News Moms Need

Foods we eat are broken down to glucose (blood sugar), which is the body’s main source of energy. Extra glucose is stored in the liver and is released into the blood stream as needed. Insulin is a hormone that helps our cells use energy from glucose.

Hypoglycemia (also called low blood glucose) is when blood glucose levels are too low. When blood glucose levels are low, your body can’t get the energy it needs.
 
Hyperglycemia (also called high blood glucose) is when your body doesn’t have enough insulin or can’t use insulin correctly. Both of these conditions are common in women with preexisting diabetes. 

Hypoglycemia is usually mild and easily treated by eating or drinking something with sugar in it. If it’s not treated, it can cause confusion and severe lightheadedness and you might pass out. Hypoglycemia can be caused by:
    • Not eating enough. This may mean you’ve been eating meals or snacks that are too small, or skipping or delaying meals or snacks.
    • Taking too much insulin
    • Getting too much physical activity

If you have hyperglycemia, you may need to change the amount of insulin you take, your meal plan or the amount of physical activity you get. Signs that you may have hyperglycemia include if you:
    • Need to go to urinate often
    • Are thirsty
    • Lose weight suddenly

Hyperglycemia can be caused by:
    • Problems with the amount of food you eat and diabetes medicine you take
    • Eating the wrong kinds of foods or more food than usual
    • Being less active than usual
    • Having an illness
    • Stress

If you have diabetes, it is important to know the early signs of hyperglycemia. If hyperglycemia is left untreated, it may develop into a more serious problem. You can read more about it at this link.

Your health care provider can monitor you for both of these conditions during pregnancy to make sure you and your baby stay healthy.

Tuesday, March 26, is Diabetes Alert Day. It is designed to teach the public about the seriousness of diabetes, particularly when the disease is left undiagnosed or untreated.

Having gestational diabetes during pregnancy significantly increases a woman’s future chances of developing diabetes. About half will develop diabetes over the next 10 years. And the mom isn’t the only one at risk - her child of that pregnancy may be at an increased risk for developing obesity and type 2 diabetes later in life.

Find out if you’re at risk for type 2 diabetes by taking the Diabetes Risk Test and talking to your family about your family history of diabetes. If left undiagnosed or untreated, diabetes can lead to serious health problems including heart disease, stroke, blindness, kidney disease, amputation, and even death.

For more information and free resources, visit the NDEP Web site at YourDiabetesInfo.org.

A maternal-fetal medicine specialist is an obstetrician who concentrates on the care of pregnant women and babies in high-risk situations. Another name for this doctor is a perinatologist.

A maternal-fetal medicine specialist treats women with a number of conditions. Complications with mom’s health, include:
• A history of multiple miscarriages or premature birth
• Diabetes (gestational or preexisting)
• Hypertension (high blood pressure)
• Preeclampsia
• Infectious disease (toxoplasmosis, parvovirus, HIV/AIDS, etc.) or chronic illness
• Rh disease
• A family history of heart, kidney, or other disease

A maternal-fetal medicine specialist often treat pregnant women who are carrying multiples (twins, triplets or more) as the risk for preterm birth is significantly increased.

This doctor also specializes in the care of women whose baby is known to have:
• Abnormal fetal growth
• A known birth defect or suspected genetic disorder, such as Down syndrome, Trisomy 13 or Trisomy 18
• A baby with macrosomia (too large)
• A baby with fetal growth restriction (too small)

If you find yourself in a position where the risk of complications is higher than the average pregnancy, ask your current health care provider for a referral to a maternal-fetal medicine specialist. You may or may not need the extra care, but it will be good to get a second opinion.

Nine months of a healthy pregnancy is the best gift you can give your future baby. There are things you can do before you get pregnant to help give your baby a better chance of a healthy and full-term birth. Talk to your health care provider before and during pregnancy about you and your partners’ health and any concerns you many have. This will help you have a healthy baby.

Before getting pregnant, ask your health provider these 9 questions.

What do I need to know about:
1. Diabetes, high blood pressure, infections or other health problems?
2. Medicines or home remedies?
3. Taking a multivitamin pill with folic acid in it each day?
4. Getting to a healthy weight before pregnancy?
5. Smoking, drinking alcohol and taking illegal drugs?
6. Unsafe chemicals or other things I should stay away from at home or at work?
7. Taking care of myself and lowering my stress?
8. How long to wait between pregnancies? (Ask your health care provider what’s best for you.)
9. My family history, including premature birth? Premature birth is when your baby is born too early, before 37 completed weeks of pregnancy.

Special thanks to the celebrities Thalia and Heather Headley for helping the March of Dimes tell women about these 9 important questions.

Too much weight before and during pregnancy can have serious health consequences not only for the mother, but for her child’s health for many years, new research shows.
 
“While it’s pretty well-known a healthy weight is crucial to a healthy and long life, new research is showing that if a woman is overweight while pregnant, her baby is more likely to be overweight,” says Alan R. Fleischman, MD, March of Dimes medical director. Health risks continue into childhood, with a higher risk of developing insulin resistance, high blood pressure and high cholesterol, all of which can lead to heart disease and diabetes.  
 
We realize that weight is a sensitive subject for many women and that some health care professionals are uncomfortable discussing it. But weight is a risk factor that can be changed, greatly improving outcomes. It’s very important to talk about this and get essential changes started. If a woman begins her pregnancy at a healthy weight, it can not only lower the risk of preterm birth and birth defects, but can give her baby a healthier start that can have life-long benefits. You can read a lot more about it at this link.

The March of Dimes recommends that women who are planning a pregnancy should get a preconception health check-up. During the visit, your health care provider can identify and treat health conditions that can pose a risk in pregnancy, such as high blood pressure, diabetes or certain infections.  Your provider can offer information on weight as well as nutrition, smoking, drinking alcohol and occupational exposures that can pose pregnancy risks. If weight might be an issue for you, don’t put off talking to your doc about about it. It will be good for both you and your baby.

The rate of diabetes continues to increase. Today, about 1 in 9 adults has diabetes. But, according to the CDC, in the next four decades, the number of U.S. adults with diabetes is estimated to double or triple. That means anywhere from 20 to 33 percent of adults could have the disease.

Diabetes is the seventh leading cause of death in the United States. Racial and ethnic minority groups are the hardest hit by diabetes and its complications.

Nearly 9 out of 100 women in the United States have diabetes. About 3 out of those 9 don’t know it. It’s very important for all women to see their health provider regularly to watch for this disease and learn how to manage it.

If you have diabetes and are pregnant or trying to get pregnant, your health care provider will want to take extra special care of you. Pregnant women who have diabetes before pregnancy (preexisting diabetes) are considered to have a high-risk pregnancy. If diabetes is not well controlled, a mom and baby could face serious health complications:

• The woman is more likely to have a miscarriage and stillbirth.
• The baby is 2 to 4 times more likely to have a serious birth defect than other babies. Heart defects and neural tube defects are more common among babies born to women with diabetes.
• The baby is likely to be very large (10 pounds or more). This makes vaginal delivery more difficult and puts the baby at risk for injuries during birth.

The time to act is now. Join Healthy People 2020 in support of American Diabetes Month. Organizations and individuals can work together in their community to prevent diabetes and its complications. Learn more and teach others about the dangers associated with diabetes and how to prevent them.

You have the power to prevent and control diabetes. If you already have diabetes, work to lower your risk of serious complications. If you don’t have the disease, learn if you are at risk for type 2 diabetes. To learn more about diabetes and what you can do to prevent it, read the information from the CDC.

On average, a developing baby’s lungs are considered to be mature and fully functional around 35 to 36 weeks after conception.  For babies born before that, breathing can be a serious challenge.  Respiratory distress syndrome (RDS) is the most common illness in the NICU.  RDS can be mild or quite severe, but the good news is that 99% of babies with RDS survive.  The babies who don’t survive usually are the youngest, smallest babies born before 26 weeks of gestation.

Surfactant is a foamy substance that lines the lungs in mature babies and keeps them from collapsing, making breathing in and out easier. Premature babies lack surfactant and their lungs collapse between breaths.  This makes inhaling air and exhaling carbon dioxide very difficult.  The energy it takes to expand and contract the lungs can be exhausting and overwhelming for these tiny babies.

Research has shown us that the earlier a baby is born the less surfactant is likely to exist in the lungs and the more likely it is for him to develop RDS.  Boys are more likely to get RDS than girls because their lungs mature more slowly. Preemies with mothers who have diabetes  or with Rh blood-type incompatibilities are at greater risk for RDS because their lungs are slower to produce surfactant.  Babies with mothers who have severe preeclampsia are more vulnerable to RDS because their normal lung development is disrupted. Babies born via cesarean delivery and without labor are at increased risk for RDS.  This is because labor produces hormones that promote lung maturation and uterine contractions may help squeeze excess fluid from a baby’s lungs, making breathing easier.

Most babies who will get RDS show symptoms within a few hours of birth.  RDS usually gets worse for a couple of days and then improves as the baby starts to produce more surfactant.  Treatment includes giving a dose or two of man-made surfactant and providing breathing assistance with oxygen, C-PAP or mechanical ventilation, depending on each baby’s needs. 

While the survival rate is extremely high, severe RDS may lead to longer-term health problems.  Mechanical ventilation can be life-saving, but it is harsh. Chronic lung disease, also known as bronchopulomonary dysplasia (BPD), comes as a result of inflammation and scaring of the lungs that may result from ventilation.  Children with severe RDS also have an increased likelihood of asthma.

Macrosomia is a term that describes an unusually large baby, weighing more than 9 pounds 15 ounces.  Aside from genetic factors (others in the family are really big), one of the main causes of macorsomia is poorly controlled diabetes during pregnancy.  Increased maternal plasma glucose levels, as well as insulin, stimulate the baby’s growth.  Pregnant women who are obese are at increased risk of having an overly large baby.  If a baby goes way past its due date, it may be overly large.  Interestingly, more male babies are macrosomic than girls, and if you have had one overly large baby you may be at increased risk of having another large baby in a future pregnancy.  I know a guy who is one of four boys, each of whom weighed over 14 pounds!  I kid you not.

With a really big baby, there is the chance of having a difficult birth.  The mother may experience perineal tearing, significant blood loss, and even damage to her tailbone.  The baby’s shoulder may get caught behind the mother’s pubic bone causing a dangerous situation and a threat to both the mother and baby, including possible infant death.
 
Some doctors will plan a cesarean delivery if a woman appears to be carrying a very large baby.  Unfortunately, late third trimester ultrasounds are not particularly accurate at measuring the baby’s size and many planned, cautionary cesarean deliveries turn out to be unnecessary.  It is always important to go over the risks and benefits to both mom and baby when discussing a planned cesarean delivery.

If you are planning for a baby in you future, now is the time to get your weight under control.  If you have diabetes, be sure to manage it carefully so that it is as controlled as possible during your pregnancy.  If you have recently had a very large baby and had gestational diabetes, make sure your doctor tests you for diabetes a few months after delivery.  Up to 20% of women who had gestational diabetes end up with postpartum diabetes and will need to manage it.

Sometimes I wish I had a crystal ball to look into the future. Did you know that your pregnancy can be your crystal ball?

Last week, the television program Today had a helpful segment on how health issues in pregnancy can sometimes predict health issues in the future. For instance, if a woman develops gestational diabetes or high blood pressure during pregnancy, she may be at increased risk for those conditions after pregnancy.

Also, your mother’s pregnancy history may tell you about some of the risks you may face. So you may want to take some time to learn about your family health history.

Today, more than 3 percent of babies in this country are born in sets of two, three or more; about 95 percent of these multiple births are twins. The high number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including premature birth (before 37 completed weeks of pregnancy). 

About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born premature. The length of pregnancy decreases with each additional baby. On average, most singleton pregnancies last 39 weeks; for twins, 35 weeks; for triplets, 32 weeks; and for quadruplets, 29 weeks.

More than half of twins and almost all higher-order multiples are born with low birthweight (LBW), less than 5½ pounds or 2,500 grams.  LBW can result from premature birth and/or poor fetal growth. Both are common in multiple pregnancies.

LBW babies, especially those born before about 32 weeks gestation and/or weighing less than 3 1/3 pounds (1,500 grams), are at increased risk of health problems in the newborn period as well as lasting disabilities, such as mental retardation, cerebral palsy,  and vision and hearing loss.   While advances in caring for very small infants has brightened the outlook for these tiny babies, chances remain slim that all infants in a set of sextuplets or more will survive and thrive.

Preeclampsia and diabetes  in the mother are two conditions that, for the safety of the mother and baby, can lead to an early delivery. Women expecting twins are more than twice as likely as women with a singleton pregnancy to develop preeclampsia. Gestational diabetes can cause the baby to grow especially large, increasing the risk of injuries to mother and baby during vaginal birth and making cesarean delivery more likely.  Babies born to women with gestational diabetes also may have breathing and other problems during the newborn period.

Have you or someone in your family had twins or triplets?  Were they in the NICU?