Gestational Diabetes and Premature Birth

How GDM Affects Mothers, Babies, and the Birth Process

A diabetic pregnant woman is checking her blood sugar level (self glycemia).
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Pregnant women with diabetes can have healthy pregnancies and healthy babies. The key is to keep diabetes under control to minimize or prevent complications. The more complicated diabetes is, the more problems it can cause. And while gestational diabetes needs to be followed closely, if it is controlled well with diet and exercise, it is not likely to be as serious as pregestational diabetes (having type 2 or type 1 diabetes before becoming pregnant).

Of course, there are still risks. Gestational diabetes, just like the other types of diabetes, can lead to premature birth as well as other complications, especially if it goes untreated.

What Is Gestational Diabetes?

Your body uses sugar for energy. The sugar goes from your blood into your body's cells with the help of a hormone called insulin. Once the sugar is in the cells, it's converted to energy or stored. But, if the body doesn't make enough insulin, or it can't use the insulin well, then the sugar has trouble moving into the cells and stays in the blood instead. High levels of sugar in the blood is called diabetes mellitus. Gestational diabetes mellitus (GDM) is diabetes that develops during pregnancy. After the pregnancy ends, gestational diabetes usually goes away, and blood sugar levels typically return to normal.

Why Does Gestational Diabetes Increase the Chances of Premature Birth?

The complications caused by elevated blood sugar levels can increase the risk of premature birth.

Studies show that the risk of premature delivery due to gestational diabetes is greater if a mother develops diabetes before the 24th week of pregnancy. After the 24th week, the chances of preterm birth go down.

How Gestational Diabetes Affects Babies

There are a number of complications that can result from gestational diabetes, some more serious for your baby than others:

  • Macrosomia: Extra sugar in mom's blood passes to her child. It can lead to excessive growth and a larger than the average baby.
  • Delivery complications: Because of a baby's larger size, injuries during childbirth ​such as the shoulders getting stuck (dystocia), ​bleeding in the head (subdural hemorrhage), or low oxygen (hypoxia) can occur. The delivery may also require the use of forceps or a vacuum, and the chances of a c-section are much higher.
  • Hypoglycemia (low blood sugar): The baby of a mom with diabetes makes extra insulin to handle all the sugar that mom passes to him during pregnancy. After birth, the supply of sugar from mom is cut off, but the child still makes extra insulin. The additional insulin is too much so it brings his blood sugar levels down too low.
  • Respiratory distress: In the weeks before a child is born, the lungs mature and produce something called surfactant. Surfactant coats the little sacs in the lungs and keeps them inflated when the baby breathes. If a baby is born early, his lungs may be immature and without enough surfactant. But, since diabetes also causes a decrease in the production of surfactant, even full term babies can have breathing issues.
  • Feeding problems: Prematurity, low blood sugar after birth, and difficulty breathing can make feedings more difficult.
  • Polycythemia: Sometimes a baby will be born with a high level of red blood cells as a result of a mom having diabetes. It can make the blood thick, and it can also contribute to breathing problems and jaundice.
  • Placental insufficiency: Problems with the placenta and the transfer of oxygen and nutrients to are not likely to occur in gestational diabetes, it is usually only seen in pregestational diabetes. But, in rare cases, if gestational diabetes comes on early and is not controlled, placental issues can lead to a smaller than average baby and IUGR.
  • Jaundice: The breakdown of red blood cells creates bilirubin. When there is a lot of bilirubin or the body cannot get rid of it fast enough, the level of bilirubin in the blood goes up causing the skin and eyes to look yellow. Babies of mothers with diabetes may take longer to get the extra bilirubin out of their body if they are premature, larger than average, or have low blood sugar.
  • Long-term concerns: Along with the complications of prematurity or a birth injury, there is also a greater chance of developing diabetes and being overweight later in life.

How Gestational Diabetes Affects Mothers

  • Higher risk of developing other health issues such as high blood pressure and preeclampsia
  • Greater chance of delivering a preemie
  • More likely to have a c-section due to premature birth, complications, or a big baby
  • Greater risk of getting gestational diabetes again with another pregnancy
  • Increased chance of type 2 diabetes

Who Is More Likely to Get Diabetes During Pregnancy?

Gestational diabetes can develop in any woman at any time during pregnancy. However, the chances of getting GDM go up if you have the following risk factors:

  • Overweight
  • Over 25 years old
  • Gestational diabetes in a previous pregnancy
  • A previous child who was large for gestational age
  • A history of Polycystic ovary syndrome (PCOS)
  • Multiple ​gestation (pregnant with more than one child)
  • A family history of diabetes
  • An ethnic background with a higher rate of diabetes such as African American, Native American, Pacific Islander, Asian, or Hispanic

How Will You Know if You Have Gestational Diabetes?

Since studies show that gestational diabetes affects up to about 9 percent of pregnancies, screening for all women takes place during routine prenatal care. Some of the ways your doctor will check you for gestational diabetes include:

  • Taking a History: Your doctor will talk to you about your family and medical history to determine if you're at a higher risk.
  • Physical Examination: A thorough physical exam can give the doctor clues about your medical health and reveal any of the signs and symptoms of high blood sugar or insulin resistance.
  • Glucose Blood Test: A fasting blood sugar of more than 126 mg/d, a non-fasting blood sugar of more than 200 mg/dL, or an HA1C of 6.5 percent or higher points toward GDM and usually means you'll need additional testing.
  • Glucose Challenge Test: Somewhere between the 24th and 28th week of pregnancy, your doctor will order a screening test. You will drink some liquid sugar, then you'll have a blood test an hour later to see how your body handles the sugar. If the results show the need for more testing, you'll have a similar, but a longer test called an oral glucose tolerance test (OGGT).

What You Can Do About a Diagnosis of Gestational Diabetes

If your doctor tells you that you have gestational diabetes, you will be monitored more closely to prevent complications. The most important thing you can do is try to keep your blood sugar levels under control by following these steps:

  • Learn how to test your blood sugar levels.
  • Exercise and eat healthy to keep your sugar down.
  • You may have to take medication if your blood sugar levels cannot be controlled by diet and exercise alone.
  • Go to all of your prenatal appointments and follow the advice and instructions that your healthcare provider gives you.

What Should You Do After Your Baby Is Born?

See your doctor. Continue to follow up with your doctor to be sure your gestational diabetes goes away. If it doesn't, your doctor will continue to monitor your sugar and treat you for type 2 diabetes.

Maintain a healthy lifestyle. Continue to eat healthy foods and work out regularly. Diet and exercise can keep your blood sugar at healthy levels and reduce the risk of obesity and developing type 2 diabetes in the future.

Breastfeed. Breastfeeding is safe even if your blood sugar levels remain high after pregnancy. Diabetes doesn't harm breast milk. Plus, breastfeeding is good for you and your baby. Not only can it help you lose weight, but it can also reduce the risk of type 2 diabetes for both you and your child later in life.

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Hay WW. Care of the infant of the diabetic mother. Current diabetes reports. 2012 Feb 1;12(1):4-15.

Hedderson MM, Ferrara A, Sacks DA. Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Obstetrics and Gynecology. 2003 October 31;102(4):850-6.

Ngai I, Govindappagari S, Neto N, Marji M, Landsberger E, Garry DJ. Outcome of pregnancy when gestational diabetes mellitus is diagnosed before or after 24 weeks of gestation. Obstetrics & Gynecology. 2014 May 1;123:162S-3S.

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