Birth and Diabetes

In the past, babies born to women with diabetes tended to be large.  This problem,  called macrosomia,  was the baby’s response to having extra amounts of glucose from the mother’s blood. To reduce the risk of delivery problems or stillbirth, these babies were usually delivered by inducing labor or a cesarean section (C-section) before or during the 37th week of a 40-week pregnancy. Now, because more women are able to manage their diabetes more intensively and better tests are available to monitor the baby’s health, most women can deliver close to their due date.

Macrosomia is less common, but sometimes the baby is too large or the woman’s pelvis is too small for a safe vaginal delivery. Trying to deliver a too-large baby vaginally can result in shoulder damage or respiratory distress for the baby. In this case, a C-section is performed.

Your blood pressure will be checked frequently throughout your pregnancy.  High blood pressure can be a sign of preeclampsia, a serious condition that occurs more often in women with diabetes. Preeclampsia may also lead to early delivery, often by C-section.

Labor is work, and usually you will not be able to eat. You will probably get an intravenous catheter (IV) so that fluids or calories can be given as needed. Your blood glucose levels will be monitored frequently during labor. You can be given insulin either as injections or through the IV. Many women don’t need insulin during active labor.

Your baby will be closely watched after birth. He or she is at risk for hypoglycemia and will have frequent blood glucose monitoring during the first 24 hours after birth. Hypoglycemia occurs because the baby has been putting out enough insulin to deal with high glucose levels in the uterus. This does not mean your baby has diabetes.  Jaundice is also common and may require therapy with lights. If your baby was delivered early or is very large for his or her age, your baby will also be evaluated for respiratory problems. It is not unusual for these babies to be in an intensive care nursery for a short time so that they can be watched very closely.

After Delivery
If you have type 1 diabetes, you may require less insulin for the first few days after delivery. If you have type 2 diabetes, you may not need insulin at all during this time. Your insulin needs will gradually go back to your prepregnancy level in about 2 to 6 weeks.

The postpartum period may be one of unpredictable blood glucose swings. Your hormones and body chemistry are in flux.

You are recovering from a major physical challenge. And you are probably exhausted from caring for your baby. If you find that keeping your blood glucose on target poses a greater challenge, try not to get too discouraged. If you find that you feel overwhelmed by trying to care for a new baby and diabetes or you are feeling depressed, contact your health care team. They can help you find sources of support or make a referral for evaluation or counseling. It’s not a sign of weakness to need help at this time. Your baby needs a healthy mother!

If you had gestational diabetes, your blood glucose levels will most likely return to normal after delivery. Nevertheless, you need to be tested for diabetes 6 weeks after your baby is born. A few women continue to have diabetes after they deliver.

If this is the case,  you will be referred to a diabetes care provider. If your postpartum glucose test is normal, you are still at greater risk for developing diabetes than women who never had gestational diabetes. 

If your postpartum test reveals a higher than normal blood glucose level, but not diabetes, your risk of developing diabetes in the next 5 years is high. About 60% of women with gestational diabetes eventually develop type 2 diabetes. The good news is that you can delay or prevent type 2 diabetes in the future with modest weight loss and moderate activity. Losing the weight you gained with your pregnancy may be enough to lower your risk. You also need to have your blood glucose level checked once a year to detect any changes. Ask to have your glucose levels tested earlier in the course of any future pregnancies. Remind all providers that you had gestational diabetes. Some drugs, such as steroids, can raise your blood glucose levels just as pregnancy did.

“Because I had gestational diabetes, I might get diabetes when I’m older.”
This is true. Gestational diabetes is a temporary form of insulin resistance that usually reveals itself about halfway through the pregnancy. This is when the hormones of pregnancy normally create extra insulin resistance. Most women are able to overcome this extra resistance to insulin. However, for women with gestational diabetes, either their pancreas is not able to make the additional insulin that is needed or their body’s cells become less efficient at taking up glucose from the blood.

Women who have had gestational diabetes are at greater risk for getting diabetes again. They have a 2 in 3 chance of developing gestational diabetes during future pregnancies. Also, their risk of developing type 2 diabetes 5 to 15 years after they had gestational diabetes rises to between 40 and 60 percent, compared with about a 15 percent risk in the general population. Obesity increases the risk of getting type 2 diabetes after having gestational diabetes to a 3 in 4 chance. Women who have had gestational diabetes can reduce their risk of developing diabetes closer to a 1 in 4 chance by keeping a healthy body weight .

Don’t forget that you can become pregnant again soon after you give birth. Even if you have not had a period, you can still ovulate. And breastfeeding does not necessarily prevent you from becoming pregnant. So, before you resume having intercourse, be sure you are using effective birth control.

Although virtually every aspect of your life may seem turned on its head after the birth of a new baby, the four basic management tools remain the same: insulin or oral diabetes medication (oral diabetes medications cannot be used while you are breastfeeding), blood glucose monitoring, meal planning, and exercise. Exercise may be the last thing you are thinking about after the baby is born. But as soon as you feel well enough and you have your doctor’s okay, taking your baby for a daily walk can help you feel better and more relaxed.

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