The majority of pregnancies are entirely normal. But in a small number of cases complications happen. It’s important to understand what could happen and why plans and preferences may have to change.
Diabetes is a condition where the body doesn’t produce enough insulin. This results in inconsistent blood sugar levels. Some women develop diabetes during pregnancy which is known as gestational diabetes (GDM). This is a common condition affecting approximately 1 in 5 women in pregnancy. There may be risk factors predicting an increased chance of developing GDM such as a raised body mass index. Or having a previous large baby (more than 4.5kg / 10lbs) but the best way to diagnose GDM is for pregnant women to have a screening test.
The test is called a glucose tolerance test and is done around 27-28 weeks of pregnancy. You will be asked to attend the clinic or hospital early in the morning having fasted since midnight. You shouldn’t have anything to eat, avoid smoking or chewing gum and should only drink plain water. You will have a blood test to measure the baseline glucose levels. You will then be given a drink of glucose and you will have a further blood test after 1,2 or 3 hours to re-measure the blood glucose levels. During the testing period you should not eat anything, smoke or chew gum and only drink plain water.
Some women will have a high fasting blood sugar. Others will have a delay in clearing the glucose from their blood so the level in the post-drink blood test is raised. If you are diagnosed with GDM you will be advised to alter your diet to cut out refined sugars and switch to wholegrain foods. Some women need tablets or insulin injections to control their blood sugar levels.
Having diabetes in pregnancy puts the baby at risk of being large for dates. This in turn increases the risk of having a difficult birth or needing a caesarean section. There is a very slight increase in the risk of stillbirth. After the baby is born, they are at risk of having low blood sugar levels. This is why it is so important to diagnose GDM and to keep blood sugars under control.
If you have GDM you will be advised to buy a glucose monitor so you can conduct your finger prick blood tests at home.
Target blood sugar levels:
- Morning levels (before eating or drinking anything)— 95 mg/dl (5.3 mmol/l)
- Levels one hour after a meal— 140 mg/dl (7.8 mmol/l)
If you have GDM you will be advised to have your baby before 40 weeks. This means that you may be advised to have labour induced if you haven’t gone in to natural labour (or had a planned caesarean for other reasons). Your paediatrician may suggest you start expressing colostrum from your breasts from 38 weeks onwards. This is to give to your baby soon after birth to prevent their blood sugar levels dropping.
Women with GDM may be at increased risk of going on to develop diabetes. You may need further tests after your pregnancy.
Blood Pressure Problems
Pre-eclampsia and hypertension are blood pressure problems of pregnancy. They can cause problems for the mother, the baby or both.
Chronic hypertension is a condition where the woman’s blood pressure is high even before pregnancy. She may be on medication to keep her blood pressure at a safe level. There are many different types of blood pressure medication and some of those drugs are not safe in pregnancy. They can cross the placenta and cause abnormalities. If you have hypertension and want to have a baby it is very important to see your GP to review your medication. If necessary, switch to a medication that is known to be safe in pregnancy. Your GP can also review your general health and blood tests to make sure you go into pregnancy in the best possible health.
Do not make any changes to your medication, without consulting first with your GP. Taking yourself off or on medications can have serious risks to your health, if not done properly.
Women with chronic hypertension are at slightly higher risk of developing pre-eclampsia during pregnancy. It is especially important that those women see their obstetrician regularly throughout pregnancy. And have their blood pressure and urine checked every visit.
Pre-eclampsia is a complication of pregnancy that affects a number of different systems in the body including blood pressure. Pre-eclampsia only happens in pregnancy or very soon after birth. The woman’s blood pressure rises and protein leaks from the kidneys. Women with pre-eclampsia experience swelling of the ankles (like most pregnant women) but also their face and fingers.
Pre-eclampsia can affect the liver and kidneys but importantly it can affect the blood supply to the placenta. This means that the baby may get less nutrients from the placenta than it should. This can affect their growth. For this reason, women with pre-eclampsia will have extra scans to monitor their baby’s growth.
If it is proving difficult to control the woman’s blood pressure or if the baby isn’t growing well, it may be necessary to deliver the baby early. This might mean that labour is induced or that you need a caesarean section.
A pregnancy that goes beyond 37 weeks is known as a full term pregnancy. If a baby is born after 37 weeks the chance of them having problems is very small. Babies born before 37 weeks are at risk of problems such as difficulty breathing on their own, keeping their body temperature up or maintaining their blood sugar level. The earlier a baby is born, the greater that risk is.
Babies born between before 36 weeks need specialist neonatal care for a period of time. This might include help with breathing called CPAP, oxygen treatment or full ventilation with a tube into their lungs. These babies are admitted to the neonatal intensive care (NICU) ward and will need specialist neonatal care for some weeks. They will need to be in a special cot to help keep them warm. They are likely to need help with feeding until they are bigger and strong enough to cope on their own. A tube is placed through the nose directly into the stomach for this. They can then have nasogastric feeding or top up of expressed breast milk or formula milk until feeding is well established.
Babies born between 24 and 28 weeks are extremely premature. They may need to be transferred off island for specialist intensive care. Sometimes if very early delivery is expected or planned, the pregnant mum is transferred off island. The baby is then born where a specialist unit for extremely preterm deliveries is co-located with the delivery facilities.
The reasons that babies are born before 37 weeks may be because the woman goes into labour too early. Or because complications mean that early delivery is in the baby’s best interests.
Some women experience early onset of labour with regular contractions. If this happens usually the mum will be given medication through an intravenous drip. This is to try to stop labour so that drugs can be given to help the baby. Giving two steroid injections to the mum can help the baby’s lungs and reduce the chance of their needing help with breathing once they are born. The drugs to stop labour are stopped once the steroid injections have been given. Some women, but not all, go on to have a preterm birth.
In some pregnancies the waters break before 37 weeks but labour contractions don’t start. Again the mum is given steroid injections and a course of antibiotics to prevent infection. The decision about when to deliver the baby is a complicated one. It is based on a number of different factors. Your obstetrician will explain their recommendations based on your individual situation.
For some pregnancies, the woman’s obstetrician may recommend early delivery. This is because they believe it is in the best interests of both mother and baby that delivery takes place before 37 weeks. Again this is a very complex area. Your obstetrician will explain their clinical decision making and agree on a treatment plan with you.