Diabetes During Pregnancy
Risks Fetal Development And Newborn Health

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Diabetes during pregnancy risks the well being of the baby, both before and after birth. 1 of every 10 pregnancies is challenged by the effects of diabetes mellitus. Yet more suffer lesser forms of glucose intolerance; enough to jeopardize fetal development and newborn health. Periconception normal glucose metabolism is crucial for favorable outcome of pregnancy. 

Gestational Diabetes

Pregnancy is associated with stress and weight gain, the common components involved in evolution of diabetes mellitus. Poor insulin response effectuates imbalance of glucose metabolism, thereby the gestational diabetes. 

Global incidence of diabetes has doubled in past decade, but only 10% of all diabetic mothers suffer from pre-existing Type 1 or Type 2 diabetes. In rest of the 90%, the onset of impaired glucose regulation occurs during pregnancy. 

The known risk factors for development of gestational diabetes are:

Risk Factors For Development Of Gestational Diabetes

Besides genetic predisposition, periconceptional good control of glucose metabolism is the decisive factor for normal fetal development.

Awareness of effects of diabetes mellitus on the fetus and the newborn can ensure good compliance of the to be parents.

Only diligent preconception health care, necessary screening and timely interventions can prevent fetal morbidity, complications of child birth and newborn health issues attributable to diabetes during pregnancy.

Diabetes during pregnancy puts IDM at health risk

The chances of abortion and premature births are significantly higher in diabetic mother with poor blood sugar control around conception. Risks of preterm delivery. birth injuries and cesarean delivery are also aggravated due to macrosomia.

High blood sugar during early phase of pregnancy, when the mother does not even know that she could be pregnant, also aggravates the risk of severe birth defects in IDM, an infant of diabetic mother. 

Deranged glucose utilization induced hyperglycemia and hyperinsulinemia endanger together cause several newborn health issues that often demand intensive care management of IDM. See the flow chart given below.

Diabetes During Pregnancy Risks The Baby's Health

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Birth defects in IDM

Diabetes during pregnancy increases the risk of birth defects. High blood glucose level around conception disturbs fetal organs development at initial stages, which leads to major defects in vital organs formation. Brain, spinal cord and heart formation is thus affected in over 50% of IDM. Kidney, intestines and bone are the other organs that are affected. 

Most common birth defects in IDM

  • Heart defects:

    1. Ventricular septal defects

    2. Atrial septal defects

    3. Aortic stenosis Transposition of the great vessels

    4. Coarctation of the aorta

    5. Hypoplastic left heart syndrome

  • Brain and spinal cord defects: Failure of neural tube closure -

    1. Meningomyelocele

    2. Encephalocele

    3. Anencephaly

  • Skeletal defects (defects in bones formation):

    1. Caudal regression syndrome - absence or incomplete formation of sacral bone.  

    2. Syringomyelia

    3. Other defects of spinal column (back bone) 

  • Kidney defects:

    1. Hydronephrosis

    2. Renal agenesis

    3. Cystic kidneys 

  • Defects in intestine formation: Atresias occur anywhere along the intestines; duodenal and rectum are however the most common. 

Hemoglobin A1C levels indicate the risk of birth defects in IDM

The risk of birth defects in IDM increases with increase in the degree and duration of inadequate glucose control in the mother. Hemoglobin A1C (hemoglobin bound to glucose) evaluation at 14 weeks of pregnancy could determine the risk of birth defects in IDM.  Hemoglobin A1C, also known as glycosylated haemoglobin, is a reliable measure of blood glucose levels over previous 2-4 months.

Couples planning pregnancy 

Couples planning pregnancy should diligently avail preconception health care. It is noted:

  • Diabetes in father does not increase the risk of birth defects in his baby, but that in mother does. 

  • Good glucose control around conception is most crucial for normal fetal development.

  • Onset of gestational diabetes after first three months of pregnancy can lead to ill effects of hyperglycemia and hyperinulinemia, but does not increase the chances of severe birth defects in the baby. Therefore, all to be mothers should maintain optimal glucose control for some weeks before conception and thereafter.

  • At 14 weeks of pregnancy Hemoglobin A1C levels below 7% (normal value is less than 5.7%) does not significantly increase the risk of birth defects of diabetes during pregnancy as compared to that in an infants of mothers without diabetes. But once the level rises above 8.5% the risk increase significantly.

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