Human nature can be very predictable. Once a new baby comes into the world, the parents will share the good news with family and friends and the baby is almost always described by their gender and birth weight before anything else.
Small babies are deemed fragile with their delicate features. They may intimidate many, especially those who have not held a newborn before. On the other end of the spectrum, are the big babies who excite us all, including the doctors.
Bernice* was a 34-year-old lady who walked into the labour ward in our national referral hospital after her contractions started at home. She had attended her antenatal clinics at a dispensary near home and the period had been uneventful.
Bernice was admitted to the ward and reviewed. Though she had good contractions, the progress did not turn out as expected. She ended up having a caesarean section as the progress of labour was too slow. The team in the operating room was treated to a surprise. They delivered a bouncing baby girl with a mop of curls on the head who weighed a whopping 5,200g! There was no way this baby would have been delivered normally!
She was so big she couldn’t fit in the resuscitaire where the babies are kept after delivery, to keep warm and dry. Everything about her was chubby and it was easy to forget that she was still as delicate as her fellow newborns, if not more.
As procedure dictates, Bernice’s baby was admitted to the newborn unit for the next three days to ensure she was all right. Despite surgery, Bernice had to make the three-hourly trips to the newborn unit to breastfeed the little one on instruction of the neonatologist. The little one had to convince the team in the newborn unit that she could hold her own before being permitted to join mummy in the ward.
Every time a woman delivers a baby weighing above 4,000g, it is prudent to screen the mother for diabetes. Local data may be limited, but a study carried out in Western Kenya and published in 2017, reported that approximately 2.9 per cent of pregnant women had diabetes. On average, 90 per cent of these mothers had developed the diabetes during the pregnancy while only 10 per cent had diabetes before getting pregnant.
Diabetes simply means the body’s capacity to maintain normal blood glucose levels has failed. In a normal setting, digested food releases glucose which is absorbed into the bloodstream. There is a normal limit for how high the concentration of glucose in the blood stream should be. Once this limit has been surpassed, the body responds by producing insulin.
Insulin is the riot police that forces all excess glucose to be removed from the blood stream and taken up by storage organs such as the liver and muscles. The insulin triggers the opening of glucose gates in these organs to allow the glucose in. Once in, the glucose is converted to glycogen, which is the storage form. There is a maximum capacity to store glycogen and once this is reached, the remaining glucose is converted to fat, which is deposited around our bodies.
In type one diabetes, one is not able to produce adequate insulin to march the level of glucose, hence the level of blood glucose rises above normal without restriction. In type two diabetes, despite one making adequate amounts of insulin, the response to its presence is inadequate. The glucose gates don’t respond well enough hence one requires higher amounts of insulin to achieve adequate results or requires medication to sharpen the response of these gates.
Gestational diabetes is a serious complication in pregnancy that requires specialised multidisciplinary care to reduce morbidity and mortality that can arise for both mother and baby. This type of diabetes is diagnosed for the first time in pregnancy and after delivery. For most patients, it will resolve. However, in a few mothers, it may persist long after the baby has come, making one chronically diabetic.
These high sugar levels in pregnancy are passed on to the baby in the womb, who ends up having excess glucose. However, since baby’s insulin production is good and the storage organs respond normally, baby ends up converting the excess glucose into excess fat that results in the large size.
LOW LEVELS OF CALCIUM
Besides the high birth weight, the baby is affected negatively in other ways. Their birth is more likely to be more traumatic due to the large size. They have slower maturation of the lungs hence at a higher risk of developing respiratory distress. They carry a higher risk of developing congenital abnormalities, especially of the brain and spinal cord. At birth, they are more likely to develop jaundice and abnormally low levels of blood calcium.
Further, having adapted to the high glucose levels, they are unable to adjust rapidly enough to the sudden cut-off from the glucose source, who is the mother. They become vulnerable to developing low blood glucose that can cause sudden death. This is why they are closely monitored and fed frequently in their early hours of life. They are also more likely to develop diabetes in their older years.
Mummy, too, isn’t spared. She carries an increased risk of heart disease, kidney failure, blindness and high blood pressure. She risks genital tract trauma during the delivery, post-partum haemorrhage and infections. This may also herald the beginning of lifelong diabetes.
These complications dictate that screening of pregnant women for diabetes should be made mandatory at 24 to 28 weeks gestation. Those found to have diabetes require initiation of treatment to manage it; close monitoring of the blood glucose levels throughout pregnancy, delivery and after; and intense monitoring of the baby during and after delivery to prevent complications and death.
Bernice was screened for diabetes after delivery and the tests confirmed she had gestational diabetes. She was lucky to have escaped the complications, but she required continued care to reduce her risk of remaining diabetic. Her chubby bundle of joy weathered the storm.