Let's talk now about risk factors
and we're speaking specifically of risk factors for
So, obesity could be a risk factor.
Hypertension, so someone with preexisting disease
would be someone who would be at risk for developing
A client over the age of 25, now you might be thinking to
well, that doesn't sound really impressive.
Now, let's think about working in maybe a teenage clinic
where we have a lot of young parents.
And so if we have a lot of young pregnant clients,
they're not necessarily going to be at risk for gestational
unless some of these other risk factors play in, so that
would be important to know.
If there's a family history of any type of diabetes, so,
gestational diabetes or type 1 or type 2,
then we want to pay attention to that.
And also, if there's a significant OB history and when I say
I mean any history, of a stillbirth or fetal macrosomia.
Macrosomia, meaning large body or big baby.
So hold on to that when we talk about fetal effects, this is
going to comeback, so remember that one.
Other complications that the client might experience would
be that they could develop preeclampsia.
So why would that be?
We've already talked about the fact that the placenta,
for someone who has gestational diabetes is not exactly
And the hormones are overshooting and causing it some
resistance, so that's already one problem.
So if your placenta is not doing one job well,
then there's a potential it could not do other jobs well,
which may lead to the development of preeclampsia.
I'm hoping you remember your 3P's of diabetes, polyurea,
polyphagia, and polydipsia.
So polyphagia where you eat a lot, well, you're not going to
see the baby doing that
cuz well, they don't really eat so that doesn't really work,
and then being thirsty.
Again, babies don't really do that so much. But, let's talk
about the third P.
Polyurea, hmm, a lot of urine. How would that be a
Well, let's think about it. What is the amniotic fluid made
And if you don't know the answer to this,
I'm getting ready to gross you out because mostly it's made
up of fetal urine, you got it.
So when you think about producing excessive urine, or
then it makes sense, the baby is not a diabetic,
and all that extra glucose from the pregnant person's blood
stream comes into their bloodstream
and oh, my, goodness, their blood sugar goes up and they
experience those 3P's as well,
so they void a lot and the amniotic fluid increases to the
point where we have polyhydramnios.
Weight gain. So this again is going to be a pregnant person
Maybe a baby's sign too but we'll talk about that in just a
Diabetic ketoacidosis, we just talked about what that looks
and because the body is trying to regulate these blood
there may actually be episodes of hypoglycemia for the
pregnant person as well.
Let's talk about some more of those potential fetal
So, remember all that glucose that's being transferred
between the pregnant person
and the baby, it's coming through the placenta and the baby
is just eating it up more and more calories
and they're getting fatter and fatter and fatter,
and I don't mean in the cute kind of fat,
I mean the kind of fat and the kind of macrosomia that can
lead to birth injuries, okay?
Also, if the baby's blood sugar is really high,
they can go into a coma as a result of hyperglycemia
which can ultimately lead to stillbirth. Is that coming back
to you now? Yes. Very good.
Now, one of the ways that we treat diabetes is that we get
the baby out of that environment,
so they may need to be delivered early,
so prematurity is definitely a possibility when we think
Now with preexisting disease, one of the things that having
abnormally high blood sugars
can do is it can change the DNA of your cells which could
lead to congenital anomalies,
especially if blood sugars are out of control during those
first eight weeks.
Remember, that's when we have the formation of organs, so
that's really important.
We can also have situations where, because we have damage to
we could develop heart disease or cardiomyopathy.
That's also a symptom of preexisting disease,
but it can happen as a result of gestational diabetes as
So now let's talk about what happens to that sweet little
baby when they come out?
So remember, the baby's been in there chilling, gobbling up
all that glucose,
because they're not a diabetic and their beta cells produce
all the insulin
that is needed to get that glucose into the cell.
So where is that glucose coming from?
It's coming from the pregnant person and it's coming through
and once the baby's born and we cut the cord, then that
connection is lost
and so now, the insulin has used up all the glucose and
what happens to the blood sugar?
Well, it goes down and now we have an infant with
Well, I tell you this thing about babies, they're really not
good at multitasking.
So when one thing goes bad, lots of things go bad.
So we start with hypoglycemia, then as the baby tries to
regulate that temperature,
well, they don't do so well with that either, then they
develop hypothermia, so they're cold.
Well, then, when that happens, then there's respiratory
distress, and they don't breathe very well.
Well, then, the next thing that happens is that the body
tries to produce
more red blood cells to get more oxygen, we overshoot and
then the baby develops jaundice.
And, then, when we think about the macrosomia, large body,
remember I said, not cute kind of fat but birth injury kind
Let's think about the baby trying to come out
and we have this nice big linebacker head that comes out
and this nice big linebacker shoulders from all that fetal
and then we have a shoulder
that keeps the baby's body from delivering and we have a
So now we have an injury, potentially, on the brachial
plexus, because we had a big baby.
See how all this sort of stacks together?
Then we can have issues with glucose intolerance,
again, because we had respiratory distress and hypothermia,
and all of those other issues, then the baby can have
trouble managing their blood sugar.
And then, as the infant gets older, remember our long term
Obesity could definitely be there and you just fill in the
on all the potential life-long complications that can result