Women who have diabetes have more complicated pregnancies than women who don't, and their babies are prone to problems after birth. Diabetes in pregnancy can be one of three types: insulin-dependent or Type 1 diabetes before pregnancy; Type 2 diabetes diagnosed before pregnancy; and gestational diabetes, which develops during the pregnancy and in many cases disappears after pregnancy. Although women who are Type 1 diabetics have babies with the most complications, newborns born to moms with Type 2 diabetes and gestational diabetes can also have problems.
Large for Gestational Age, or LGA
Newborns larger than 10 lbs. are more common in women with diabetes of any type, because the extra glucose circulating through her system and the placenta put extra weight on the baby. LGA, also known as macrosomic, babies have a more difficult time during delivery; their large size makes them prone to shoulder dystocia, where shoulders larger than the head may get stuck after the head is delivered. In most newborns, the head is the largest part of the baby, and once it's delivered, the shoulders follow. More diabetic moms need cesarean section to deliver their infants.
Respiratory Distress
The Merck Manual says respiratory distress is more common in LGA infants, whose lungs mature more slowly than babies of non-diabetic moms. This--coupled with the fact that diabetic mothers often deliver early because of the size of their babies and may need to be delivered by cesarean--gives three reasons that respiratory distress occurs in these infants: early delivery, cesarean section and diabetic mothers. Your doctor should be aware of the possible risk of respiratory distress and may send the baby to be observed in the nursery for a short time after delivery.
Jaundice
Newborns of diabetic mothers have an excess of red blood cells circulating in their systems, according to Merck. Because the breakdown of red blood cells leads to jaundice, and because newborns of diabetic moms may be hypoglycemic--which can make them poor feeders--bilirubin (the byproduct of red blood cell breakdown) can lead to jaundice, a yellow tinge to the skin and whites of the eyes. Treatment is extra fluid to wash out the bilirubin in the stool or treatment with ultraviolet light. Keeping bilirubin levels low is essential to prevent brain damage.
Hypoglycemia
Newborns of diabetic mothers are more likely to have hypoglycemia, or low blood sugar, after delivery. The unusually high amounts of glucose circulating through the placenta are suddenly cut off after delivery and the baby becomes hypoglycemic. Hypoglycemia can cause the baby to be jittery or lethargic. Poor feeding is common, which makes hypoglycemia worse because glucose is needed from feeding to raise blood sugar. Hypoglycemia can result in brain damage if not promptly treated with glucose, either by mouth or by IV.
Birth Defects
Type 1 diabetic women have infants with an increased risk of birth defects. Blood sugars that are high before a woman knows she's pregnant can damage the developing organs of the fetus. Babies born to insulin-dependent diabetic moms are two to four times more likely to have birth defects, says the March of Dimes. Heart defects and neural tube defects such as spina bifida are the most common types of birth defects. Miscarriage and stillbirth are also more common in Type 1 diabetics. Keeping blood sugars under control, especially in the first weeks of pregnancy, is essential to prevent birth defects.
