Gestational Diabetes

Gestational diabetes is one of the most common health issues that can occur during pregnancy. It occurs when the mother is first diagnosed with diabetes partway through the pregnancy. The key to mitigating the effects of gestational diabetes is diagnosing it early using an oral glucose tolerance test. If gestational diabetes is not diagnosed properly, it can lead to macrosomia in the baby (abnormally large fetal size), which puts the baby at risk for neonatal hypoglycemia. It can also lead to jaundice, premature birth, birth asphyxia and reduced uteroplacental perfusion (RUPP), which harms both mother and child by reducing blood flow between baby and mother.


Gestational Diabetes and Birth Injury

Gestational diabetes is a condition in which diabetes (high glucose levels) is first diagnosed during pregnancy.  It is one of the most common pregnancy conditions, affecting 18% of all pregnant women.  Gestational diabetes usually starts midway through the pregnancy, and it occurs when the body cannot make and use as much insulin as it needs.  Insulin is used to convert glucose (blood sugar) into energy.

Early diagnosis and treatment of gestational diabetes is critical to the health and well being of the mother and baby.  If physicians don’t promptly diagnose and treat the condition, it can lead to a macrosomic (very large) baby, which can increase the risk of birth injuries such as hypoxic ishcemic encephalopathy (HIE), brachial plexus injuries, Erb’s palsy and cerebral palsy.  It is recommended that women with gestational diabetes be closely monitored and treated.

Causes of Gestational Diabetes

Pregnancy hormones can block insulin from doing its job.  A hormone called placental lactogen can interfere with susceptible insulin receptors.  When this happens, glucose levels  increase in the pregnant woman’s blood.

Risk Factors for Gestational Diabetes

A woman is at greater risk for gestational diabetes if she has any of the following conditions:

  • Is older than 25 years of age during pregnancy
  • A family history of type 2 diabetes
  • Gave birth to a baby that weighed more than 9 pounds or had a birth defect
  • Previous poor obstetric history
  • High blood pressure and preeclampsia
  • Too much amniotic fluid
  • An unexplained miscarriage or stillbirth
  • Overweight before pregnancy
  • Polycystic ovary syndrome
  • A previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycemia

Signs and Symptoms of Gestational Diabetes

Usually there are few or no symptoms, and in most cases, gestational diabetes is diagnosed by testing for it during pregnancy (screening).

Symptoms may include:

  • Blurred vision
  • Fatigue
  • Frequent infections, including those of the bladder, vagina, and skin
  • Increased thirst
  • Increased urination
  • Nausea and vomiting
  • Weight loss despite increased appetite

Diagnosing Gestational Diabetes Through Blood Tests

The American Congress of Obstetrics and Gynecologists (ACOG) recommends that all pregnant women receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for gestational diabetes.  Women who have risk factors for it may have this test earlier in the pregnancy, typically around the 18th week of pregnancy.

Usually, testing for gestational diabetes is done by having the pregnant woman drink a syrupy solution, with a blood test to check glucose level given an hour later. A follow up test is then given, whereby the pregnant woman fasts overnight, and then has her blood sugar tested the next morning.  After the test, she will drink a solution that has an even higher level of glucose than the syrupy solution given during the initial test.  The woman’s blood glucose level will then be checked every hour for a period of three hours.  If at least two of the blood glucose readings are higher than normal, the woman will be diagnosed with gestational diabetes.

Treatment for Gestational Diabetes

Once a woman is diagnosed with gestational diabetes, the physician will have her monitor her diabetes by testing her glucose level at home. The most common way involves obtaining a drop of blood from a finger and putting it on a machine that will give a glucose reading.  The goals of treatment are to keep blood glucose levels within normal limits during the pregnancy, and to make sure the growing baby is healthy.

With gestational diabetes, frequent check-ups by the physician are essential, especially during the last three months of pregnancy.  The physician will carefully monitor the woman’s blood glucose levels.  Other tests to monitor the baby’s health include:

  • Fetal monitoring to check the size and health of the fetus.
  • A nonstress test (NST), which measures the baby’s heart rate. The heart rate should increase when the baby moves. If the baby’s heart doesn’t beat faster during movement, the baby may not be getting enough oxygen.
  • A biophysical profile (BPP), which combines a nonstress test with an ultrasound study of the baby. There is a scoring system that enables the physician to evaluate the baby’s heartbeat, movements, breathing and overall muscle tone, and determine whether the baby is surrounded by a normal amount of amniotic fluid. The baby’s scores on heartbeat, breathing and movement help the physician determine if the baby is getting enough oxygen. When the amniotic fluid is low, it may mean that the baby hasn’t been urinating enough. This could indicate that over time, the placenta has not been working as well as it should.

In addition to close monitoring, it is recommended that mothers with gestational diabetes be treated with diet, oral hypoglycemic medications or insulin.

Birth Injuries Associated with Gestational Diabetes

Babies born to mothers who have gestational diabetes (especially if uncontrolled) are at risk for the following conditions and complications:

  • Newborn jaundice
  • Premature birth
  • Macrosomia and Gestational DiabetesMacrosomia: This occurs because of the increased blood glucose and insulin levels, which stimulate fetal growth. A baby with macrosomia weighs more than 4000 grams regardless of gestational age. This may increase the likelihood of a C-section or vacuum extractor or forceps birth. It also may result in shoulder dystocia (the baby’s shoulder is preventing the baby from being able to get through the birth canal since it is caught on the pelvis) or cephalopelvic disproportion (the baby’s head is too large to fit through the mother’s pelvis). These delivery problems may lead to brain bleeds and hemorrhaging and problems with oxygenation like hypoxic ischemic encephalopathy (birth asphyxia).
  • Reduced uteroplacental perfusion (RUPP): RUPP is a serious condition that affects blood flow between the mother and fetus, and it can cause harm to the health of both.  RUPP is a reduction in the flow of fluids, including blood (which carries oxygen and nutrients), to and from the placenta.
  • Low blood sugar
  • Seizures
  • Stillbirth (if untreated)

Labor Induction and Gestational Diabetes

It is common practice to induce labor prior to 40 weeks for women with gestational diabetes as a strategy to reduce complications, especially those related to macrosomia. Labor induction is often planned at 38 ½ to 40 weeks’ gestation, and can occur when the baby’s lungs are found to be mature, antepartum tests are normal the diabetes is controlled and the mother doesn’t have vascular disease.

ACOG recommends consideration of C-section delivery in diabetic women when estimated fetal weight exceeds 4500 grams.  Some researchers recommend considering C-section delivery when the estimated weight is between 4000 and 4500 grams, after evaluating obstetrical history and clinical measurements of the pelvis.  Physicians should be alerted to the possibility of cephalopelvic disproportion if  dilation or descent stops during labor, and the baby’s estimated weight exceeds 4000 grams.  These researchers also suggest consideration of C-section delivery in diabetic women who demonstrate significant protracted labor and failure of descent.

There are many factors a physician has to consider when caring for a woman with gestational diabetes and her baby.  Due to the variety and complexity of these issues, it is essential that mother and baby be monitored very closely and treated with expertise throughout the pregnancy, labor and delivery.


Legal Help for Gestational Diabetes and Birth Injury

Reiter & Walsh, P.C. | Trusted Birth Injury Attorneys

Birth Injury Attorneys | Reiter & Walsh, PC | Gestational DiabetesGestational diabetes can cause an array of complications, especially if a physician fails to diagnose the condition or treat it properly. These failures can constitute negligence, and if this negligence causes injury to the mother or baby, it is medical malpractice. Reiter & Walsh, P.C. was established specifically to handle birth trauma cases, and we have experience handling cases related to gestational diabetes. Our specific focus on birth injury allows our attorneys to provide unparalleled legal service to our clients. Our attorneys handle cases all over the United States, in places including Pennsylvania, Tennessee, Mississippi, Texas, Wisconsin, Michigan, Ohio, Washington D.C., Arkansas, and more. Additionally, our team handles cases involving military hospitals and federally funded clinics.

If your child was diagnosed with a birth injury from mismanaged gestational diabetes, the award-winning birth injury lawyers at ABC Law Centers can help. To begin your free case review, you may contact us in any of the following ways:

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Sources

  • Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC. Gestational diabetes in the United States: temporal trends 1989 through 2004. Am. J. Obstet. Gynecol. 198(5),525.E1-525.E5 (2008).
  • American Diabetes Association. Clinical practice recommendations 2001: gestational diabetes mellitus. Diabetes Care 24(Suppl. 1),S77-S79 (2001).
  • Maso, Gianpaolo, Salvatore Alberico, Uri Wiesenfeld, Luca Ronfani, Anna Erenbourg, Eran Hadar, Yariv Yogev, and Moshe Hod. “GINEXMAL RCT: Induction of labour versus expectant management in gestational diabetes pregnancies.” BMC pregnancy and childbirth 11, no. 1 (2011): 1-7.

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