By Nr Chinonso Cynthia Ukah. BNSc, RN, RM. Freelance Health Writer and DLHA Volunteer. Medically reviewed by the DLHA Team.
.jpg)
A black pregnant woman holding her bulging abdomen in her hands.
Diabetes in pregnancy has adverse complications on both the mother and the unborn child. These can be both short-term and long-term.
The short-term complications of diabetes in pregnancy in the baby include:
Foetal Growth Retardation
Macrosomia (Big baby)
Pre-term birth, and
Stillbirth
This occurs in women with poorly controlled type 1 diabetes. Fetal growth restriction, also known as intrauterine growth restriction, is a condition that occurs when the foetus fails to grow to normal weight while in the womb [1].
This may result from high blood sugar in the mother's blood, which damages the blood vessels responsible for carrying nutrients to the baby in the womb.
The growth restriction pattern in babies born to diabetic mothers usually differ depending on the type of diabetes. [2].
Careful monitoring of blood glucose is often advised to carry out delivery at a time when the risks are very low. The American Diabetes Association (ADA) recommends self-monitoring of blood glucose at least four times daily: fasting and either before meals or 1–2 hours after meals [2].
In addition to glucose control, regular antenatal visits and care are recommended.
Macrosomia means big baby. It is the growth of a baby with a weight higher than the absolute birth weight for age (greater than 4,000 g or 4,500 g), irrespective of the number of months spent in the womb. [3].
Women who have had previous big babies are at a five- to ten-fold increased risk of having another big baby.
Big babies are more common than small babies among diabetic women. In 1920, Jorgen Pedersen hypothesized that maternal hyperglycemia is associated with fetal hyperinsulinemia and fetal hyperglycemia. [3]
Too much insulin released by the baby causes overuse of glucose, which in turn causes an abnormal increase in weight. This results in a complication known as fetal hypoglycemia when the baby is born.
Babies born to diabetic mothers may be delivered before 37 completed weeks of pregnancy. [4]
According to the World Health Organization (WHO) an estimated 13.4 million babies were born too early in 2020. Many of those who survived faced a lifetime of disability, including learning disabilities and visual and hearing problems. [5]
Preterm birth sometimes occurs due to spontaneous preterm labor or because there is a medical indication to plan an induction of labor or caesarean birth early.
The WHO further found that in low-income settings like Africa, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. [5]
This signals a need for prompt action towards controlling diabetes before it worsens to cause preterm birth, as appropriate resources to manage its aftermath may not be readily available in some African countries.
Stillbirth is a tragic complication that can occur in pregnancies affected by diabetes. It refers to the death of a baby in the womb after 20 weeks of pregnancy. [3]
The risk of stillbirth is higher in women with poorly controlled diabetes. This is often due to the effects of high blood sugar on the placenta and the baby's development.
Because diabetes damages the placenta, regular monitoring and good blood sugar control is advised to reduce the risk of stillbirth in diabetic pregnancies.
The short-term effects of diabetes in pregnancy in the mother include:
Polyhydramnios
Caesarean surgery (section)
Preeclampsia, and
Sepsis
Polyhydramnios is a condition where there is too much amniotic fluid surrounding the baby in the womb. It is more common in pregnancies complicated by diabetes.
About 78% of women in a mini literature review carried out in 2023 had polyhydramnios as a result of complicated diabetes. [4]
This excess fluid puts pressure on the mother's uterus and surrounding organs, causing discomfort and potentially leading to preterm labor.
Polyhydramnios also increases the risk of cord prolapse, where the umbilical cord comes out before the baby during delivery, which can be dangerous.
Regular ultrasound scans are often recommended to monitor amniotic fluid levels in diabetic pregnancies.
Women with diabetes in pregnancy have a higher chance of needing a caesarean section for delivery. This is often due to the increased risk of having a large baby (macrosomia).
A caesarean section involves surgically delivering the baby through an operation (cut) in the mother's abdomen and uterus.
Early caesarean section aims to avoid complications like vaginal tears while trying to deliver a large baby, breech presentations caused by polyhydramnios etc. However, they can also cause problems including longer recovery times and potential complications in future pregnancies. [6]
Some doctors prefer to carry out the caesarean section at 38 weeks when the baby's lungs are already matured to avoid risks of birth asphyxia (oxygen deprivation) from lack of adequate exchange of gases (i.e., oxygen and carbon dioxide) [6]
Preeclampsia is a serious condition characterized by high blood pressure, protein in urine and signs of damage to other organ systems, most often the liver and kidneys, in pregnant women. [4]
Women with diabetes have a higher risk of developing preeclampsia, especially if their diabetes is poorly controlled.
Symptoms can include severe headaches, vision changes, upper abdominal pain, and swelling in the face and hands. [4]
Close monitoring of blood pressure and regular urine tests are important for early detection and management of preeclampsia in diabetic pregnancies.
Sepsis is the body's extreme reaction to an infection. It is a life-threatening condition that causes widespread inflammation and organ failure.
Pregnant women with diabetes have an increased risk of developing infections, which can potentially lead to sepsis.
Common signs of sepsis include fever, fast heart rate, rapid breathing, confusion and body pain. It can also lead to septic shock, multiple organ failure and death. [7]
The risk is particularly high during and immediately after delivery, as diabetes can impair the body's ability to fight off infections.
Prompt recognition and treatment of infections is necessary for preventing sepsis in diabetic mothers.
In the baby
The long-term complications of diabetes in pregnancy in the baby after birth include:
Risk of obesity and type 2 diabetes and multiple brain and developmental challenges
Children born to mothers with diabetes during pregnancy have an increased risk of developing obesity and type 2 diabetes later in life. [8]
This is thought to be due to the exposure to high glucose levels in the womb, which can affect the child's metabolism and insulin sensitivity.
Some studies suggest that children born to mothers with poorly controlled diabetes during pregnancy may have an increased risk of brain (cognitive) and developmental issues. These can include learning difficulties and behavioral problems. [8]
The long-term effects of diabetes in pregnancy in the baby after birth include:
Increase risk of type 2 diabetes and cardiovascular disease.
Women who develop gestational diabetes during pregnancy have an increased risk of developing type 2 diabetes later in life. [8]
Regular screening and lifestyle modifications are recommended for these women after pregnancy.
Women with a history of diabetes in pregnancy, particularly those who develop preeclampsia, have an increased risk of heart and blood vessel disease later in life. [8]
Complications are not uncommon in pregnant diabetic women globally especially when the diabetes is not well managed. The good news remains that with good monitoring and control of blood glucose (sugar) before and during pregnancy, coupled with regular antenatal care, you can greatly reduce your risks of complications from diabetes during pregnancy. However, the challenges of medical care that are common in most African countries does impact the level of complications that African diabetic women may face.
If you have diabetes before getting pregnant or you are diagnosed with diabetes in pregnancy, you should adopt a healthy lifestyle and work closely with your healthcare providers in order to reduce your risk of complications and give yourself and baby the best shot at healthy outcomes.
1. Gutaj P, Wender-Ozegowska E. Diagnosis and Management of IUGR in Pregnancy Complicated by Type 1 Diabetes Mellitus. Curr Diab Rep. 2016;16(3):39. doi:10.1007/s11892-016-0732-8. Available from here.
2. Fasoulakis Z, Koutras A, Antsaklis P, Theodora M, Valsamaki A, Daskalakis G, et al. Intrauterine Growth Restriction Due to Gestational Diabetes: From Pathophysiology to Diagnosis and Management. Medicina (Kaunas). 2023 Jun;59(6):1139. doi:10.3390/medicina59061139. Available from here.
3. Akanmode AM, Mahdy H. Macrosomia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan- [updated 2023 May 16]; Cited 2024 Oct 10. Available from here.
4. Preda A, Iliescu DG, Com?nescu A, Zoril? GL, Vladu IM, For?ofoiu MC, et al. Gestational Diabetes and Preterm Birth: What Do We Know? Our Experience and Mini-Review of the Literature. J Clin Med. 2023 Jul;12(14):4572. doi:10.3390/jcm12144572. Available from here.
5. World Health Organization. Preterm birth [Internet]. Geneva: World Health Organization; 2023 May 10 [cited 2024 Oct 10]. Available from here.
6. Boulvain M, Stan CM, Irion O, Pregnancy and Childbirth Group C. Elective delivery in diabetic pregnant women. Cochrane Database Syst Rev. 2001 Apr 23;2001(2):CD001997. doi: 10.1002/14651858.CD001997. Available from here.
7. World Health Organization. Sepsis [Internet]. Geneva: World Health Organization; 2024 May 3. [Cited 2024 Oct 10]. Available from here.
8. Sheiner E. Gestational Diabetes Mellitus: Long-Term Consequences for the Mother and Child Grand Challenge: How to Move on Towards Secondary Prevention? Front Clin Diabetes Healthc. 2020 Nov 4;1:546256. doi: 10.3389/fcdhc.2020.546256. Available from here.
Related:
Diabetes in Pregnancy in Sub-Saharan Africa: An Overview
Type 1 Diabetes Mellitus: An Explainer for Africans
Type 2 Diabetes: What Africans Need to Know
Published: October 11, 2024
© 2024. Datelinehealth Africa Inc. All rights reserved.
Permission is given to copy, use and share content for non-commercial purposes without alteration or modification and subject to source attribution.
DATELINEHEALTH AFRICA INC., is a digital publisher for informational and educational purposes and does not offer personal medical care and advice. If you have a medical problem needing routine or emergency attention, call your doctor or local emergency services immediately, or visit the nearest emergency room or the nearest hospital. You should consult your professional healthcare provider before starting any nutrition, diet, exercise, fitness, medical or wellness program mentioned or referenced in the DatelinehealthAfrica website. Click here for more disclaimer notice.
