March 3, 2004
Gestational Diabetes, Hypoglycemia
Question from Grandville, Michigan, USA:
I gave birth to twin boys in 1997. I was hospitalized with pre-term labor for eight weeks until their birth in late August. I was tested for gestational diabetes at 28 weeks and was told I was borderline. My research since has shown I was only borderline according to one protocol while all others placed me in the category of having the disease. The doctor said he would check my sugar again at 32 week. The test was never administered.
We did an amniocentesis at 33 weeks and found that the boys’ lungs were fully developed and that they each weighed six pounds. Needless to say, we stopped all medications and I went into labor. The doctor came in after the labor was very intense and told me that I might have gestational diabetes. He said that, if I hadn’t gone into labor he would have checked my sugar, but since I was in labor and the babies were coming, we would just proceed with the delivery.
When the babies were born their sugar levels both dropped to 2 mg/dl [0.1 mmol/L]. Yes, I did say 2 mg/dl [0.1 mmol/L]. According to the records, it took the lab over 30 minutes to get the results to the neonatal unit and it then took the neonatal unit an additional 30 minutes to get the glucose drip started on the boys. Twin one’s glucose level did not get above 40 mg/dl [2.2 mmol/L] for almost three days. His brother recovered quite nicely within a few hours.
Twin one has many health problems including severe asthma/allergies, reflux, swallow dysfunction, oral motor dysphasia, and gross motor discoordination. Twin two has very minimal problems, including asthma and ADHD.
When the doctor determined that I may have had gestational diabetes and noticed that I wasn’t checked at 32 weeks, should he have let the delivery proceed or should he have tried to get my diabetes under control? The effect of the intrauterine complications couldn’t be stopped, but look at what happed with the early on-set hypoglycemia. I’ve done a little bit of research on the effects on the undiagnosed diabetes and one suggested poorer intellectual and psychomotor development, as well as obesity and impaired glucose tolerance. Can you help explain any of this to me? Also, can you help me understand what the effects, both short and long term, could be on a child when his sugar levels are as low as twin one’s were right after birth? The bottom line is, does any of this have anything to do with the twins’ health problems?
The questions your are asking are very complex for a detailed answer over the Internet. Specific questions about complications of hypoglycemia during the newborn period should be addressed to a pediatrician since this is outside my area of expertise. Neonatal hypoglycemia can result from maternal diabetes, but, usually, the baby responds well to glucose replacement and will adjust insulin production within a few days. The severity of hypoglycemia in your children was impressive for gestational diabetes.
Other causes of neonatal hypoglycemia can be infection which also is related to pre-term delivery. If there were an infection, it may take longer for improvement in blood sugar to occur. A severe infection could account for some of the problems that your child is having. Usually, the complications of undiagnosed diabetes are associated with hyperglycemia starting from conception rather than gestational diabetes that tends to occur in the latter part of pregnancy. Nevertheless, persistent hyperglycemia in the mother may be associated with obesity in childhood. Poor intellectual and psychomotor development can have many causes and an exact mechanism due to diabetes is not known.
Additional comments from Dr. Donough O’Brien:
Whilst there are some reasons to believe that the newborn infant’s central nervous system has some degree of resistance to severe and prolonged hypoglycemia, there is also good evidence that this could well have been the cause of twin one’s subsequent neurological problems, albeit not of his asthma or allergies.