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Fetal Complications of Gestational Diabetes Mellitus

Fetal Complications of Gestational Diabetes

fetal complications of gestational diabetes mellitus

Fetal complications of gestational diabetes mellitus are not uncommon. Diabetes during pregnancy may result in complications ranging from mild to very severe. Children born to diabetic mothers are also at an increased risk of diabetes later in life.

Gestational diabetes or GDM is defined as diagnosis of diabetes during 24-28 weeks of pregnancy. If it is diagnosed before this time window, it is usually attributed as previously undiagnosed diabetes.

The test used for diagnosis/screening is called oral glucose tolerance test(OGTT). Approximately 6% of pregnant female in US and 2-38% in rest of the world develop GDM, It imposes quite a lot of complications and risks to both the mother and the baby that requires special consideration to avoid morbidity and mortality.

Fetal Complications of Gestational Diabetes:

Macrosomia (Large size babies):

Macrosomia fetal complication of gestational diabetes mellitus

  • One of the most common fetal complications of gestational diabetes is an abnormally large sized baby which in medical terminology is called macrosomia. It is defined as a birth weight of 4.5 kg or more.
  • The risk of macrosomia is further increased by maternal obesity and poorly controlled blood sugars.
  • According to one report the risk of macrosomia with gestational diabetes in obese mothers was 22.3% as compared to 13.6% in non obese mothers.
  • The mechanism behind these complications is that raised blood sugar levels in mother leads to increase in transfer of sugar and other nutrients through the placenta to the baby and this raises insulin levels in the fetus and ultimately accelerates fetal growth.
  • Fetal growth pattern is abnormal characterized by normal head size but broad shoulders and widened chest and abdomen which contributes to mechanical complications during delivery

Macrosomia is defined as a birth weight of 4.5 kgs or more

Congenital Abnormalities in Children born to Diabetic Mothers:

  • These are the abnormalities present at birth and involve major organ systems in babies born to diabetic mothers and includes the following defects:
    • Cardiovascular:
      • Atrial and ventricular septal defects,
      • Transposition of great arteries,
      • Coarctation of the aorta, and
      • Patent ductus arteriosus
    • Central Nervous System:
      • Anencephaly (absence of head),
      • Microcephaly (small head), and
      • Neural tube defects
    • Gastrointestinal System:
      • Duodenal atresia,
      • Situs inversus,
      • Imperforate anus,
      • Small left colon syndrome

Preterm delivery and Gestational diabetes:

  • The incidence of preterm delivery in gestational diabetes is much higher as compared to non diabetic mothers and contributes to complications like still birth and respiratory problems in neonate and enhances the need for icu care.

Preterm delivery is higher in GDM

Perinatal asphyxia:

  • This is another common complication defined as lack of blood supply or oxygenation in an infant that occurs that occurs immediately before or after birth. According to a study 43 out 162 infants suffered this complication.

Newborns should be immediately provided with supplemental oxygen

Injuries during birth:

  • These injuries usually occur due to mechanical complications due to macrosomia and the most common amongst these is shoulder dystocia that occurs in 1/3rd of babies born to diabetic mothers.
  • It is an emergency condition that occurs during a vaginal delivery. What happens is that as the baby moves down the birth canal his shoulder gets stuck behind the mother’s pelvic bone and the baby gets stuck with in the birth canal and this can lead to asphyxiation, brachial plexus injury, bone fracturs-usually clavicle and humerus and subdural haemorrhage.

Shoulder dystocia is the most common mechanical complication of diabetes during pregnancy

Respiratory distress syndrome:

  • The risk of neonatal respiratory syndrome is markedly increased as maternal hyperglycaemia delays surfactant synthesis and lung maturation. Secondly due to preterm delivery babies born have lungs which are yet to be matured.

Babies with RDS may require surfactant

Hypoglycemia (low blood glucose):

  • This is another frequent complication that occurs in babies during the first 24 hours of life and is characterized by a blood sugar of less than 40mg/dl.
  • It occurs because raised sugar levels in mother causes an increase in blood insulin levels as well that crosses the placenta and enters fetal circulation and after birth that insulin is still there in the baby’s blood but the glucose supply from the mother is no more and this causes hypoglycemia that requires repeated monitoring sometimes glucose infusion.

Babies with persistent hypoglycemia may require glucose infusion

Long term complications of gestational diabetes mellitus:

autism fetal complication of GDM

Autism and Diabetes in later life may be associated with GDM

  • These include development of diabetes, metabolic syndrome and obesity later in life. Reports have also shown an increased incidence of autism and other advese neurodevelopmental outcomes.

Take-Home (Patients Education)

  • Take home message for patients is that GDM can cause lots of complications in new-born that can result in mortality or long term consequences resulting in social stresses and financial burden to the family.
  • The only way to avoid this is timely diagnosis, frequent monitoring and proper management which can significantly decrease the incidence of these complications.

Signs and Symptoms of Hypoglycemia in Newborns, Pregnant, and Old Age

What do you think?

Written by Diabetes Doctor

I am an Internist practicing medicine for the last fifteen years. Over the years, I have learned that medicine is not about prescribing pills. True medical practice is helping people.
I do prescribe pills as well but the best results I get are when I motivate people to overcome their problems with little changes in their lifestyles.
Since most of my patients are obese, have diabetes, hypertension, high cholesterol levels, I am writing at dibesity.com when free.
Dibesity, I know the correct word is diabesity. Ignore this! Be with us.

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