More diabetics are able to successfully carry pregnancies to term today, due to improved treatment of blood sugar before and during pregnancy. Yet some complications are still common in diabetic deliveries. Diabetic mothers need close attention before and during delivery to prevent complications that can harm her or the baby.
Macrosomia
Infants born to diabetic mothers are often large for gestational age (LGA), or macrosomic, meaning that their weight is greater than the 90th percentile for their gestational age, acording to the Merck Manual. For full-term babies, this is a weight over 4,500 g, or 9 lbs., 15 oz. Macrosomia occurs because of the increased glucose levels circulating to the baby through the placenta. Large infants may not be able to navigate the birth canal; mothers with diabetes are more likely to require Cesarean-section delivery. LGA infants are often lethargic, poor feeders and are more prone to develop respiratory distress after delivery.
Shoulder Dystocia
Some diabetic babies make it through the birth canal without difficulty, but get stuck at the pelvic outlet because their shoulders are broader than normal. Most babies have a larger head circumference than shoulder circumference, so if the head is able to be delivered, the body follows suit. However, if the shoulder circumference is greater than the head circumference, the baby may get stuck. This is an obstetrical emergency, because the head is already delivered. Shoulder dystocia is more common in diabetic mothers, and affects both mother and baby.
Infant complications include fractured collarbone and injury to the brachial plexus nerve, which controls arm movement. The baby can become hypoxic, lacking oxygen, or can die. Maternal complications include hemorrhage, uterine rupture from manual pressure on the organ to help expel the infant and severe tears of the perineum, according to an article published in the April 1, 2004 American Family Physician by Elizabeth Baxley, M.D., of the University of South Carolina School of Medicine and Robert Gobbo, M.D., of the University of California at Davis Family Practice Network.
Hypoglycemia
Hypoglycemia, or low blood sugar, can affect both mothers and babies. Hypoglycemia during labor can be prevented by administration of intravenous solutions containing glucose and close monitoring of blood glucose. Insulin needs drop during labor and for up to 24 to 72 hours after delivery, the American Diabetes Association states, and insulin adjustments may be needed. Babies of diabetic mothers often develop hypoglycemia within one to two hours after birth from the drop in glucose circulating through their blood and should be monitored closely for signs of hypoglycemia. These infants should breastfeed or be given glucose-containing solutions shortly after birth.
