Gestational Diabetes Mellitus and its risks to the baby

Vaishnavi Kardale, Bioinformatics Centre, Savitribai Phule Pune University

During pregnancy, several different hormones are produced in the body like human placental lactogen, cortisol, and progesterone for the maintenance of a healthy pregnancy. Over time the amount of these hormones increases in the body and they start resisting the effects of insulin, the hormone that is responsible for maintaining the blood sugar level. Insulin is responsible for moving the glucose from the bloodstream into the cells. During pregnancy, glucose needs to be provided to the fetus for its growth and development. So, the body becomes slightly insulin resistant so that the glucose stays in the bloodstream and gets transported to the fetus. 

What is gestational diabetes mellitus(GDM)?

Sometimes the insulin resistance becomes too strong and the blood glucose levels may rise abnormally. This can cause gestational diabetes. This condition typically develops during the 24th and 28th weeks of pregnancy. Although this condition is common and temporary if left untreated gestational diabetes raises the chances of developing type 2 diabetes in the future. If gestational diabetes is poorly managed it can also raise the child’s risk of developing type 2 diabetes later in life. Other complications include an overweight baby at the time of birth, preterm (early) birth, serious breathing difficulties, hypoglycemia, and stillbirth.

What is neonatal hypoglycemia?

Neonatal hypoglycemia occurs within 24 hours of birth. Hypoglycemia can bring about some serious and long-lasting neurological problems. Unfortunately, hypoglycemia is asymptomatic and does not have any specific symptoms. So, screening programs have been developed and widely accepted for the early development and management of hypoglycemia. These guidelines include early feeding, blood glucose monitoring, and regular assessment of clinical conditions. International Association of Diabetes and Pregnancy Study Group’s criteria to diagnose GDM led to more women being diagnosed with GDM, with consequently more babies monitored on a high-risk pathway for hypoglycemia. This has increased the workload on midwives. It has also led to the admission of healthy babies who might not need any special monitoring.

What was the study about?

In a study at a teaching hospital in South East England, the risk of neonatal hypoglycemia concerning maternal characteristics (age, BMI, ethnic background), treatment for diabetes during pregnancy, use of insulin infusion during pregnancy, etc. 

What did the researchers find?

The study found that the risk of neonatal hypoglycemia is not predictable from the maternal background and medication. The researchers found that in babies born to women with GDM without other risk factors for hypoglycemia if the first blood glucose is more than 2.6mmol/L further measurements are not required. All babies with hypoglycemia had blood glucose levels less than 2.6mmol/L. Using this 2.6mmol/L threshold, extended monitoring can be avoided for 60% of babies. With this information now, we should tailor postnatal care plans for babies born to mothers with gestational diabetes mellitus to avoid excess workload in NICUs, among midwives, and wastage of resources.

Also read: Liquid biopsy and droplet digital PCR help to detect Colorectal cancer
Source: Park, E.H.G., O’Brien, F., Seabrook, F. et al. Safe threshold of capillary blood glucose for predicting early future neonatal hypoglycaemia in babies born to mothers with gestational diabetes mellitus, an observational, retrospective cohort study. BMC Pregnancy Childbirth21, 499 (2021). https://doi.org/10.1186/s12884-021-03973-5

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About the author: Vaishnavi is a master’s student at the Bioinformatics Centre, Savitribai Phule University. She is interested in protein folding mechanisms and wants to study them further. She loves travelling and eating ice cream. As a pastime, she likes to read, paint and scroll through social media.