ASSIGNMENT

ON
DIABETIC BABY

SUBMITTED TO SUBMITTED BY

DIABETIC BABY
Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). Like
other types of diabetes, gestational diabetes affects how your cells use sugar (glucose).
Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's
health.
While any pregnancy complication is concerning, there's good news. Expectant mothers can help
control gestational diabetes by eating healthy foods, exercising and, if necessary, taking
medication. Controlling blood sugar can keep you and your baby healthy and prevent a difficult
delivery.

In women with gestational diabetes, blood sugar usually returns to normal soon after delivery.
But if you've had gestational diabetes, you have a higher risk of getting type 2 diabetes. You'll
need to be tested for changes in blood sugar more often.

For most women, gestational diabetes doesn't cause noticeable signs or symptoms. Increased
thirst and more-frequent urination are possible symptoms.

When to see a doctor

If possible, seek health care early — when you first think about trying to get pregnant — so your
doctor can check your risk of gestational diabetes along with your overall wellness. Once you're
pregnant, your doctor will check you for gestational diabetes as part of your prenatal care.

If you develop gestational diabetes, you may need checkups more often. These are most likely to
occur during the last three months of pregnancy, when your doctor will monitor your blood sugar
level and your baby's health.

Causes

Researchers don't yet know why some women get gestational diabetes and others don't. Excess
weight before pregnancy often plays a role.

Normally, various hormones work to keep your blood sugar levels in check. But during
pregnancy, hormone levels change, making it harder for your body to process blood sugar
efficiently. This makes your blood sugar rise.

Risk factors

Some women have a greater risk of gestational diabetes. Risk factors for gestational diabetes
include the following:
  Overweight and obesity.

 A lack of physical activity.

 Previous gestational diabetes or prediabetes.

 Polycystic ovary syndrome.

 Diabetes in an immediate family member.

 Previously delivering a baby weighing more than 9 pounds (4.1 kilograms).

 Race — Women who are Black, Hispanic, American Indian and Asian American have a
higher risk of developing gestational diabetes.

Complications

Gestational diabetes that's not carefully managed can lead to high blood sugar levels. High blood
sugar can cause problems for you and your baby, including an increased likelihood of needing a
C-section to deliver.

Complications that may affect your baby

If you have gestational diabetes, your baby may be at increased risk of:

 Excessive birth weight. Higher than normal blood sugar in mothers can cause their
babies to grow too large. Very large babies — those who weigh 9 pounds or more — are
more likely to become wedged in the birth canal, have birth injuries or need a C-section
birth.

 Early (preterm) birth. High blood sugar may increase women's risk of early labor and
delivery before the due date. Or early delivery may be recommended because the baby is
large.

 Serious breathing difficulties. Babies born early to mothers with gestational diabetes

may experience respiratory distress syndrome — a condition that makes breathing difficult.

 Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational

diabetes have low blood sugar (hypoglycemia) shortly after birth. Severe episodes of
hypoglycemia may cause seizures in the baby. Prompt feedings and sometimes an
intravenous glucose solution can return the baby's blood sugar level to normal.
  Obesity and type 2 diabetes later in life. Babies of mothers who have gestational
diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

 Stillbirth. Untreated gestational diabetes can result in a baby's death either before or

shortly after birth.

Complications that may affect you

Gestational diabetes may also increase your risk of:

 High blood pressure and preeclampsia. Gestational diabetes raises your risk of high
blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes
high blood pressure and other symptoms that can threaten the lives of both mother and
baby.

 Having a surgical delivery (C-section). You're more likely to have a C-section if you

have gestational diabetes.

 Future diabetes. If you have gestational diabetes, you're more likely to get it again
during a future pregnancy. You also have a higher risk of type 2 diabetes as you get older.

If you have diabetes and plan to have a baby, you should try to get your blood glucose levels
close to your target range before you get pregnant.

Staying in your target range during pregnancy, which may be different than when you aren’t
pregnant, is also important. High blood glucose, also called blood sugar, can harm your baby
during the first weeks of pregnancy, even before you know you are pregnant. If you have
diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage
your diabetes. Working with your health care team and following your diabetes management
plan can help you have a healthy pregnancy and a healthy baby.

Plan to manage your blood glucose before you get pregnant.

If you develop diabetes for the first time while you are pregnant, you have gestational diabetes.

How can diabetes affect my baby?

A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8
weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can
increase the chance that your baby will have birth defects, such as heart defects or defects of the
brain or spine.

High blood glucose levels during pregnancy can also increase the chance that your baby will be
born too early, weigh too much, or have breathing problems or low blood glucose right after
birth.

High blood glucose also can increase the chance that you will have a miscarriage NIH external
link or a stillborn baby.1 Stillborn means the baby dies in the womb during the second half of
pregnancy.

How can my diabetes affect me during pregnancy?

Hormonal and other changes in your body during pregnancy affect your blood glucose levels, so
you might need to change how you manage your diabetes. Even if you’ve had diabetes for years,
you may need to change your meal plan, physical activity routine, and medicines. If you have
been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to
your due date, your management plan might change again.

What health problems could I develop during pregnancy because of

my diabetes?
Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney
disease, especially if your blood glucose levels are too high.

You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is
when you develop high blood pressure and too much protein in your urine during the second half
of pregnancy. Preeclampsia NIH external link can cause serious or life-threatening problems for
you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and
have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before
37 weeks, you and your doctor may consider other options to help your baby develop as much as
possible before he or she is born.

How can I prepare for pregnancy if I have diabetes?

If you have diabetes, keeping your blood glucose as close to normal as possible before and
during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups
before and during pregnancy, following your diabetes meal plan, being physically active as your
health care team advises, and taking diabetes medicines if you need to will help you manage
your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you
and your baby stay healthy.

Work with your health care team

Regular visits with members of a health care team who are experts in diabetes and pregnancy
will ensure that you and your baby get the best care. Your health care team may include

 a medical doctor who specializes in diabetes care, such as an endocrinologist or

a diabetologist
 an obstetrician with experience treating women with diabetes
 a diabetes educator who can help you manage your diabetes
 a nurse practitioner NIH external link who provides prenatal care NIH external
link during your pregnancy
 a registered dietitian to help with meal planning
 specialists who diagnose and treat diabetes-related problems, such as vision problems,
kidney disease, and heart disease
 a social worker or psychologist to help you cope with stress, worry, and the extra
demands of pregnancy

Planning the birth

There are some risks associated with giving birth if you have gestational diabetes. Your
healthcare professionals should explain your options for giving birth before you make your birth
plan.

If your ultrasound scans have shown that your baby is large, you may be advised to have an
early induction (starting labour artificially) or planned caesarean section. Even if you’ve had a
caesarean section before, you may still be able to give birth vaginally if you want to.

Your team may advise you to give birth in a hospital. This is because it has all the facilities
needed to look after you and your baby during and after labour.

If you have any other health problems, such as being overweight or any spinal nerve-related
problems, you may be advised to see an anaesthetist. They can talk to you about the different
methods of pain relief suitable for you during the birth.

When to have your baby

If your pregnancy goes on for too long, it may increase the risk of problems for you and your
baby.

If you live in England and Wales, you will be advised to have your baby before 41 weeks. If you
don’t go into labour naturally by then, you will be offered an induction or advised to have
a planned caesarean section. You may be advised to have your baby earlier than this if you have
complications, such as high glucose levels, high blood pressure or a big or small baby.      
In Scotland, most women with diabetes in pregnancy are advised to have labour induced within
40 weeks.

If your labour starts before 37 weeks

If you go into labour early, you may also be given medication to help your baby’s lungs develop.

If you’re on insulin and have steroids, your insulin dose will be increased and your glucose
levels will be closely monitored. This is because steroids can raise your blood glucose.

Monitoring during labour

It’s important that your glucose levels stay in the target range during labour. This will prevent
your baby’s glucose getting low in the first few hours after they’re born. This is known as
transient neonatal hypoglycaemia.

When you are in active labour, your blood glucose should be measured every hour to make sure
it stays at a safe level. You may be given insulin and glucose through a drip to help with this.

This is more likely to happen if you are already giving yourself insulin injections. If you
managed your glucose levels through diet alone, you may need very little additional monitoring
during labour.

If you are exhausted, if your baby is distressed, or if they are not moving out of the birth canal,
you may need an assisted birth. This is when the doctor uses special instruments to help deliver
the baby during the last stage of labour.

During labour, your baby’s heart rate should also be continuously monitored.

What happens after my baby is born?

Your baby’s health
Your baby will stay with you unless they need extra care.

There is no reason why you can’t breastfeed your baby if you have gestational diabetes. In fact, it
can help protect their future health. If you’ve had gestational diabetes your baby may be at
greater risk of developing obesity and or diabetes in later life. But breastfeeding can reduce these
risks, as well as protect your baby against the risk of infections, asthma and heart disease.

However you choose to feed your baby, you should start feeding them as soon as possible after
birth (within half an hour) and then every 2-3 hours. This will help your baby’s glucose stay at a
safe level.

A few hours after the birth, your healthcare team will test your baby’s glucose level by pricking
their heel to get a drop of blood. Your baby will not enjoy this but it should be very quick, so try
not to let it upset you. The test is done to keep your baby safe.

Your baby may need to be looked after in a neonatal unit if they:

  are unwell
 need close monitoring or treatment
 need help with feeding
 were born prematurely.
Find out more about feeding your baby after birth.

Your health
You’ll probably be advised to stop taking any diabetes medication straight away after your baby
is born. This is because gestational diabetes usually settles after birth.

Your glucose levels should be tested to make sure they have gone back to normal before you go
home. You should also have a diabetes test about 6-8 weeks after your baby is born. This is
important, because some women will still have diabetes after pregnancy.

Women who have had gestational diabetes have a higher risk of developing type 2 diabetes. This
means you will be advised to have a test once a year, which you can arrange at your GP's
surgery.

Find out more about the long-term implications of gestational diabetes.

If you become pregnant again

If you’ve had gestational diabetes before, you are at risk of getting it again in your next
pregnancy. If you’re planning to get pregnant again, trying to live a healthy lifestyle now will:

 improve your fertility

 protect your baby’s future health
 reduce your risk of problems in pregnancy.
Find out more about getting pregnant if you’ve had gestational diabetes before.

What does all this mean for you?

If your birth experience is different to what you had hoped for, this can be difficult to come to
terms with. It is important to remember that labour and birth often does not go to plan, whether it
is complicated by gestational diabetes or not. For many women, knowing more
about induction and caesarean births helps them feel mentally prepared for what may happen.

Get a checkup

Have a complete checkup before you get pregnant or as soon as you know you are pregnant.
Your doctor should check for

 high blood pressure

 eye disease
 heart and blood vessel disease
  nerve damage
 kidney disease
 thyroid disease

Pregnancy can make some diabetes health problems worse. To help prevent this, your health care
team may recommend adjusting your treatment before you get pregnant.

Don’t smoke

Smoking can increase your chance of having a stillborn baby or a baby born too early.2 Smoking
is especially harmful for people with diabetes. Smoking can increase diabetes-related health
problems such as eye disease, heart disease, and kidney disease.

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone.
You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips
on quitting, go to Smokefree.gov External link.

See a registered dietitian nutritionist

If you don’t already see a dietitian, you should start seeing one before you get pregnant. Your
dietitian can help you learn what to eat, how much to eat, and when to eat to reach or stay at
a healthy weight before you get pregnant. Together, you and your dietitian will create a meal
plan to fit your needs, schedule, food preferences, medical conditions, medicines, and physical
activity routine.

During pregnancy, some women need to make changes in their meal plan, such as adding extra
calories, protein, and other nutrients. You will need to see your dietitian every few months
during pregnancy as your dietary needs change.

Be physically active

Physical activity can help you reach your target blood glucose numbers. Being physically active
can also help keep your blood pressure and cholesterol levels in a healthy range, relieve stress,
strengthen your heart and bones, improve muscle strength, and keep your joints flexible.

Before getting pregnant, make physical activity a regular part of your life. Aim for 30 minutes of
activity 5 days of the week.

Talk with your health care team about what activities are best for you during your pregnancy.

Avoid alcohol

You should avoid drinking alcoholic beverages while you’re trying to get pregnant and
throughout pregnancy. When you drink, the alcohol also affects your baby. Alcohol can lead to
serious, lifelong health problems for your baby.
Adjust your medicines

Some medicines are not safe during pregnancy and you should stop taking them before you get
pregnant. Tell your doctor about all the medicines you take, such as those for high cholesterol
and high blood pressure. Your doctor can tell you which medicines to stop taking, and may
prescribe a different medicine that is safe to use during pregnancy.

Doctors most often prescribe insulin for both type 1 and type 2 diabetes during pregnancy.3 If
you’re already taking insulin, you might need to change the kind, the amount, or how and when
you take it. You may need less insulin during your first trimester but probably will need more as
you go through pregnancy. Your insulin needs may double or even triple as you get closer to
your due date. Your health care team will work with you to create an insulin routine to meet your
changing needs.

Take vitamin and mineral supplements

Folic acid NIH external link is an important vitamin for you to take before and during pregnancy
to protect your baby’s health. You’ll need to start taking folic acid at least 1 month before you
get pregnant. You should take a multivitamin or supplement that contains at least 400
micrograms (mcg) of folic acid. Once you become pregnant, you should take 600 mcg
daily.4 Ask your doctor if you should take other vitamins or minerals, such as iron or calcium
supplements, or a multivitamin.

What do I need to know about blood glucose testing before

and during pregnancy?
How often you check your blood glucose levels may change during pregnancy. You may need to
check them more often than you do now. If you didn’t need to check your blood glucose before
pregnancy, you will probably need to start. Ask your health care team how often and at what
times you should check your blood glucose levels. Your blood glucose targets will change during
pregnancy. Your health care team also may want you to check your ketone levels if your blood
glucose is too high.

During your pregnancy, you may need to check your blood glucose levels more often.

Target blood glucose levels before pregnancy

When you’re planning to become pregnant, your daily blood glucose targets may be different
than your previous targets. Ask your health care team which targets are right for you.

You can keep track of your blood glucose levels using My Daily Blood Glucose Record (PDF,
44 KB) . You can also use an electronic blood glucose tracking system on your computer or
mobile device. Record the results every time you check your blood glucose. Your blood glucose
records can help you and your health care team decide whether your diabetes care plan is
working. You also can make notes about your insulin and ketones. Take your tracker with you
when you visit your health care team.

Target blood glucose levels during pregnancy

Recommended daily target blood glucose numbers for most pregnant women with diabetes are

 Before meals, at bedtime, and overnight: 90 or less

 1 hour after eating: 130 to 140 or less
 2 hours after eating: 120 or less3

Ask your doctor what targets are right for you. If you have type 1 diabetes, your targets may be
higher so you don’t develop low blood glucose, also called hypoglycemia.

A1C numbers

Another way to see whether you’re meeting your targets is to have an A1C blood test. Results of
the A1C test reflect your average blood glucose levels during the past 3 months. Most women
with diabetes should aim for an A1C as close to normal as possible—ideally below 6.5 percent—
before getting pregnant.3 After the first 3 months of pregnancy, your target may be as low as 6
percent.3 These targets may be different than A1C goals you’ve had in the past. Your doctor can
help you set A1C targets that are best for you.

Ketone levels

When your blood glucose is too high or if you’re not eating enough, your body might make
ketones. Ketones in your urine or blood mean your body is using fat for energy instead of
glucose. Burning large amounts of fat instead of glucose can be harmful to your health and your
baby’s health.

You can prevent serious health problems by checking for ketones. Your doctor might
recommend you test your urine or blood daily for ketones or when your blood glucose is above a
certain level, such as 200. If you use an insulin pump, your doctor might advise you to test for
ketones when your blood glucose level is higher than expected. Your health care team can teach
you how and when to test your urine or blood for ketones.

Talk with your doctor about what to do if you have ketones. Your doctor might suggest making
changes in the amount of insulin you take or when you take it. Your doctor also may recommend
a change in meals or snacks if you need to consume more carbohydrates.

Prevention

There are no guarantees when it comes to preventing gestational diabetes — but the more
healthy habits you can adopt before pregnancy, the better. If you've had gestational diabetes,
these healthy choices may also reduce your risk of having it again in future pregnancies or
developing type 2 diabetes in the future.

 Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on
fruits, vegetables and whole grains. Strive for variety to help you achieve your goals
without compromising taste or nutrition. Watch portion sizes.

 Keep active. Exercising before and during pregnancy can help protect you from
developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of
the week. Take a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity —
such as parking further away from the store when you run errands or taking a short walk
break — all add up too.

 Start pregnancy at a healthy weight. If you're planning to get pregnant, losing extra
weight beforehand may help you have a healthier pregnancy. Focus on making lasting
changes to your eating habits that can help you through pregnancy, such as eating more
vegetables and fruits.

 Don't gain more weight than recommended. Gaining some weight during pregnancy is
normal and healthy. But gaining too much weight too quickly can up your risk of
gestational diabetes. Ask your doctor what a reasonable amount of weight gain is for you.