Gestational Diabetes and Newborns

I have a friend who was just diagnose with gestational diabetes. She has an appointment to meet with a nutritionist next week. Her OB thinks that she should be able to manage it without having to go on insulin. She's looking up information on the web to learn more about it but was wondering what happens after she gives birth. From what she understands, the gestational diabetes usually just goes away, but what about for her infant? She knows that the baby will be monitored for few days after birth, but does she need to mention the gestational diabetes to the pediatrician? If the baby is monitored and his blood glucose levels are fine, what happens after discharge? Will the pediatrician have to monitor the baby repeatedly during well baby visits and such? Does the baby need special treatment?

Can any of you who have gone through this share your experiences and provide some insight to her?

Thanks,
Joyce

I had mild gestational diabetes when I was pregnant with DS, but it was completely diet controlled. They changed the criteria for diagnosis with in the past few years, so it "catches" more people.

In terms of baby, the only thing they did was check his blood sugar every 4ish hours for 24 hours. Sometimes baby will have low sugar at birth (to compensate for mom's high sugar, baby might produce too much insulin). My DS was fine, so I had no experience with it, but I was told that they might have to give a little formula or sugar water over the first day if he was low. I mentioned it to the ped, and it *might* put him at higher risk for diabetes later, but it's not something that has been checked or monitored at the ped since the initial visit.

On the diet, tell her to take the nutritionist with a grain of salt. I saw a bad one who tried to convince me that I needed to eat 3 meals and one snack that were way too much food to put into my 8 months pregnant belly. After a ton of tears and a discussion with my FIL (who specializes in GDM), I realized it's not too bad. In fact, we started eating healthier at home and DH lost 20 pounds my last trimester.

Also, it generally resolves at the baby's birth (I ate about a pound of sugar candy in the hospital after DS was born) for mom. They also did an extra ultrasound at 34 weeks and were going to induce shortly after my due date (although DS came before then) because of it.

For my second pregnancy, the OB just said that they test twice. I have the first glucose tolerance test at 16-18 weeks and then again at the normal time.
HTH!

Ilana

Hi,
I had GD and managed to control it thru diet and exercise.
After the delivery, they monitored my glucose and the diabetes was gone in 8-9 hrs. I remember my DH went out the same evening and got me a *huge* Jamba juice b'cos I missed it so much.
They also monitored my poor DD - if I remember right they pricked her 3 times (this hurt me more than all the times I pricked myself - crazy mom hormones!!). I *think* it was only for the first 3-4 hrs but definitely not more than a day.
If I remember right (maybe some of the medicos will chime in) they actually monitor the infant for *low* glucose - since the mom keeps her glucose low (thru medication/diet etc), they worry that the baby might have low blood sugar. In which case, I think they give the baby milk or formula or whatever to up the glucose.
The ped's office standard form asks about GD and other things about the pregnancy and labor so yes, it is on record there.
HTH and your friend has a safe and healthy pregnancy and delivery,
eta - i just noticed that the pp said exactly the same thing so that's reassuring :)

Yes, the PP's are correct. They monitor the baby for low blood sugar, b/c the mom's high BS can triger the baby to produce too much insuling. They will feed the baby right after s/he is born, even if you want to strictly breastfeed (so that can be annoying) but they just want to make sure the baby isn't starving. Then they monitor the babies blood sugar for a day or so. I have type II diabetes, and my DS's sugars were fine. As long as the Mom has decent control everything should be fine.
HTH
Reena
Mom to Dovi 3/16/04

Reena is right, however, exclusively BF babes of moms with GD do not neccessarily need formula or sugar water. They need to nurse right after birth, and their blood sugars are monitored, as per hospital protocol. The appropriate response to a moderately low value is to nurse the baby again, if at all possible. I have taken care of several GD babies who had moderately low sugars, treated with nothing but nursing. For severely low sugars, and repeated low sugars, formula supplements may be indicated, or IV glucose solutions. Certainly no baby with normal behavior should be given formula right at birth before allowing the baby to nurse, and checking the sugar AFTER nursing. Check out www.bfmed.org , the Academy of Breastfeeding Medicine, they should be releasing their updated protocol soon. (its under hypoglycemia)

I had severe GD - shots, constant monitering, increased dosage as my pregnancy advanced etc. I was super vigilant about every morsel of food that went in my mouth and walked like I was told. Tell your friend not to be suprised if she needs a cs. After I gave birth, they checked the baby and she was fine. My diabetes was gone within 3 or 4 days i.e I could stop taking insulin shots. Her pediatrician should check on the baby at the hospital and should know about the GD already. If everything looks good at the hospital they probably won't do anything else I don't remember mine doing anything. GD is really scary at first, but if you do what the dr says, it is very managable and won't be a big deal.


Karin and Katie 10/24/02

We also let breastfeeding moms with GDM nurse if the baby is not having persistent problems with blood sugars. If the baby has symptoms of hypoglycemia or he/she keeps having low blood sugars, then the baby may get formula or IV fluid with sugar in it--but that's actually quite unusual. Your friend just needs to be aware that she may not be able to exclusively breastfeed initially and that her baby will get poked a certain amount, per hospital protocol. Usually, there are no further issues once the blood sugars normalize. She, on the other hand, is at slightly higher risk for developing non-gestational diabetes later.

I guess it depends on the hospital. Dovi was 8lb 13 oz at birth, and since he was large, they wanted to give him formula right away after the birth. His sugars were fine though. So after that, they let me nurse him. It really wasn't a big deal, but they still wanted him to have formula even though he sugar was not low. Had I really objected, they probably would have let me nurse, but at the time, I just didn't think it was worth arguing about. Who has the energy five minutes after birth anyway?
Also, I don't know if this was mentioned, but they will induce you at 40 weeks, or earlier if need be, and I had tons of ultrasounds and NST's in my ninth month.

Reena
Mom to Dovi 3/16/04

just to echo previous posters...

I had Gestational diabetes, which was not a surprise, because although I am not diabetic, almnost all of my ancestors are, so it's always hovering out there ready to strike.

I self tested my blood 5 times a day. This may sound unplesant, but it is great. Here's why. The diet I was given to control suger was brutal. 50 carb 3 times a day (one coke is 50 carb) and 25 carb (like a plain yogurt) for 2 snacks a day = 5 meals.

It's a starvation diet. On that diet, I had trouble walking about. I could manage that diet normally, but pregnancy made me ravenous.

However, not all food is created equal. For example, 2 teaspoons of rice (probably about 10 carb) would shoot my blood sugar way up above maxium limit. However, a large fruit salad, which probably rated 100 carb, squeaked in right under the limit.

I could eat 3/4 of a alice of pizza and still make the number. That's 75 carb or so.

One 1/2 slice of a small apple pie, not sure of the carbs, shot my blood sugar way over. The was my only slice of pie the entire pregnancy.

Chicken, beef, broccoli, etc., have almost no carbs. I ate plates of those. It looks weird to see a person sit down with an entire plate of broccoli, but I was really hungry.

Once I determined my own food reactions, I was able to stay under my blood sugar limit of 130. Real diabetics would have a party to be able to stay below 130 without insulin.

I had c-sections. After 3 hours of pushing with first child, went to c-section.

For 2nd baby, doctor required c-section and did it 2 weeks early. with GD, not only the size of the baby, but weight can be positioned differently (in the shoulders) making it harder to pass through.

Both babies were about 8.5 lbs. Both needed glucose and formula the first day, but were fine and have shown no signs of diabetes.

After I had my babies, I didn't care whether I had high blood sugar or not. I was just so hungry. I ate and ate. Once all was settled and follow up visits occured and blood testing, indeed, I was fine.

Here's the biggest perk. You will hear other pregnant women say they can't stop eating m&ms or whatever. The GD mother can't abuse her body. I got back down to my prepregnancy weight in 3 weeks, and it has never gone back up.

Good luck!