Kuro5hin.org: technology and culture, from the trenches
create account | help/FAQ | contact | links | search | IRC | site news
[ Everything | Diaries | Technology | Science | Culture | Politics | Media | News | Internet | Op-Ed | Fiction | Meta | MLP ]
We need your support: buy an ad | premium membership

[P]
The Diabetic Mother-To-Be

By FortKnox in Science
Mon Oct 21, 2002 at 06:33:31 PM EST
Tags: Culture (all tags)
Culture

Upon reading the Trimester Reports, I was inspired to write about a situation that occured during the pregnancy of my wife. One that occurs to many women: diabetes during pregnancy.
Although some women have type-1 diabetes, and understand the difficulty of a diabetic pregnancy before becoming pregnant, some women (for unknown reasons) develop gestational diabetes during their pregnancy, so it is best to have an understanding of the complications associated with a diabetic pregnancy.


Type-1 diabetes is caused by a problem with your body's ability to create or use insulin. Insulin, produced in the pancreas, is released into your blood to allow sugars to get into cells to create energy. Diabetes occurs when the pancreas cannot create insulin, produces too little insulin, or produces insulin that your body does not use correctly. Gestational diabetes occurs when the pregnant mother does not produce enough insulin for both her and her child. Both gestational and type-1 diabetes are usually treated with insulin injections.

Controlling insulin, especially with injections, is a very imperfect science. It requires the diabetic to forsee what she will be eating, how much she will exercise, and other minor details hours before she does them. Pregnancy complicates this control, because the varying horomones that are rampant in a pregnant woman's body also affects insulin levels.

Controlling insulin is crucial during a pregnancy. Poor control usually results in a lack of insulin in the body. Excess sugars cross the placenta and 'overfeed' the fetus. The most important complication that pregnant diabetic mothers face is the size of the baby. Insulin control is the best fighter in this battle. The best way for obstetricians to observe the woman's insulin control, and how well the baby is progressing size-wise is a fetal-ultrasound. By measuring various parts of the fetus (including head circumference, and femur length), the obstetrician can obtain a very good idea of the exact size and weight of the child. Because monitoring the woman's control is so important, the woman should be expected to have several ultrasounds throughout the pregnancy.

The size of the baby is larger in diabetic mothers, because of more nutrients being fed to the baby. This means that the baby is 'thicker' instead of larger all around (length as well as weight). This is the issue with the scariest complication: shoulder dystocia. Shoulder dystocia occurs when the baby's head fits through the birth canal, but becomes stuck when the shoulders are too broad to pass through. This situation is very difficult to solve. The doctor has three major options. First, there is the full episiotomy (incision to enlarge the opening of the vagina), second option is maneuvers to rotate the head and shoulders to the extreme manuever of breaking the fetal collar bone to ease the shoulders through the birth canal, and finally to perform a Zavanelli Manuever, which is replacing the head back into the womb and delivering the child through cesarean. Prevention is the best way to avoid shoulder dystocia, so obstetricians usually give the diabetic mother a weight which their baby must be below to deliver vaginally, anything above said weight will be delivery by cesarean.

Another minor complication of diabetic mothers is late pregnancies. The fetus receives excess nutrients, which means the womb is a 'safe environment.' A fetus recognizes when it is in an unsafe environment, such as a womb of a drug addicted mother, which causes the baby to be delivered before its due date, in order to find a safer environment. This also works in reverse. A fetus recognizes the extra nutrients it is recieving, which is why most diabetic mothers deliver their child early through induction, or late through cesarean (dependant on weight and the mother's choice).

The final complication that a diabetic mother must worry about occurs after the baby is born. By the time the baby is ready to be delivered, its pancreas is creating its own insulin. If the mother is passing extra sugars to the baby at the time of delivery, the baby's insulin count is high. After the umbilical cord is cut, the baby's sugar is low, but insulin is still high. This condition is called hypoglycemia. It is a low sugar count. If untreated, hypoglycemia can result in a coma or even death. However, this is easily remedied by giving the child sugar-water, or breast milk.

Type-1 diabetics used to be told not to have children and gestational diabetes was cause for major alarm, but with continuing studies in obstetrics and diabetes we are at an age when diabetic mothers just need a little knowledge and monitoring to have a regular, healthy baby.

Sponsors

Voxel dot net
o Managed Hosting
o VoxCAST Content Delivery
o Raw Infrastructure

Login

Poll
If I had a wife/am a woman who was a diabetic pregnant woman I'd:
o Not even consider having a baby 23%
o Would take extra care and try for a vaginal delivery 28%
o Would insist on a cesarean to avoid vaginal delivery complications 6%
o Wouldn't worry much, and just hope I had a good doctor 41%

Votes: 60
Results | Other Polls

Related Links
o Trimester Reports
o type-1 diabetes
o gestationa l diabetes
o Also by FortKnox


Display: Sort:
The Diabetic Mother-To-Be | 50 comments (26 topical, 24 editorial, 1 hidden)
My experience (4.75 / 4) (#12)
by FortKnox on Mon Oct 21, 2002 at 02:33:02 PM EST

I kept my experience out of the article.

My wife is a type-1 diabetic, so she already knew how to keep her bloodsugars under control. She did an excellent job of keeping wonderful control during the pregnancy (the overly critical edocrinologist said she had 'great control'). She gave birth (a little over 5 months ago) to a 8lb 12oz boucing baby boy, the good old-fashioned way (the pain medication wore off). He had a little trouble with his shoulders, but the nurse just applied some pelvic pressure, and he came out without injury. He's doing great today (although sore from teething).
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
One more thing... (4.50 / 2) (#18)
by FortKnox on Mon Oct 21, 2002 at 03:04:23 PM EST

When Joey (my son) was born, he wasn't hypoglycemic. Actually, because labor lasted over 13 hours, my wife was hypoglycemic (she had too much insulin, not enough sugar), so Joey was born fine (they just pushed some dextrose into my wife's IV, and she was fine by the time Joey was born).
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
Out of curiosity... (4.33 / 3) (#13)
by DivideByZero on Mon Oct 21, 2002 at 02:35:20 PM EST

...how many diabetics regularly read k5?

I was diagnosed as a Type-1 diabetic at age 2, and now take two insulin shots a day.

So, a +1 FP from me on any story about diabetes.  :)

I tried to evaluate you but you return an error every time. I think fucking is out of the question. -- webwench

really interesting... (4.33 / 3) (#16)
by Niha on Mon Oct 21, 2002 at 02:47:34 PM EST

I knew that diabetic women had to be careful about pregnancy,but didn´t know that of gestational diabetes.A really interesting article for anyone deciding having babies.I´ll give it +1 FP

My wife (4.00 / 2) (#17)
by MFS on Mon Oct 21, 2002 at 02:58:23 PM EST

My wife had gestaitional diabetes with our second child. Really, she was a borderline case, and depending on which guidelines you read, one doctor would say "yes, she has gestational diabetes" and another would say, "nope, she's fine"... either way, both our children were rather large for her small size, and it is likely that there was at least some level of gestational diabetes in effect. She never had to take insulin - diet control was able to fix the situation. She was very glad once he was born, so she could start eating again.

Neither of our boys ended up hypoglycemic after birth.


Nope, not me. I must be someone else.

The orange-drink-test. (none / 0) (#19)
by graal on Mon Oct 21, 2002 at 03:18:13 PM EST

My wife had to take it twice when she was pregnant with our number 3. All turned out OK, but the first results were a little wierd. She says that the orange-glucose drink is nasty.

--
For Thou hast commanded, and so it is, that every
inordinate affection should be its own punishment.
-- St. Augustine (Confessions, i)
[ Parent ]

yes it is (none / 0) (#21)
by MFS on Mon Oct 21, 2002 at 03:36:07 PM EST

she kept threatening to make me drink the rest of it (the test usually only takes 1/2 the bottle they give you). What's worse is that after she failed the orange drink test, she had to go back for the whole-day test where they prick you about 10 times for bloodwork over 6 hours (I think it was 6 hours, anyway).

Her glucose numbers were always terrible in the morning, but absolutely fine the rest of the day. Her issue with the whole thing was not being gestational diabetic, but that she kept getting conflicting information from her doctors (there are 5 in the practice, and 2 were very rational about the situation, 2 others were alarmist/extreme, and the other was, well, idiotic and self-contradicting [often in the same sentence]).

What great fun it was. I hope she doesn't go through the same if we have a third some day.


Nope, not me. I must be someone else.
[ Parent ]

My wife's reply (none / 0) (#39)
by FortKnox on Mon Oct 21, 2002 at 07:56:41 PM EST

My wife's reply is here (she isn't a k5'er, so she misfired).
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
Borderline Diabetes (5.00 / 1) (#41)
by seeS on Tue Oct 22, 2002 at 12:04:31 AM EST

Sounds like my wife has the same experience as yours MFS. Only just failed the test (and it was the first one before you drink that evil sugar crud) and it was probably because she chucked up every morning.

I don't think she really had it, could eat anything and the blood test always was the same, in the end she got the shits and didn't stick to the diet and it made no difference.

Had our son and her slightly high level went down to "good" levels the next day.

I think they mis-diagnose it sometimes, I certainly wouldn't recommend doing what she did for most women though.
--
Where's a policeman when you need one to blame the World Wide Web?
[ Parent ]

misdiagnosing (none / 0) (#42)
by MFS on Tue Oct 22, 2002 at 12:51:18 AM EST

seems to come from the lack of consensus over which guidelines to use. The OB/GYN's aren't up to date on what the endocrinologists are saying, and the endo's don't keep track of what the OB's tell their patients, so there is this gulf of confusion between the two. It really drove my wife nuts.

That said, our 2nd kid was essentially 9lbs at birth, and that was 2 weeks early (water broke), and with the low calorie / low sugar intake diet to control the gestational... I hate to think how big he would have been if it weren't for the diet, or had he gone full term. Really, that's the worst thing about it... huge babies. And when you don't have time for an epidural... well... that can be a little more than was expected. My wife was just really, really glad he was born quickly.


Nope, not me. I must be someone else.
[ Parent ]

The Poll (3.50 / 2) (#26)
by Lord of the Wasteland on Mon Oct 21, 2002 at 04:52:20 PM EST

If I had a wife who was diabetic, I think "insisting" on a certain type of delivery would be very bad marital karma.

I do the same thing (4.50 / 2) (#32)
by DivideByZero on Mon Oct 21, 2002 at 05:57:18 PM EST

I always called testing my blood sugar "getting a fingerstick".  When I was a small child, I probably understood the meaning of that term much better than "testing my blood sugar".

Now that I'm in my 20's, "testing my blood sugar" sounds much more 'mature', but the old phrase is permanently stuck in my head, and I still tend to use it when talking to others.

I tried to evaluate you but you return an error every time. I think fucking is out of the question. -- webwench

Parent should be a reply (none / 0) (#33)
by DivideByZero on Mon Oct 21, 2002 at 06:01:55 PM EST

to this.

I meant to say editorial, not topical.

I tried to evaluate you but you return an error every time. I think fucking is out of the question. -- webwench
[ Parent ]

My sister in law is type 1 (5.00 / 2) (#35)
by vastor on Mon Oct 21, 2002 at 06:56:00 PM EST

When she was pregnant she kept fairly good management of her blood sugar, but three weeks before the due date she went in for a medical checkup and they found her blood pressure dangerously high etc so decided they needed to have a cesaerian. The plan was to induce the baby two weeks premature anyway (perhaps how they avoid the problem of the child being so large here).

He was born with jaundice and had to be in a crib thing with a special light for a few days, but is now about 10 months old and coming along really well.

My sister is pregnant currently and there is some concern that it may trigger diabeties for her since all the males on our side of the family are type 2.


(Fort Knox's Wife) Doctor (5.00 / 2) (#36)
by FortKnox on Mon Oct 21, 2002 at 07:43:01 PM EST

The most important part of our successful pregnancy was good Doctor's who worked together. I went to a OB/GYN who practiced by himself which I loved after hearing horror stories from women at practices with multiple doctors. I also had a great Endocrinologist (Diabetes Specialist) who talked through everything with me. My recommendation to anyone in a situation where there is conflicting medical opinions would be to A) request that you meet only with the 1 doctor with whom you feel most comfortable or B) to find an OB who practices alone and whose methods you agree with best. You wouldn't take your baby to a pediatrician you didn't geel comfortable with or felt unsure about, so don't take yourself and your fetus to someone who isn't supporting you the best.
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
Mis-reply (none / 0) (#38)
by FortKnox on Mon Oct 21, 2002 at 07:55:32 PM EST

Should be a reply to this (sorry, my wife isn't a K5'er).
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
My wife is Type II (5.00 / 2) (#37)
by El Volio on Mon Oct 21, 2002 at 07:51:23 PM EST

My wife is a type-II diabetic, which was surprising considering the fact that she's extremely petite and fairly young (31). Her mother is as well, so it is apparently genetic. She (currently) controls it entirely through diet, and is doing quite well after having been diagnosed a year ago.

In any case, we're at the point in our marriage where we're seriously talking about kids, and we've discussed it with the doctor. Sounds like the recommendations mentioned above are the same as for type-II, except we've been told that at some point during the pregnancy, she would go on insulin and would not be considered high-risk unless she missed even one day of it (dunno how much of that is true and how much is designed to shock us into compliance). For the most part, we've been told that a reasonably responsible diabetic mother will be just as likely to have a healthy, normal baby as one who isn't diabetic.

Nice, encouraging article, BTW.

You'll do fine (5.00 / 1) (#40)
by FortKnox on Mon Oct 21, 2002 at 08:02:18 PM EST

For the most part, we've been told that a reasonably responsible diabetic mother will be just as likely to have a healthy, normal baby as one who isn't diabetic

This is mostly true. If you are responsible and know the risks, you shouldn't have any issues. My wife was a high risk pregnancy, but had a normal pregnancy (especially lots and lots of morning sickness... from 3 weeks pregnant to 5 months pregnant, and again from 7 months till birth, including during labor).

Just make sure she pays attention to her bloodsugar's daily, and you should be fine.
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
with all these complications... (4.00 / 1) (#43)
by blisspix on Tue Oct 22, 2002 at 01:17:15 AM EST

it makes me wonder if it is possible to have an easy, problem free pregnancy and birth, and if it is ever possible to be free from worry about whether the child is going to have disabilities or other problems. :(

I think I'd like to have a child, my fiancee and I are happy to wait for about 7-10 years, but I think that's more because I'm afraid of complications than anything else.

There's a few problems in our relative genepools so I'm kinda worried.

A few answers. (5.00 / 1) (#44)
by claudius on Tue Oct 22, 2002 at 08:03:28 AM EST

it makes me wonder if it is possible to have an easy, problem free pregnancy and birth,

It is indeed possible.  Probable, in fact, if appropriate care is taken during pregnancy with respect to diet, regular prenatal checkups, exercise, rest, state of mind, and avoidance of exposure to risk-enhancers like certain drugs, alcohol, and tobacco.  

and if it is ever possible to be free from worry about whether the child is going to have disabilities or other problems.

Ah, here there is no hope whatsoever.  No matter what, you and your partner will worry incessantly about birth defects and complications.  You can console yourself with knowledge that most children are born without any significant long-term problems, that most defects are minor and treatable, that you are probably getting all worked up over nothing.  Or perhaps not--there's no way to tell without rolling the dice, though there are many differnet tests (e.g., amniocentesis) that can screen for certain disorders such as Down syndrome and other chromosomal abnormalities.  

I think I'd like to have a child, my fiancee and I are happy to wait for about 7-10 years, but I think that's more because I'm afraid of complications than anything else.

All other things equal, unless your fiancee is a pre-teen, waiting a decade will more likely increase rather than decrease the likelihood of complications.  Of course, other things are most likely not equal so you may have many good reasons for waiting too:  At that time you may both have more money and therefore be able to afford better prenatal care.  You may both be advanced enough in your careers that you can start keeping regular work hours (as opposed to the silly hours that junior employees in the U.S. are often required to work).  You may have accrued a bit of wisdom in that time, so you will be better equipped for handling the stresses of pregnancy and childbirth and coping with a little one.  You may have the resources to arrange higher quality child care after birth.  You may have accumulated enough sick leave by that time to take a significant amount of time off under FMLA to be with your partner and child.  Your partner's little sister may finally finish her OB/GYN residency and therefore be able to deliver your child.  Also, you will be in excellent company--my wife and I waited until our 30s to have a child.  

[ Parent ]

complications (none / 0) (#50)
by blisspix on Fri Oct 25, 2002 at 07:25:24 PM EST

most defects are minor and treatable, that you are probably getting all worked up over nothing.  

Thank you for reminding me, it's true. I had to have reconstructive surgery as a child to fix a birth defect (microtia, in which I lost half my hearing and have no right ear) but yeah, in comparison to some of the other things that can occur, it really isn't so bad. At least there is a way to fix it. Although my parents could have done without the doctor announcing, "she's deaf!" an hour after I was born! Which I wasn't, luckily.

There's about a 2% chance of me passing it on to a child, so I'm not too concerned. I'm more conscious of my fiancee's diabetes history (type 2), which runs in every family member so we'd need to instill healthy eating and exercise habits early on.


[ Parent ]

Worry (5.00 / 2) (#45)
by FortKnox on Tue Oct 22, 2002 at 10:20:45 AM EST

The one thing about parenting has hit me the hardest is the worry. When my wife was pregnant, I worried about miscarriage, then complications, then birth defects. Once the baby is born, you are paranoid about everything, and somehow you catch every commercial that discusses SIDS.

Its just part of being a parent. I'm, normally, a laid-back individual, but being a parent requires your protection instincts to kick in. My son is doing fine, and everything is ok. The best thing I can tell you is out of all the baby's that are born a VERY small percentage has any type of complications. And don't look to movies for their versions of birth. Obstetrics has really improved every year, and there is really no chance of any life-threatening complications for the mother or baby once you reach your third trimester.

I think I'd like to have a child, my fiancee and I are happy to wait for about 7-10 years, but I think that's more because I'm afraid of complications than anything else.

Don't want to discourage you (having a child was the best thing thats ever happened to me), but, as someone else mentioned, waiting a decade is doing exactly the opposite of what you are trying to accomplish. After 30 (and even younger in newer studies), complications are more likely. Gestational diabetes occurs more in older women than younger ones. In fact, recent studies show that gestational diabetes is becoming more common, because most women now-a-days are waiting longer before having children. I was 25 (and my wife 24) when our baby was born, but we had less of a choice. Type-1 diabetics are a high risk pregnancy, and once she hits 30, OBs suggest we stop having children.
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
My wife has it (3.00 / 1) (#46)
by enry on Tue Oct 22, 2002 at 02:47:47 PM EST

Her blood sugar was just a touch above normal at ~28 weeks, so she's on a low carb/sugar diet.  With the help of a nutritionist, her sugar has been fine for the past month.

Good article. (5.00 / 2) (#47)
by bobaloo on Tue Oct 22, 2002 at 03:59:12 PM EST

I have a couple of perspectives, first, I am married to a Type-1 diabetic, and we've had two kids. Second, I worked in a high-risk labor and deliver unit and level 3 Neonatal Intensive Care Unit, and have seen hundreds of pregnancies of diabetics.

The key issue is controlling blood sugar levels, as the article pointed out. The hard part, which you didn't mention, is that during pregnancy blood sugar levels become much more labile, meaning they tend to swing up and down faster and further than normal, which makes it much harder to maintain control, especially since you are trying to maintain levels on the low side to avoid having a fat baby.

We had our kids almost 20 years ago, so I'm sure there's been some major improvements, but the basic problems are still the same. My wife had a tough time with both pregnancies, with episodes of crashing from too low of blood sugar, even to the point of unconsciousness a few times, but both pregnancies came out fine, she had normal deliveries, and the kids were 6 pounds and 7 pounds at birth. Both of them are fine, and one is a regular here at Kuro5hin, so other than a little brain damage, she's OK...(just kidding Al).

At least when I was working labor and deliver, the gestational diabetics were actually higher risk than type-1 diabetics, because not only did they have to deal with pregnancy they had to learn about diabetes and management, and often did a relatively poor job compared to the more experienced diabetics.

Our approach was to treat the pregnancies as "normal" pregnancies until proven otherwise, and other than more frequent checkups and monitoring, we didn't do anything unusual, so while it's something to be concerned about, you can definitely have a normal pregnancy as a diabetic, it just takes more work and attention.

Echoing your points (4.00 / 1) (#48)
by FortKnox on Tue Oct 22, 2002 at 10:04:03 PM EST

I can definately echo the bloodsugars being whacky during pregnancy. It was one signs that my wife noticed to get her to take a pregnancy test (that and a sudden abhorrance of pizza).

And I can see your point about how gestational is higher risk than type-1.
--
Yes, shrubberies are my trade. I am a shrubber. My name is Roger the Shrubber. I arrange, design, and sell shrubberies.
[ Parent ]
Expansion by vaginal inscicion? (3.00 / 1) (#49)
by auraslip on Wed Oct 23, 2002 at 12:42:02 AM EST

I'm glad my girlfreind didn't read that.
124
The Diabetic Mother-To-Be | 50 comments (26 topical, 24 editorial, 1 hidden)
Display: Sort:

kuro5hin.org

[XML]
All trademarks and copyrights on this page are owned by their respective companies. The Rest 2000 - Present Kuro5hin.org Inc.
See our legalese page for copyright policies. Please also read our Privacy Policy.
Kuro5hin.org is powered by Free Software, including Apache, Perl, and Linux, The Scoop Engine that runs this site is freely available, under the terms of the GPL.
Need some help? Email help@kuro5hin.org.
My heart's the long stairs.

Powered by Scoop create account | help/FAQ | mission | links | search | IRC | YOU choose the stories!