Gestational diabetes placenta deterioration
The gestational diabetes placenta
The placenta is the organ between the baby and mother which is responsible for providing oxygen and nutrients to the baby through the blood flow in the umbilical cord and removing waste and carbon dioxide from the baby, back to the mother. As we know, gestational diabetes increases the amount of glucose flowing through the bloodstream to the baby but the gestational diabetes placenta may also have growth, structural and functional differences to that of a non-diabetic mother:
In diabetes, the placenta undergoes a variety of structural and functional changes (rev. in1–3). Their nature and extent depend on a range of variables including the quality of glycemic control achieved during the critical periods in placental development, the modality of treatment, and the time period of severe departures from excellent metabolic control of a non-diabetic environment.
Placental structure and function can be changed as a result of maternal diabetes. The nature and extent of these changes depend on the type of diabetes and on the gestational period.
Gestational diabetes placenta issues
Having gestational diabetes means that we are at a higher risk of having placenta issues, although other factors can also cause placenta issues such as other types of diabetes, hypertension, anaemia, blood clotting disorders, smoking and drug abuse during pregnancy.
Many terms may be used for gestational diabetes placenta issues such as placenta deterioration, placenta insufficiency, placenta failure, placenta dysfunction, premature ageing, calcification and impaired placenta function.
Gestational diabetes placenta issues can occur when there are problems with blood flow through the placenta. The earlier problems are detected in the pregnancy, the more severe the complications can be for the baby.
Complications linked to gestational diabetes placenta issues
- IUGR (Intrauterine growth restriction)
- SGA (baby grows small for gestational age)
- Premature labour
- risk of oxygen deprivation at birth for baby
- low body temp at birth for baby
- low blood sugar levels at birth for baby
Symptoms of gestational diabetes placenta deterioration
There can be no symptoms of placenta issues at all, but the good thing with gestational diabetes is that we are monitored regularly at hospital with additional growth scans and checks. If you are not offered additional growth and doppler scans you should call your diabetes team and midwife to discuss this. A timetable of recommended antenatal appointments with gestational diabetes is available in the NICE guidelines and can be viewed here.
- Changes in baby's movements - if there is an increase, decrease or change in pattern of baby's movements then call your maternity assessment unit as soon as you notice. It is important to explain that you have gestational diabetes and explain your concerns. For further advice around baby's movements during pregnancy, please take a look at the Count the kicks website for the most up-to-date and correct advice. Never feel that you are being a nuisance by getting your baby's movements checked (even if you have been getting checked lots) and do not be fobbed off.
- A sudden drop in blood sugar levels - levels dropping much lower than usual for you to very low levels (2.0's - 3.0's mmol/L) consistently can be a sign that there are issues with the function of the placenta. It is best to consult a medical professional if you see a drop in levels like this.
- Frequent hypos in insulin controlled mothers - frequent hypos with lack of ability to raise blood sugar levels following hypo treatment and a need to dramatically decrease insulin therapy should be called in to a medical professional for advice.
- Levels not raising after eating - levels which are not raising after eating typical meals can suggest there are issues with the placenta function and so you should call your diabetes team to discuss this. Please note: if you have recently started or increased medication or insulin, have been very active or have eaten a meal lacking in carbohydrates and high in protein and fat, then you may not see a raise in blood sugar levels and may even see a lower reading than before your meal. This is not a concern. The concern arises when there are no raises in levels after eating throughout the day.
- Lack of or slowed growth of baby - baby's which have slowed growth may be at risk of placental issues. This is detected during an ultrasound growth scan and your medical professionals will discuss with you the best plan of care.
Blood sugar levels dropping or normalising and concern over placenta deterioration
Many ladies with gestational diabetes see a natural drop in blood sugar levels after around 36 - 37 weeks. Insulin resistance presents well at 24 - 28 weeks and is at its worst between 32 - 36 weeks. This is due to hormonal changes, the baby growing rapidly causing the placenta to work harder and it pushing out more insulin resisting hormones. After this time, (around 37 weeks) the release of hormones slows down and ease off meaning insulin resistance may improve slightly and your blood sugar levels may start to normalise, requiring a reduction in insulin therapy if you have been using insulin and you may need to increase the amount of carbohydrates eaten to keep levels stabilised.
Remember that 'good' blood sugar levels are not the concern, but a dramatic drop and/or levels not raising after eating.
The placenta naturally ages at the end of the pregnancy and so it can be a sign that your pregnancy is coming towards the end and baby may be getting ready to appear!
If you have any concerns over gestational diabetes placenta issues or dropping blood sugar levels then you should discuss these with your health care professionals. It is not worth sitting, questioning and worrying, give your diabetic team a call and discuss your concerns.
What happens if placenta deterioration is suspected?
If you suspect placenta deterioration then you should contact a medical professional immediately. Most women will be asked to go to hospital for assessment and depending on the gestation, if following monitoring, dopplers or scans there is any cause of concern you may be admitted for care or assessed daily. A plan of care will be discussed which may involve you having steroid injections to help mature your baby's lungs (depending on your gestation and mode of birth) and you may be advised to have an induction or earlier than planned caesarean section.
It can be an extremely scary time, but your health care professionals should answer any questions you have and will help you work on the best plan of action for your baby and you.
Histological abnormalities were observed more frequently in the diabetic placentas compared to the controls. These findings support the hypothesis that impaired placental function is one of the main reasons for the increased frequency of fetal complications in diabetic pregnancies