What are the risks of gestational diabetes for the child?
Scientific support: PD Dr. Sandra Hummel
The majority of women with gestational diabetes have a normal pregnancy and give birth to a healthy child despite the elevated blood glucose values.
However, if blood glucose is persistently elevated, this can impact the health of mother and child and result in complications during the birth. The child is also more at risk of being overweight and developing type 2 diabetes.
By adapting lifestyle - ideally before pregnancy - the risks for mother and child can be reduced. The father’s lifestyle also contributes to the health of the child.
What is the health impact of gestational diabetes for the child?
During pregnancy, the mother’s metabolism changes to provide the growing child with sufficient energy. If the unborn child, however, persistently receives too much glucose through the umbilical cord, this can affectv arious areas in the child’s body. There is also the risk of premature birth.
Birth weight: If too much glucose enters the growing child’s body, the child's pancreas produces more insulin. The hormone that lowers blood glucose is also one of the most important growth hormones and stimulates fat storage. As a result the child stores more body fat. The unborn child can then grow excessively and reach a higher birth weight (over 4000 grams). This can make the birth more difficult or require a C-section.
Birth complications: If the child has a higher birth weight, their shoulders are more likely not to fit through the birth canal. The birthing process then grinds to a halt. This emergency must be treated by experienced obstetricians.
Directly after the birth: Children of mothers with gestational diabetes can have adjustment problems directly after the birth. This happens in rare cases even if the gestational diabetes is well managed.
These adjustment problems may include:
- A higher risk of low blood sugar (hypoglycemia)
- Breathing problems
- A higher risk of newborn jaundice
For this reason, infants are observed after birth by neonatologists. Early feeding 30 minutes after the birth is also recommended. This is ideally breast-feeding. If the baby can not latch on to the breast, the child can be given newborn milk or colostrum as an alternative. Colostrum is collected from the mother even before the birth and taken to the delivery room.
What role does the mother’s weight play?
The body mass index (BMI) before pregnancy and weight gain during pregnancy affect the child and the birth. Excess weight gain during pregnancy is associated with an increased rate of high blood pressure in pregnancy, more intense labor and increased birth weight of the newborn infant. A C-section may then be necessary. In the long-term, the children are also more at risk of being overweight.
The US-American Institute of Medicine (IOM) recommends how much weight women should gain during the entire pregnancy. Doctors world wide use this as a guideline.
Good to know:
Early diagnosis, lifestyle adjustment of the expecting mother and expert treatment can prevent the consequences of gestational diabetes for the child.
The guidelines recommend that women:
- who are underweight before the pregnancy (body mass index (BMI) of under 18.5) should gain between 12.5 and 18 kg during the entire pregnancy
- who are a normal weight before the pregnancy (body mass index (BMI) between 18.5 and 24.9) should gain between 11.5 and 16 kg during the entire pregnancy
- who are overweight before the pregnancy (body mass index (BMI) of 25 to 29.9) should gain between 7 and 11.5 kg during the entire pregnancy.
- who are obese before the pregnancy (BMI of over 30) should gain between 5 and 9 kg during the entire pregnancy.
The BMI is calculated by body weight in kilograms (kg), divided by height in meters (m) squared: BMI = (weight in kg) / (height in m)².
What are the long-term consequences of gestational diabetes for the child?
Many studies indicate that maternal gestational diabetes can promote the development of overweight and obesity in the child. It also appears to increase the risk of the child developing type 2 diabetes or metabolic syndrome.
The mechanisms by which the mother's elevated blood glucose levels influence the likelihood of later obesity, type 2 diabetes or metabolic syndrome are not yet sufficiently clear.
It is not only the mother's, but also the father’s lifestyle that influence the child's long-term health - especially at the time of conception. Experts therefore recommend a healthy lifestyle for the parents to prevent the child from becoming overweight later on and thus having a higher risk of type 2 diabetes or metabolic syndrome.
It is best to adjust lifestyle before planning the pregnancy and to maintain it during and after the pregnancy.
Good to know:
If the parent’s lead a healthy lifestyle, this promotes the health of the child during and after the pregnancy. Parents should adapt their lifestyles before the pregnancy so that they are in a normal weight range.
Further information on gestational diabetes
Sources:
Crane, J. M. G. et al.: The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. In: J Obstet Gynaecol Can, 2009, 31: 28-35
Deutsche Diabetes Gesellschaft et al.: S3-Leilinie Gestationsdiabetes mellitus (GDM) - Diagnostik, Therapie und Nachsorge. Langfassung. 2. Auflage. 2018
Deutsche Diabetes Gesellschaft et al.: S3-Leilinie Gestationsdiabetes mellitus (GDM) - Diagnostik, Therapie und Nachsorge. Patientinnenempfehlung. 2. Auflage. 2018
Hu, Z. et al.: Maternal metabolic factors during pregnancy predict early childhood growth trajectories and obesity risk: the CANDLE Study. In: Int J Obes, 2019, 43: 1914-1922
von Kaisenberg, C. et al. (Hrsg.): Die Geburtshilfe: Schulterdystokie. 6. Auflage. Springer-Verlag (Letzter Abruf: 14.12.2022)
Masalin, S. et al.: Impact of smoking on gestational diabetes mellitus and offspring birthweight in primiparous women. In: Acta Obstet Gynecol Scand, 2020, 99: 1632-1639
Schäfer-Graf, U. et al.: Gestationsdiabetes mellitus (GDM), Diagnostik, Therapie und Nachsorge – Kurzfassung der S3-Leitlinie. In: Diabetologie, 2021, 16: S215-S225
As of: 14.12.2022