Despite improvements in obstetrical care and the ability of good health care providers to more closely manage blood sugar levels, diabetes in pregnancy remains a significant medical complication, threatening the well being of both mother and baby.
It has long been recognized that the degree of blood sugar control both prior to and during pregnancy will significantly influence the health and well being of the baby. Generally speaking, poor blood sugar control is recognized as posing an increased health risk to both mother and baby.
Because good blood sugar control prior to pregnancy and at the time of conception has been recognized as being beneficial to a good outcome, safe and careful obstetricians will closely manage the diabetes of their patients and otherwise attempt to obtain optimal blood sugar control before the pregnancy begins.
It has long been recognized that women with poorly controlled diabetes in pregnancy are at much higher risk for developing hypertensive disorders during pregnancy, including pre-eclampsia.
The babies of mothers with poorly controlled diabetes in pregnancy are at a much higher risk for neonatal hypoglycemia and other metabolic abnormalities during the first days of life.
Where maternal diabetes is poorly controlled during pregnancy, there may be a resulting delay in the maturation of the baby’s lungs, thereby greatly increasing the risk that the baby will suffer from Respiratory Distress Syndrome, also called Hyaline Membrane Disease.
It has also long been recognized that the babies of mothers with poorly controlled diabetes in pregnancy will be at significant risk for growth abnormalities during pregnancy. Overly large babies are characterized as suffering from “macrosomia.” Macrosomia is typically defined as a fetal weight greater than 4,000 grams or approximately, 8 lbs., 12 oz. at birth
The macrosomic babies of poorly controlled diabetics are at greatly increased risk for suffering trauma at birth, and particularly shoulder dystocia, which is associated with brachial plexus injuries and resultant Erb’s or Klumpke’s Palsy.
It is felt that maternal vascular disease associated with poorly controlled diabetes in pregnancy may also lead to uteroplacental insufficiency, wherein the transfer of nutrients and oxygen from the mother’s placenta to the baby is impeded, thereby causing a fetal growth abnormality.
Thus, depending on the extent of maternal vascular disease associated with poorly controlled diabetes in pregnancy, many babies, instead of growing too much, will be growth restricted, suffering from what is known as Intrauterine Growth Restriction or IUGR.
In those cases where diabetes in pregnancy is poorly managed, maternal diabetic ketoacidosis may result. Diabetic ketoacidosis is a severe complication which poses a significant risk of fetal mortality.
Because of the significant maternal and fetal health risks associated with diabetes in pregnancy, rigorous obstetrical management is necessary to ensure a good outcome for both mother and baby.
Many safe and careful obstetricians will refer their patients who suffer from diabetes in pregnancy to endocrinologists or maternal-fetal specialists, doctors who have special training and expertise in the management of patients with diabetes in pregnancy.
Optimal control of blood sugars by a safe and careful obstetrician will usually be obtained through a detailed plan of diet, exercise and, if necessary, the use of insulin.
Most safe and careful obstetricians will also establish a rigorous regimen to monitor a patient’s blood sugars in order to determine whether optimal blood sugar control is being obtained. Typically, this will include self-monitoring by the patient of her “fasting” blood sugars as well as her blood sugars one and two hours after meals.
The safe and careful obstetrician will also typically monitor blood sugar levels with additional tests performed during each prenatal visit.
In addition to carefully monitoring and treating a patient with diabetes in pregnancy, safe and careful obstetricians will also initiate a regimen of fetal surveillance to routinely assess the effect of the maternal diabetes on the developing baby.
Such fetal surveillance may consist of ultrasonography, serial nonstress testing or biophysical profile testing.
Because the risks associated with poorly controlled diabetes in pregnancy are so potentially grave, many safe and careful obstetricians will deliver their patients prior to term.