Red Blood Cells. If there are only a little more than normal, it will need no treatment. But, if the number of red blood cells is very high, it will cause the blood to become very thick and decrease the flow into the small blood vessels called capillaries. Very thick blood also clots easily, sometimes producing clots where it shouldn't. If your baby's high number of red blood cells needs to be treated, the doctors can remove some blood and replace it with a fluid that does not contain red blood cells.
Meconium Plug - Meconium is the name for the stool in the baby's first bowel movement. Sometimes it can be very hard so that it will not pass easily. If this happens, it is called a meconium plug. It may cause the baby's abdomen (tummy) to become large and uncomfortable. Sometimes it needs to be treated by taking the baby to the x-ray department and placing some fluid through a tube placed in the baby's anus. The fluid will help loosen the plug and allow the stool to pass. Usually once the stool starts passing, the problem does not recur. Because IDM's may be delivered early, they may have the other common problems of premature infants.
Will my baby develop diabetes later on? Being an IDM does not mean the baby will have diabetes later on or in adult life. But, because the tendency toward diabetes runs in families, the IDM is at the same risk as other members of the family, and at a little higher risk than the general population.