Risks of gestational diabetes

If you have gestational diabetes, you will have been told that gestational diabetes holds risks to the mother and baby, but women tell us they are not always clear exactly what those risks are.

A risk means there is a chance that something might happen. It is important to remember that with every pregnancy there are some risks. Keep in mind that most women with gestational diabetes have healthy pregnancies and healthy babies. 

These things are very unlikely to happen to you, but understanding the risks may help you see why it is important that you follow your healthcare team’s advice.

The risks linked to gestational diabetes are caused by blood glucose levels being too high. If you can keep your blood glucose as close as possible to the ideal level, your risks will be reduced.

Risk of having high blood glucose levels

If your blood glucose level is high, it can cause high blood glucose levels in your baby. Your baby will produce more insulin in response, just like you do. This can make your baby grow larger than normal, which makes you more likely to need to be induced or to have a Caesarean so that your baby is born safely. Other risks associated with gestational diabetes are birth trauma (for you or the baby), low blood glucose in your baby and perinatal death (the baby dying around the time of the birth). Keeping your glucose levels under control throughout your pregnancy, and during labour reduces all these risks.

Risk of stillbirth at the end of pregnancy

For all women, the risk of stillbirth or the baby dying shortly after the birth increases when the pregnancy goes over 42 weeks, so all women in the UK who go past their due date are offered an induction date set before 42 weeks. One study has shown that for women with gestational diabetes there is an increased risk of stillbirth after 40 weeks plus 6 days and so if you live in England you will be advised to have an induction before you reach this point.

"You find all these things out, and they are all incredibly rare, but I did really worry. That’s why I was so motivated to manage my glucose levels."Beth, mum of two

Terms you might hear if you have gestational diabetes

Macrosomia - Macrosomia means a big baby. Babies weighing more than 4kg (8lb 8oz) at birth are called macrosomic.

Birth trauma  - Either the mother or baby can be affected when it is difficult for the baby to be born. Macrosomia increases the chances of this happening. Trauma may include physical symptoms, such as bone fractures or nerve damage for the baby, or tearing and severe bleeding for the mother as well as psychological distress.

Shoulder dystocia - Condition where the baby’s shoulder is stuck in your pelvis once the head has been born. This can squash the umbilical cord, so the team need to use additional interventions to deliver the baby quickly and safely.

Perinatal death - This means death around the time of birth and includes stillbirth (when a baby is dead at birth) and neonatal death (when a young baby dies).

Neonatal hypoglycaemia - This is a condition in which your baby’s blood sugar levels are too low. If left untreated, hypoglycaemia can cause damage to the baby’s brain that can lead to developmental delay, but if your team know that you have gestational diabetes then your baby’s glucose levels will be tested to check there are no problems with glucose levels.

If you have gestational diabetes, you are at higher risk of these complications, but many women do not develop any complications at all.

Risks to the baby's health after the birth

Gestational diabetes may also have some effects on the baby’s health. High insulin levels in the baby (caused by high blood glucose levels in the mother) may lead to low blood glucose levels in the baby after birth, so the baby is more likely to need to be cared for in a specialist baby unit in the hospital.

Keeping the risks in perspective

It is natural to find these possibilities worrying. The truth is that there are risks associated with gestational diabetes – and even treatment cannot remove those risks altogether. But it is important to put this into perspective. Every pregnancy has some risks, whether or not the mother has gestational diabetes. Being diagnosed is a good step towards helping you reduce those risks. By getting support from your healthcare team, and following the guidance you can lower the risks as far as possible.

"I suppose everybody who is pregnant has something – there’s always something that doesn’t go right – but I was really worried. You just want it to be perfect, don’t you."Kate, mum of one

Sources

  1.  NHS Choices [ accessed April 2015] Gestational diabetes - complications http://www.nhs.uk/Conditions/gestational-diabetes/Pages/Complications.aspx Review date: 07/08/2016
  2. NICE (2015) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period, National Institute of Health and Care Excellence https://www.nice.org.uk/guidance/ng3
  3. NICE (2008) Induction of labour, Clinical guideline 70, National Institute for Clinical Excellence, Londonhttp://www.nice.org.uk/guidance/cg70/resources/guidance-induction-of-labour-pdf
  4. NCCWCH (2015) Diabetes in pregnancy Management of diabetes and its complications from preconception to the postnatal period NICE Guideline 3, Methods, evidence and recommendations. National Collaborating Centre for Women's and Children's Health  http://www.nice.org.uk/guidance/ng3/evidence/full-guideline-3784285 p 470
  5. [7] Medscape (Reviewed April 2014) Neonatal hypoglycaemia http://emedicine.medscape.com/article/802334-overview

 

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