Gestational Diabetes and Labor
By Idesha S. Reese
What is Gestational Diabetes Mellitus?
Gestational diabetes mellitus is a blood sugar imbalance that develops or is first diagnosed during pregnancy. Gestational diabetes is caused by a change in how a woman’s body processes insulin. Insulin is a hormone that regulates that amount of glucose in the blood and a pregnant woman’s body becomes more resistant to insulin which can lead to higher than normal blood sugar levels. The increased blood sugar is transferred to the baby through the placenta and must be monitored and controlled for the health and development of the baby.
Who is at risk?
Any pregnant woman can develop gestational diabetes but certain women are at greater risk. Some risk factors include:
- Age >25 – Women over the age of 25 are at greater risk of developing gestational diabetes
- Overweight – Women who are considered significantly overweight with a body mass index (BMI) of 30 or higher are at greater risk for development of GDM
- Family and personal health history – Women who have prediabetes, have family medical history of a parent or sibling with Type 2 diabetes and/or have had gestational diabetes in previous pregnancies are more likely to develop gestational diabetes
- Ethnicity – women who are of African American, Native American, Hispanic, Asian American or Pacific Islands descent are in a higher risk category for developing gestational diabetes
Monitoring and Treatment for GDM
Currently, gestational diabetes mellitus is thought to affect approximately 7% of all pregnant women. However, with proper diagnosis, monitoring and treatment, many mothers with gestational diabetes carry and deliver healthy babies successfully. Women at average risk for developing gestational diabetes will likely undergo a screening test during the second trimester, between 24 and 28 weeks gestation. Treatment for gestational diabetes mellitus can range from nutritional counseling and a special diet to regular glucose monitoring and medications like insulin. Most treatment plans also include doctor approved exercise. Treatment for gestational diabetes should be tailored to the patient for the best outcome.
Many women with gestational diabetes make it to 37+ weeks of gestation and are able to deliver their babies through their medically appropriate mode of delivery. However, in some instances, gestational diabetes can affect labor and how the baby is delivered. Just because a woman has gestational diabetes doesn’t mean problems will occur during labor and delivery. All concerns should be discussed with your doctor to ensure you are well informed and to help your doctor to ensure the best possible outcome for you and your baby.
- Fetal macrosomia – large for gestational age baby; a baby with a birth weight of 8 pound 13 ounces regardless of gestational age.
- Risk for shoulder dystocia due to fetal macrosomia – shoulder dystocia is a specific case of obstructed labor whereby after the delivery of the head, the anterior shoulder of the infant cannot pass or requires significant manipulation to pass, below the pubic bones. It is diagnosed when the shoulders fail to deliver shortly after the fetal head.
- Higher Risk for delivering via Cesarean Section – due to larger size of the baby, mother may not be able to push baby through birth canal, may not fully dilate to 10 cm or baby may get stuck in the canal which can lead to baby not being able to breathe.
- Jaundice – a medical condition with yellowing of the skin or whites of the eyes, arising from excess of the pigment bilirubin. Treatment may include phototherapy (light therapy). GDM is not the only cause of jaundice in babies.
- Hypoglycemia – a condition in which the amount of blood glucose (sugar) in the blood is lower than normal (under 50 mg/dL).
- Premature birth (prior to 37 weeks) – this can be due to induction because of large size or because the mother’s high blood glucose levels may increase the risk of preterm labor.
- Respiratory Distress Syndrome – a breathing disorder in newborns caused by immature lungs, sometimes occurs in full-term babies born to mothers who have gestational diabetes mellitus.
- Preeclampsia – gestational diabetes is a risk factor for preeclampsia. Risk for gestational diabetes is higher if mother already has preeclampsia. Preeclampsia results in an escalation in blood pressure, 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. The only cure for preeclampsia is to deliver the baby and placenta however, vaginal delivery with preeclampsia comes with its own set of difficulties.
- Miscarriage – women with gestational diabetes are at increased risk for miscarriage.
- Stillbirth – women with gestational diabetes are at increased risk for stillbirth.
What can you do?
Controlling your glucose through diet and moderate exercise early in your pregnancy as well as keeping pregnancy weight gain within the recommended range can help even the balance. If you develop gestational diabetes, follow your treatment plan but also let your doctor know if you have concerns or if something isn’t working. Gestational diabetes is a game changer but with appropriate diagnosis and management, you can still have a positive pregnancy experience with the best possible outcome in labor and delivery.