Birth Defects and Gestational Diabetes

Gestational diabetes is a condition when the blood glucose level is elevated during pregnancy in a woman undiagnosed with diabetes prior to this. When not controlled and managed well this can be life-threatening as it is often associated with long-term complications affecting every system and part of the body. That said, it is also important to understand that a gestational diabetes diagnosis does not mean that the baby will surely be born with birth defects. Studies have proven that the likelihood of this happening is only if the mother’s weight before getting pregnant was in the overweight or obese range, with a body mass index (BMI) of 25 or higher.

Research done with regard to the incidence of birth defects, both cardiac and non-cardiac have shown that 2% of the children with single birth defects were born to mothers who had diabetes before their pregnancy, while 5% of those born with multiple defects were born to diabetic moms. It was diabetes that was diagnosed before the pregnancy that seemed to be associated with a larger range of birth defects whereas only a limited group of birth defects were associated with gestational diabetes. Children born to women with diabetes were found to have serious birth defects like heart problems, brain and spinal defects, oral clefts, kidney and gastrointestinal tract defects, and limb deficiencies.

It is a proven fact that the risk of birth defects can be greatly reduced with the help of excellent control of diabetes and by keeping a healthy lifestyle leading up to and throughout the pregnancy. The intake of folic acid tablets in the preconception stage itself can have a huge bearing on preventing the baby from spinal defects. The incidence is approximately 20/1000 when compared with 1 to 2/1000 in non-diabetic women for neural tube defects if folic acid tablets haven’t been taken and if the sugar levels are haywire throughout the pregnancy. Examining the spine is difficult when the fetus is in an inappropriate position and hence this could be hard to ascertain as the pregnancy progresses. It is better to be safe than sorry in matters as this, especially when a baby’s life is in question.

There are many observations as to why a high blood sugar is associated with birth defects. One reason could be that the mother’s high glucose can lead to the same in the embryo, thereby causing biochemical abnormalities that increase oxidative stress. As a result of this action there could be an incomplete closing of the neural tube causing defects like spina bifida. The fetal cardiac defects are associated with raised maternal glycosylated hemoglobin levels.

The importance of being at an optimal weight, planning the pregnancy well ahead and keeping diabetes under control before getting pregnant cannot be stressed enough. Once a birth defect has been identified in the early stages of pregnancies, termination might unfortunately be the only way out and this is not an easy decision for all the parties involved. Keeping good control of blood glucose levels in gestational diabetes is one of the most important ways to significantly decrease the likelihood of the baby developing congenital anomalies. The recommended HbA1c level one should aim to achieve before and during pregnancy is 43 mmol/mol (6.1%). Studies have shown that for each 11 mmol/mol (1%) rise in HbA1c above 45 mmol/mol (6.3%), the risk of birth abnormalities rises by 30%.

Now you can connect with Dr Hema Divakar, Senior ObGyn and Specialist with a rich experience in the field of Gestational Diabetes Care

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https://www.youtube.com/channel/UCaNrDQK_E7XWAi7dFP71ryA/videos