Gestational Diabetes Care

High Risk Pregnancy Considerations

Diabetes in the mother is one of the most common reasons a pregnancy is considered “high risk.” Whether a woman had type 1 or 2 diabetes before she got pregnant or develops gestational diabetes in her third trimester, she will need to be monitored by a perinatologist—a doctor who specializes in pregnancy complications. Thanks to the special collaboration between MarinHealth and UCSF Health, Braden Diabetes Center patients can see an expert perinatologist without leaving Marin.

Insulin Resistance

Weight gain and hormonal changes are a normal part of pregnancy. These changes cause a woman’s body to make less insulin. What’s more, the body uses insulin less effectively during pregnancy, a condition known as insulin resistance. By late pregnancy, all women experience a degree of insulin resistance. According to the American Diabetes Association, nearly 10 percent of these women will develop gestational diabetes.

Pregnant women are routinely tested for gestational diabetes some time between weeks 24 and 28 of pregnancy. If a woman is diagnosed with the condition, she must take immediate action to manage her blood sugar. Most women’s blood glucose levels return to normal in the weeks after delivery. However, in 5 to 10 percent of women, blood glucose levels do not return to normal, and they are diagnosed with diabetes.

Onsite Experts from UCSF Health

A perinatologist’s goal is to prevent premature birth unless the health of the mother or baby is in danger. Our Braden Diabetes Center provides moms-to-be with diabetes with oversight and testing by UCSF Health perinatologists. If a pregnant woman develops complications, MarinHealth Medical Center has 24-hour access to UCSF Health perinatologists. Babies born prematurely are cared for in our Level II Neonatal Intensive Care Unit (NICU). MarinHealth Medical Center also has UCSF Health neonatologists onsite to care for infants who need special medical attention.

Understand the Risks

If diabetes is not well managed during pregnancy, mother and baby will both have high blood glucose. This can lead to a variety of complications.

Risks to the Mother

• High Blood Pressure or “Preeclampsia”
  Gestational diabetes raises the risk of high blood pressure and preeclampsia, a serious complication of pregnancy that can threaten the lives of both mother and baby.
• Developing Type 2 Diabetes Later in Life
  Once a woman has had gestational diabetes, she is more likely to get it again during a future pregnancy. She is also at risk for developing diabetes as she gets older and should talk to a diabetes educator or Registered Dietitian Nutritionist about preventive measures.
• Cesarean Delivery
  Infants born to women with gestational diabetes can be larger than average (macrosomia), weighing nine or more pounds. Such babies often need to be delivered by cesarean.

Risks to the Baby

• Macrosomia
  If a mother has unmanaged gestational diabetes, the excess glucose in her blood will find its way to the baby’s bloodstream. This stimulates the baby’s pancreas to make insulin to manage the glucose. Some of that extra glucose will also be stored as fat. For this reason, infants born to women with gestational diabetes may have a larger than normal body—a condition called macrosomia.
• Hypoglycemia at Birth
  Babies born to women with gestational diabetes may be born with low blood glucose, or hypoglycemia, which can precipitate the need for closer hospital attention.
• Respiratory Distress Syndrome
• Stillbirth
• Jaundice
  Jaundice is a medical condition that causes yellowing of the skin or whites of the eyes due to an excess of bilirubin, an orange-yellow pigment formed in the liver. Newborns with jaundice need to be treated with light therapy in the neonatal intensive care unit (NICU).
• Weight Problems Later in Life
  Babies born to women with gestational diabetes are statistically more likely to be overweight as adults and may eventually develop type 2 diabetes themselves.

When Women with Diabetes Become Pregnant

The risks for women with diabetes who choose to get pregnant are the same as for women with gestational diabetes, with these additional concerns:

• Stillbirth
• Worsening of diabetes-related eye problems
• Worsening of diabetes-related kidney problems
• Infections of the urinary bladder and vaginal area

Pregnancy for Women With Diabetes

Whether a woman has type 1 or type 2 diabetes, she will need to work with her doctor to closely manage her blood glucose before conceiving. When a woman with unmanaged diabetes gets pregnant, she can expose her baby to high blood glucose and ketones, a toxic byproduct of excess blood glucose, early in her first trimester. This increases the risk of birth defects and miscarriage, because the first seven weeks are when the baby’s organs are forming. That’s why it’s essential to bring diabetes under good management at least three to six months before conception, and maintain excellent blood glucose management throughout pregnancy.