Curious Parents

Gestational Diabetes is the name given to diabetes which occurs for the first time during pregnancy.  Gestational Diabetes (GDM) affects up to 12% of pregnancies in Ireland, and that number is rising as obesity levels rise in tandem.

In pregnancy, a lot of changes happen in the body. Hormones are released and metabolic changes happen to make sure the baby in the womb receives enough nutrients. One of the changes that happens is called insulin resistance.

Insulin is a hormone that is produced by the pancreas. It helps the body move sugar from the bloodstream into the cells of the body, where the sugar is then used for energy. Insulin allows the cells of your body to use the sugar consumed in your diet and helps keep your blood sugar level from getting too high or too low.

When the body is not able to adapt to these changes this results in Gestational Diabetes.

Gestational diabetes does not result in any apparent symptoms. However, certain characteristics can make GDM more likely;

• • • • • • • • • • if you are overweight,
                  • if you’ve previously had a baby who weighed 10lbs or more,
                  • have Polycystic Ovarian Syndrome,
                  • have a family history of diabetes,
                  • if you’ve had gestational diabetes in a previous pregnancy,
                  • or are of South Asian, Black Caribbean or Middle Eastern descent

A test for gestational diabetes may be recommended for you, and is carried out typically between 24 and 28 weeks of pregnancy.

The test used to diagnose GDM is called a glucose tolerance test. The GTT will usually include some form of fasting the evening before the test. A blood test will be done before having anything to eat or drink.

Then something sweet and sugary will be given (like a jug of Lucozade!) and two more blood tests will be taken at hourly intervals. This way, the results from all tests can be compared, and it is easy to see how high your blood sugar rises after sugar is ingested. This allows the doctors or midwives to judge whether gestational diabetes is present.

Gestational Diabetes usually disappears after the baby is born, but it is still very important to recognise it and treat it. This can minimize the risk of short and long term complications to mother and baby. 

by Meadhbh Aine O’Flaherty

You have just been given a glucose tolerance test and found out you have gestational diabetes (GDM) – what happens next and what does that mean for you and your baby?

The good news is that it’s very important to identify and diagnose GDM, because that means it can be treated and managed, which can reduce the risk of any complications.

Complications of gestational diabetes can include:

• A higher risk of developing preeclampsia than women without GDM.
• Women with GDM are at higher risk of having a large baby, which is called macrosomia. When a baby is macrosomic, their shoulders and abdomen are often disproportionately larger than their heads. This makes passage through the birth canal more challenging and can result in shoulder injuries, prolonged delivery, and reduced oxygen supply to the baby.
• Having a larger baby can also cause problems for mum during delivery which can result in a caesarean section or birth injury.
• Preterm delivery
• Breathing problems in the newborn
• Low blood sugar in the newborn.
• Women with GDM are at higher risk of developing type 2 diabetes and cardiovascular disease later in life than women with non-diabetic pregnancies.
• Children born to mothers with GDM have an increased risk of obesity and diabetes later in life. 

If you have gestational diabetes, you will need to carefully monitor your diet, exercise and blood sugar. For example; drinking less fruit juice and fizzy drinks and eating less chocolate and refined starch. Whole grains, lean protein and fresh vegetables are better choices for mums dealing with gestational diabetes. It is really important not to skip or miss meals, as this helps to keep your blood sugar balanced. Regular exercise can also help!

If you have gestational diabetes you may also need to learn how to check your blood- sugar levels and record your results.

For most women with gestational diabetes, it should be possible to control the condition and keep sugar levels within a normal range. You can do this by making dietary adjustments and by increasing levels of exercise. However, for a minority of women with gestational diabetes, exercise and diet will not be enough. These women will require medication (either oral sugar-lowering medication or insulin) during pregnancy. More frequent check-ups will be recommended if you are using insulin during your pregnancy. This is to ensure that your blood sugar is well controlled and that there are no further complications arising which could affect you or the baby.

Gestational diabetes should go away after birth. However, your blood sugar levels will be tested at your 6 week postnatal check-up. This is to ensure that you no longer have any signs of diabetes. Make sure to remember that if you have had gestational diabetes that you could be at risk of developing type 2 diabetes further down the road and should get tested by your doctor every 1-2 years.

With a bit of planning it is possible to have a healthy and happy pregnancy while dealing with gestational diabetes!

by Meadhbh Aine O’Flaherty

The exact cause of pre-eclampsia remains unknown; however, researchers and doctors believe that it can happen when the placenta does not form properly.

Throughout pregnancy the placenta serves an important role in supplying oxygen and nourishment from the mum to the baby as they grow. In order to support the growing baby, the placenta needs a large, continual supply of blood from the mum. The baby needs this support for healthy growth.

If the placenta does not form properly, this can set off changes in the mum’s body that can have negative effects on both mum and baby.

A common sign used to diagnose pre-eclampsia is proteinuria, which is the term used to describe the presence of too much protein in the urine. Waste products are ordinarily removed from the blood by the kidneys for excretion via urine. When the kidneys are not working properly, proteins that should remain in the blood may be excreted into the urine, resulting in proteinuria.  In mum, pre-eclampsia can lead to kidney dysfunction, which can then lead to proteinuria.

The presence of proteinuria and/or other signs of organ dysfunction, in addition to high blood pressure are the key features for the diagnosis of pre-eclampsia.

Pre-Eclampsia can affect anyone; however certain factors can place you at higher risk for development:

• • • • • • • • • • • If you have a previous history of Pre-Eclampsia,
                    • If you have a family history of the condition,
                    • If it is your first pregnancy,
                    • If you have had a child, but it has been at least 10 years since your last pregnancy,
                    • If you have a BMI greater than 30,
                    • If you are 40 years old or older,
                    • If you have a multiple pregnancy, like twins or triplets.
                    • If you have had previous conditions, like chronic high blood pressure, diabetes, kidney disease and migraine headaches.

Since your risk of developing pre-eclampsia may be affected by these it is important that you make your midwife/doctor aware of your family and medical histories.

Approximately 2-8% of pregnancies worldwide can be affected by pre-eclampsia(1) . In Ireland, 2-3% of all pregnancies are affected by pre-eclampsia – but this rises to 5-7% for first time pregnancies. (2)

1. Edgardo Abalos, Cristina Cuesta, Ana L. Grosso, Doris Chou, Lale Say, Global and regional estimates of preeclampsia and eclampsia: a systematic review, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 170, Issue 1, 2013, Pages 1-7, ISSN 0301-2115, http://dx.doi.org/10.1016/j.ejogrb.2013.05.005. (http://www.sciencedirect.com/science/article/pii/S0301211513001966 )
2. https://hse.ie/eng/services/publications/Clinical-Strategy-and-Programmes/Diagnosis-and-Management-of-Pre-eclampsia-and-Eclampsia.pdf

Pre-eclampsia is a serious condition. If symptoms arise you should notify your doctor or midwife. Symptoms of pre-eclampsia include:

• Headache that won’t go away with medication
• Swelling of face and eyelids
• Blurred or spotty vision
• Sudden nausea and vomiting after 20 weeks
• Generally feeling unwell after 20 weeks.

However, it is possible not show any of these symptoms. It is therefore very important that you attend all your antenatal appointments for proper monitoring.

In our next blog post, we’ll take you through what can happen if you are diagnosed with Pre-eclampsia, the treatments for it, and how research is looking to improve care for mothers with Pre-eclampsia.

By Aoife Delany

Persistent Pulmonary Hypertension of the Newborn (PPHN) is the long and difficult name of a breathing complication that can affect the ability of newborn babies to supply their body with the oxygen it needs. This occurs in roughly 2 out of every 1000 newborns after birth. Treatments are available and can result in a positive outcome for the baby.

‘We see about between 20 and 30 babies a year that would have persistent pulmonary hypertension, and that’s out of 9000 deliveries that we get in the Rotunda. So, we would see about 1 or 2 babies a month. You could argue that it’s not common but we see it often enough.’
– Prof Afif El Khuffash, Neonatologist /Department Head of Neonatology and Clinical Associate Professor at the Rotunda Hospital.

When the fetus is developing it is surrounded by liquid called the amniotic fluid. The fetus does not breathe air like us but instead gets their supply of oxygen from mum through the placenta and the umbilical cord. At this point the lungs do not need to be inflating or deflating to breathe. The lungs are filled with liquid.

After birth the newborn lungs are put under pressure to kickstart the breathing process. This is why babies cry after birth! The change from getting oxygen through the placenta to inhaling it as air is a difficult process and requires help from the blood vessels. The blood vessels to the lungs expand after birth and help the lungs to function properly.

‘When the baby is born and takes his or her first breath, the oxygen (and also some chemical reactions that happen within the body) make the blood vessels in the lungs open up. That allows blood to flow into them and then the baby begins to rely on the lungs to get oxygen into their system.’

PPHN happens when the vessels do not expand correctly. This leads to increased pressure in the vessels and diverts the blood back to the rest of the body without picking up oxygen from the lungs. Oxygen that is inhaled is not easily absorbed into the blood because of the tightness of the blood vessels. The reason this happens is due to a number of factors but sometimes the cause is unknown.

‘Any condition that would damage the lungs would also prevent the blood vessels in the lungs from opening up, e.g.  infection, lung prematurity and having a disruption to the blood flow to the baby around the time of delivery. Also something called meconium aspiration syndrome where babies who are stressed can pass meconium, which is the substance that’s present in their gut, while they’re in the womb. If they pass that into the amniotic fluid and then inhale it that actually can cause quite significant damage to the lungs. And that’s why because there are lots of different pathways that can affect how the lungs behave and how the blood vessels open one single treatment doesn’t always work.’

Some of the symptoms of PPHN include:

●     Fast, hard breathing

●     Noises when the baby exhales (moaning, grunting)

●     Pale blue skin colouring and blue lips, hands and feet

●     Low blood pressure

Other symptoms include low blood oxygen levels. The symptoms are a result of the lack of oxygen in the baby’s body, turning the extremities blue and causing them to struggle for breath.

PPHN is a serious condition and it definitely sounds scary, but there are many treatments available to help newborns with PPHN. Stay tuned for our next blog where we will outline some of the treatments that are used, and how research is helping to find even more!

By Emma Buchet

When the signs and symptoms of PPHN are present, doctors will perform a heart ultrasound test to confirm the diagnosis. Like an ultrasound used during pregnancy, this ultrasound shows the inside of the baby’s body. The ultrasound allows the doctor to exclude other conditions and look at the blood vessels and the pathway that the blood is taking in the heart. PPHN may be confirmed if the doctor sees that the blood is being diverted to areas other than the lungs. The treatment methods for PPHN all focus on raising the baby’s oxygen levels.

• An oxygen rich environment: There are different treatments available but enriching the oxygen in the air that the baby breathes is almost always used. Tubes from an oxygen rich source can be placed into the baby’s airway or the baby may be placed in an oxygen hood.

•     A comforting environment: Babies will be kept in a warm environment and distractions such as loud noises and handling will be kept to a minimum. This is to decrease stress and allow the baby’s body to relax and accept the treatment better. Stress causes an increased need for oxygen (for example heavy breathing during exercise).

•     Medicine: If required, medicine might be given to manage the baby’s blood pressure or to help the breathing process. Surfactant can be used to improve oxygen absorption or, the baby might be sedated to decrease the level of oxygen needed. A chemical called Nitric Oxide (NO) can also be used, as this expands the blood vessels and allows more blood to reach the lungs. If the PPHN is very serious a procedure called ECMO is used. This is similar to dialysis where the baby’s blood is taken out of the body in tubes, oxygenated outside the body and returned in a closed loop.

If caught early then PPHN can be resolved, and the baby and mum can both lead healthy, normal lives.

By Emma Buchet