Labor management in diabetes

Tight control of the mother’s blood glucose is absolutely essential during labor. There are different regimes in different centers but all are based on the principle of continuous infusion of both dextrose (glucose) and insulin.

The mother's blood-sugar is checked every hour and adjustments in the rate of the infusions made accordingly. This is aimed at maintaining her blood-sugar within a strict (normal) range, to minimize complications to the baby after delivery.

Possible immediate complications, post-delivery

If blood-sugar control has been poor during labor, the baby may soon develop severe hypoglycemia (low blood-sugar) as well as an imbalance of some essential minerals such as calcium and magnesium.

This may be in addition to respiratory difficulties to which these babies are prone. The baby's condition may deteriorate quite rapidly, requiring intensive care.

Neonatal jaundice risk

Babies born to diabetic mothers are, indeed, prone to develop jaundice, but this is hardly ever serious. This develops a few days after delivery and is usually quite mild. The jaundice is the result of presence of the pigment Bilirubin in the body. Bilirubin needs to undergo a process called conjugation in the liver to be eliminated. This organ, which is immature at this stage, is overwhelmed by the quantities of the pigment.

The level of the pigment (bilirubin) causing the jaundice will be checked in the baby's blood. If this is found to be significantly raised, treatment will be given. The baby is put under a special light (phototherapy) which help eliminate this pigment from the baby’s system. This is rarely necessary.

Neonatal Jaundice: How phototherapy works

This form of very effective therapy was first introduced in Britain in the late 1950s. It made its debut in the United States a decade later. Visible light is shone directly onto the baby’s skin and this converts the pigment bilirubin into soluble pigments which can then be removed from the body without needing the process of conjugation in the liver.

Diabetes after delivery

After delivery, the mother’s insulin requirement goes down and this occurs immediately. In some cases, it may be necessary to actually stop insulin temporarily (for 24 to 48 hours) before resuming at a dose used before conception.

In any case, the blood glucose will be monitored closely in the first 24 hours to determine her individual requirements.

Ensuring a good outcome...

Good blood sugar control is key to controlling the condition before conception, in pregnancy, and during labor and delivery. If this is achieved, the mother's expectations and outcome should be virtually similar to anybody else's.

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