What happens after baby is born with gestational diabetes?

What happens after baby is born when you've had gestational diabetes will depend on your type of birth and your birth plans.

Babies born to mothers with gestational diabetes are at risk of hypoglycaemia (low blood sugar levels) and so it is recommended that babies have their blood sugar levels checked following birth in addition to the usual newborn checks.

 

What to expect after baby is born - checks on babies born to diabetic mothers

Neonatal or newborn hypoglycaemia

Newborn babies of diabetic mothers when there has been poor diabetic control in pregnancy will often struggle with their own blood sugar levels after birth.  This is due to the baby overproducing their own insulin whilst growing in the uterus to help process the excess sugars passed from the mothers bloodstream.

These babies may have high insulin levels persisting in the first few days after birth which can result in hypoglycaemia as they are no longer receiving excess sugar from the mothers bloodstream and they may struggle to regulate their own insulin production to normal levels.

Babies of mothers who have had reasonably good blood glucose control may still suffer with low blood sugar levels after birth too and so it is recommended that all babies born to diabetic mothers (including gestational diabetes) have their blood sugar levels checked.

Testing baby for hypoglycaemia following birth with gestational diabetes

after baby is born gestational diabetesIn the majority of hospitals, newborns born to diabetic mothers are routinely monitored for hypoglycaemia.

Each hospital is different as to how they monitor the blood sugar levels, but the procedure is the same.

A midwife or nurse will heel prick the baby to obtain enough blood to be tested on a blood glucose test monitor, the same as we use to monitor our own blood sugar levels throughout the pregnancy.

You may find watching this distressing as sometimes (but not always) baby may become distressed, screaming and crying once they have been pricked with the lancet.

You may notice that your baby's foot looks blue or purple in colour following the testing too.  As much as this may seem terrible for your baby to go through, it is very important that levels are checked to make sure they are not suffering hypoglycaemia.

The amount of tests taken can vary and the times taken, but your hospital will have a policy which they will follow.

The most commonly used test times are 3 tests, 3 hours apart either before or after feeding which must all be above a certain target.  Once again, different targets are used for this. NICE recommends a target of >2.0mmol/l

Some hospitals may have longer testing times such as 3 hourly for 24 hours and we have seen some of our mothers in our Facebook support group inform us that they do not test babies for hypoglycaemia in their hospital, or because they were diet controlled the baby will not be tested.

Our advice would be to enquire about testing for hypoglycaemia after baby is born and raise concerns should you have any.

NICE guidelines recommend in their 'Preventing and assessing neonatal hypoglycaemia' guideline that

1.5.7 All maternity units should have a written policy for the prevention, detection and management of hypoglycaemia in babies of women with diabetes. [2008]

BM record - complications of gestational diabetes baby

 

After baby is born - testing following a home birth

If you have a home birth then a midwife may come to test your baby's blood sugar levels or you may opt to test your baby's blood sugar levels yourself with your own equipment and inform your hospital of any concerns.

 

Prevention of hypolgycaemia

  1. Keep blood sugar levels within target and stabilised  - It is best try to keep your blood sugar levels within your targets and stabilised throughout your pregnancy, avoiding high spikes in levels, especially leading up to and during labour. Some mothers will be on a sliding scale insulin & glucose drip to control blood sugar levels during labour, but this may not be necessary if you gain good control over your levels.
  2. Skin to skin and 1st feed - Once baby is born, skin to skin is very important and initiating a first breast feed within the first 30 mins will aid good blood sugar levels in baby.
  3. Colostrum harvesting - Many mothers with gestational diabetes harvest colostrum before the birth of baby to be able to give the newborn top up feeds, should breast feeding be a problem, or to give additional top up feeds in between feeds as colostrum is the best thing to raise blood sugar levels.
Colostrum harvesting and feeding

newborn being fed colostrum via syringe, click here to learn more about colostrum harvesting

 

NICE guidelines

1.5 Neonatal care

Initial assessment and criteria for admission to intensive or special care

1.5.1 Advise women with diabetes to give birth in hospitals where advanced neonatal resuscitation skills are available 24 hours a day. [2008]

1.5.2 Babies of women with diabetes should stay with their mothers unless there is a clinical complication or there are abnormal clinical signs that warrant admission for intensive or special care. [2008]

1.5.3 Carry out blood glucose testing routinely in babies of women with diabetes at 2–4 hours after birth. Carry out blood tests for polycythaemia, hyperbilirubinaemia, hypocalcaemia and hypomagnesaemia for babies with clinical signs. [2008]

1.5.4 Perform an echocardiogram for babies of women with diabetes if they show clinical signs associated with congenital heart disease or cardiomyopathy, including heart murmur. The timing of the examination will depend on the clinical circumstances. [2008]

1.5.5 Admit babies of women with diabetes to the neonatal unit if they have:

  • hypoglycaemia associated with abnormal clinical signs
  • respiratory distress
  • signs of cardiac decompensation from congenital heart disease or cardiomyopathy
  • signs of neonatal encephalopathy
  • signs of polycythaemia and are likely to need partial exchange transfusion
  • need for intravenous fluids
  • need for tube feeding (unless adequate support is available on the postnatal ward)
  • jaundice requiring intense phototherapy and frequent monitoring of bilirubinaemia
  • been born before 34 weeks (or between 34 and 36 weeks if dictated clinically by the initial assessment of the baby and feeding on the labour ward). [2008]

1.5.6 Do not transfer babies of women with diabetes to community care until they are at least 24 hours old, and not before you are satisfied that the baby is maintaining blood glucose levels and is feeding well.[2008]

Preventing and assessing neonatal hypoglycaemia

1.5.7 All maternity units should have a written policy for the prevention, detection and management of hypoglycaemia in babies of women with diabetes. [2008]

1.5.8 Test the blood glucose of babies of women with diabetes using a quality‑assured method validated for neonatal use (ward‑based glucose electrode or laboratory analysis). [2008]

1.5.9 Women with diabetes should feed their babies as soon as possible after birth (within 30 minutes) and then at frequent intervals (every 2–3 hours) until feeding maintains pre‑feed capillary plasma glucose levels at a minimum of 2.0 mmol/litre. [2008, amended 2015]

1.5.10 If capillary plasma glucose values are below 2.0 mmol/litre on 2 consecutive readings despite maximal support for feeding, if there are abnormal clinical signs or if the baby will not feed orally effectively, use additional measures such as tube feeding or intravenous dextrose. Only implement additional measures if one or more of these criteria are met. [2008, amended 2015]

1.5.11 Test blood glucose levels in babies of women with diabetes who present with clinical signs of hypoglycaemia, and treat those who are hypoglycaemic with intravenous dextrose as soon as possible.[2008, amended 2015]

 

SIGN guidelines

7.10 INFANTS OF MOTHERS WITH DIABETES

Labour and delivery should only be undertaken in a maternity unit supported by neonatal intensive care facilities.

There is no need for routine admission of the infant to the neonatal unit.

There is insufficient evidence on the preferred method of cotside blood glucose measurement in neonates; however, whichever method is used, the glucose value should be confirmed by laboratory measurement.

Neonatal hypoglycaemia is defined at blood glucose <2.6 mmol/l and is associated with adverse short and long term neurodevelopmental outcomes

 

HSE guidelines

5.5.3 Neonatal Care

● Neonates should be nursed at the mother’s bedside unless admission to intensive care is necessary (C)37.

● Early breast feeding (within 1 hr) should be encouraged.

● Neonates of women with diabetes are at an increased risk of hypoglycaemia, macrosomia, respiratory distress and hypocalcaemia52.

● Following delivery, neonatal blood glucose concentration falls quickly then rises and stabilises by approximately 2-3 hours of birth53.

● Routine blood glucose measurement in the well baby at term during the first 2–3 hours after birth should be avoided; however where there is clinical concern blood sampling should be performed (C)37.

● Screening for hypoglycaemia should generally be performed prior to the second feed (approximately 4-6 hrs) in the well baby at term54.

● The diagnosis of neonatal hypoglycaemia is controversial. No conclusive evidence exists that defines the optimum cut off point below which serious adverse short and long term neurodevelopmental outcomes occur. An operational threshold of a blood glucose level <2.6mmol/L has been proposed55.

● Blood glucose should be tested using a quality assured method which has been certified for neonatal use10.

● Hypoglycaemia should be confirmed by laboratory testing56.

● Babies who display clinical signs of hypoglycaemia should be transferred to neonatal intensive care for intravenous dextrose bolus and intravenous fluids56.

What happens if my baby fails a heel prick test?

If your baby's blood sugar levels are below the hospital target, then in most cases testing is started again to achieve a set of consecutive above target readings.

If the reading is below target more than twice in a row and after feeding, your baby may be given colostrum top up feeds, formula top up feeds, tube feeds, glucose solution or gel, or if there is a greater concern, they may need to be given a intravenous fusion of glucose in order to raise their blood sugar levels.

 

After the heel prick tests - future testing of baby

After your baby has passed the heel prick tests for hypoglycaemia, there are no further checks on your baby for diabetes.

Babies born to mothers with gestational diabetes are at a higher risk of having obesity and type 2 diabetes later in life. Use the information gained during your gestational diabetes pregnancy to make healthy life choices for your whole family and the future.

Should you have any concerns that your baby or child has any problems relating to gestational diabetes, or concerns that your baby/child has diabetes then you should consult a medical professional.

 

What about the mother after baby is born?

After baby is born and the placenta is delivered, the cause of gestational diabetes has gone. Mothers should be tested for diabetes following birth.

Our post birth testing page explains more details of testing after baby is born and future testing. Post birth testing is important as women that have been diagnosed with gestational diabetes have a higher risk of developing type 2 diabetes.

 

I've been told my baby will be taken to special care after delivery due to gestational diabetes

We have seen a few mothers in Ireland & England be told that their baby will be taken into special care following birth purely due to the mother being diagnosed with gestational diabetes.

Unless there are other complications then this is not necessary and goes against current recommendations (linked above) which state that the baby should receive skin to skin as soon as possible and should remain by the mother's bedside, especially important for those wishing to breast feed.

We urge you to research the matter further and make clear your plans for after the baby is born.

 

How long will I be in hospital for after baby is born?

dateThis question is one of those 'how long is a piece of string' questions. It's very hard to answer how long you may need to stay in hospital after baby is born. It will depend on checks your hospital complete and how well both you and baby are doing.

With relation to gestational diabetes this is the NICE recommendation:

1.5.6 Do not transfer babies of women with diabetes to community care until they are at least 24 hours old, and not before you are satisfied that the baby is maintaining blood glucose levels and is feeding well.[2008]

Other complications

jaundice gestational diabetesGestational diabetes can cause many complications during the birth and for the baby.

A common complication after baby is born which is higher risk in gestational diabetic babies is jaundice. You can read more about jaundice on our complications page.

To read more details of complications linked to gestational diabetes, please take a look at our complications page.

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