Does mother's diabetes cause baby's diabetes?

Experiments 10.4 Special care of the baby after birth Gestational Diabetes Mellitus (GDM) is a condition in which high blood sugar level is diagnosed for the first time during pregnancy (usually in the second half of pregnancy) and the person has not previously had diabetes (type 1 or type 2). In other words, GDM is specific during pregnancy and is diagnosed when glucose imbalance occurs, usually between 24 and 28 weeks of pregnancy. Timely screening and diagnosis is very important because proper control of mother's sugar prevents complications for mother and fetus. Why does blood sugar rise during pregnancy? During pregnancy, the placenta secretes hormones such as human placental lactogen hormone, estrogen, progesterone, cortisol, etc., which increase tissue resistance to insulin. As a result, the pancreas must produce more insulin to maintain normal blood sugar. If the ability of pancreatic beta cells to increase insulin production is not enough, blood sugar rises and GDM occurs. This mechanism shows the main difference between GDM and other types of diabetes. The difference between gestational diabetes and type 1 and type 2 diabetes - **Type 1 diabetes**: an autoimmune disease in which the immune system attacks insulin-producing cells (beta) and leads to an absolute lack of insulin. It usually appears at a young age and requires lifelong insulin therapy. - **Type 2 diabetes**: a chronic disorder characterized by insulin resistance in tissues along with a gradual decrease in beta cell function. Genetic and lifestyle factors (obesity, inactivity, poor diet) play an important role. - **Gestational diabetes (GDM)**: It has the most in common with type 2 diabetes (that is, the role of insulin resistance), but its onset is clearly during pregnancy, and its important cause is hormonal changes during pregnancy. Unlike type 1, GDM is usually not autoimmune (with rare cases requiring an accurate diagnosis). Also, GDM often improves after delivery, but its history increases the risk of developing type 2 diabetes in the future. ### How common is it? The prevalence of gestational diabetes is reported to be highly variable worldwide (usually due to differences in diagnostic criteria and populations studied). In the United States, estimates as high as **7–9%** of **pregnancies** have been reported (depending on period and criteria). In many countries where the prevalence of obesity and type 2 diabetes is higher, GDM statistics are also higher. In addition, the prevalence trend has been increasing in recent years with the increase in the age of mothers and the increase in the prevalence of obesity. Risk factors for gestational diabetes Factors that increase the likelihood of GDM include: - **Overweight or obesity before pregnancy** (high BMI) - **Family history of diabetes** (affected father or mother) - **History of GDM in previous pregnancy** or birth of a very heavy baby (macrosoma) - **high age of the mother** (increasing risk with increasing age; especially over 35 years, but the risk also increases from younger ages) **combined metabolic conditions** such as polycystic ovary syndrome (PCOS) or prediabetes (impaired glucose tolerance) - **History of stillbirth or repeated abortions in some cases** and also some ethnic groups (higher prevalence has been reported in some populations). Review studies and new data have identified these factors as major risk factors. ### When should screening be done? For most pregnant women, standard screening is done between 24 and 28 weeks of pregnancy. If a person has high risk factors (eg, high BMI, history of GDM, family history of diabetes), some guidelines recommend an early glucose or HbA1c or OGTT test at the first pregnancy visit to detect pregestational diabetes or overt diabetes. Relation between maternal diabetes and infant health The short and general answer: No—the mother's diabetes is not "contagious" or something that is directly transmitted to the baby. However, the presence of diabetes or high blood sugar during pregnancy (either pre-pregnancy diabetes or gestational diabetes) can create risks and short-term and long-term consequences for the baby through genetic factors and especially through the "intrauterine environment" (exposure of the fetus to high sugar and hormonal changes). ### How does the mother's sugar status affect the fetus? Here we examine the factors that can affect the mother's sugar status on the fetus. 1. **Passage of sugar through the placenta and the response of the fetal pancreas:** Maternal glucose (sugar) easily passes through the placenta and enters the fetal circulation; But maternal insulin practically does not cross the placenta. Due to the exposure of the fetus to high sugar, the pancreas of the fetus is activated and produces more insulin (fetal hyperinsulinemia). This hyperinsulinemia stimulates excessive growth of adipose tissue and weight gain of the fetus (macrosoma). The clinical consequences of this mechanism include difficult delivery, shoulder damage (shoulder dystocia) and the need for cesarean delivery. 2. **Effect on metabolism and oxygenation of the fetus:** Increased metabolism and oxygen consumption due to hyperinsulinemia may make the fetus more vulnerable to lack of oxygen and with the emergence of polycythemia (increased red blood cells), increase the risk of jaundice (hyperbilirubinemia) and the need for special neonatal care. 3. **Metabolic programming:** Exposure of the fetus to an unfavorable metabolic environment (such as hyperglycemia) can affect the child's life through epigenetic changes and cellular regulation and increase the risk of obesity, glucose tolerance disorder, and type 2 diabetes in childhood or adulthood. This idea has been well seen in large studies such as HAPO and its subsequent follow-ups. Or mother's diabetes necessarily leads to baby's diabetes? No - maternal diabetes is not necessarily "transmitted" to the baby. But exposing the fetus to hyperglycemia (high blood sugar) in utero has both short-term consequences (e.g., macrosomia, neonatal hypoglycemia, respiratory problems) and increased long-term metabolic risk in the child (obesity, impaired glucose tolerance, and increased likelihood of type 2 diabetes in the future). Also, for type 1 diabetes, the case is more complicated: family transmission of type 1 depends on genes and environmental factors, and evidence shows that the probability of transmission from the father is higher than from the mother in some studies. Scientific review of available evidence Large studies have shown that maternal hyperglycemia is associated with an increased risk of high birth weight (macrosomia), difficult delivery, need for cesarean section, immediate hypoglycemia after birth (neonatal hypoglycemia), respiratory problems, and need for special neonatal care. Many of these findings have been seen in large multicenter studies (such as HAPO and its subsequent follow-ups) and systematic reviews; In other words, the higher the mother's sugar level, the greater the risk of these consequences. ### Long-term evidence (childhood to adulthood) - Many studies and meta-analyses show that children of mothers who had hyperglycemia during pregnancy (both GDM and pre-gestational diabetes) are more likely to be obese, have a higher body mass index, and impaired glucose tolerance in childhood and adolescence than children of mothers without diabetes. But the size of the effect and the time of occurrence of these problems are different in different studies. - However, it is difficult to separate "direct intrauterine influence" from "genetic and familial/postnatal environmental influences"; That is, part of the increased risk may be caused by shared genetics or family behaviors (diet, physical activity, maternal weight). Studies that have controlled for the effects of maternal obesity have shown that part of the association between GDM and child obesity is attenuated by controlling for pre-pregnancy BMI; That is, maternal obesity is an important confounding factor. ### About type 1 diabetes in children The evidence on whether exposure to maternal diabetes or GDM during pregnancy increases the risk of type 1 diabetes in the offspring is "contradictory" and complex. Family and epidemiological studies have shown that when one of the parents has type 1 diabetes, the child is more likely to have it; But interestingly, in many data sets, father-to-child transmission (i.e., an affected father) has a greater risk for the child than transmission from an affected mother—the exact reason for this difference is not clear, and may play a role in genetics, epigenetic changes, or early pregnancy selection/sorting. Therefore, for type 1, no definite and simple conclusion can be made; The subject needs a detailed follow-up and further studies. Conditions that increase the likelihood of infection (or negative consequences for the child) These factors have been reported in various studies to be associated with an increased risk of neonatal or long-term outcomes in children: **Pregestational diabetes** — Because it affects the first weeks (organization period), it is associated with an increased risk of congenital abnormalities and more severe consequences. Birth control is very important. - **Improper sugar control (high HbA1c or unstable glucose)** during pregnancy — the more severe or earlier in pregnancy hyperglycemia, the more severe the consequences and the higher the probability of long-term effects. - **pre-pregnancy overweight/obesity** — is both independently associated with an increased risk of obesity and metabolic problems in the child and with an increased likelihood of GDM in the mother. Therefore, maternal obesity is "a strong confounder". - **Family history of diabetes (father or mother)** - Having a positive history in parents, especially for type 1 and type 2 diabetes, increases the risk of children. - **early onset or uncontrolled diabetes (eg, uncontrolled diabetes in the first trimester)** — the risk of abnormalities and adverse effects increases. The role of maternal diabetes care and control in reducing risk Preconception care for women with pre-pregnancy diabetes reduces the amount of birth defects and improves glycemic control during early pregnancy. As a result of this type of planned care, the risk of certain outcomes during pregnancy is reduced. - **Accurate sugar control during pregnancy** (daily glucose control, appropriate HbA1c targeting in case of pre-pregnancy diabetes, diet and medication/insulin if needed) reduces the risk of many neonatal outcomes immediately after birth (macrosomia, hypoglycemia, respiratory problems, intrauterine death). Professional associations have always emphasized that the severity of problems related to gestational diabetes largely depends on the degree of hyperglycemia. ### What is still uncertain or limited by evidence? - Can careful control of sugar during pregnancy significantly reduce the **long-term** risk of obesity or type 2 diabetes in the child? The definitive answer is not yet complete. Some interventions during pregnancy (such as nutrition/exercise programs) have been able to reduce the rates of GDM and macrosomia, but convincing and sustained effects on reducing obesity or diabetes in children in later years have been less proven or much less than expected. In other words, "pre-pregnancy" or "postnatal" interventions (such as promoting appropriate infant nutrition, breastfeeding promotion, nutritional care, and family activity) are likely to be more important and effective in reducing long-term risk. Prevention and care solutions Here we examine the ways that prevent diabetes for babies. ### blood sugar control during pregnancy Mother's blood sugar control during pregnancy is the most important and proven factor in preventing diabetes complications for mother and fetus. When blood sugar is kept within the normal range, the risk of macrosomia (high fetal weight), difficult delivery, cesarean delivery, intrauterine death and neonatal hypoglycemia is significantly reduced. Sugar control means continuous measurement of blood sugar with a glucometer or continuous monitoring devices (CGM), checking HbA1c in certain periods and adjusting medication or insulin under the supervision of a doctor. Women with pre-pregnancy diabetes should control their sugar even before trying to get pregnant so that the fetus is not exposed to high sugar in the first trimester when its organs are forming. For those suffering from gestational diabetes, careful daily monitoring and lifestyle changes can prevent many complications. In fact, the closer the mother's average blood sugar is to the normal level, the more guaranteed the baby's future health will be. ### proper nutrition and physical activity Healthy eating is one of the main foundations of managing diabetes in pregnancy. Under the supervision of a nutritionist, mothers should eat a balanced diet that includes complex carbohydrates (such as whole-wheat bread, brown rice, beans), adequate protein (chicken, fish, eggs, low-fat dairy), and adequate amounts of fruits and vegetables. Avoiding simple sugars, soft drinks and high-fat and fried foods is of great importance, because these foods cause severe fluctuations in blood sugar. Dividing meals into smaller but frequent meals (4 to 6 meals a day) helps maintain blood sugar stability. Along with nutrition, regular physical activity such as daily walking, swimming or pregnancy yoga plays a key role in improving the body's sensitivity to insulin and reducing blood sugar. Light and safe activities not only help control diabetes, but also improve mood, reduce stress, and prevent excessive maternal weight gain. ### The importance of regular medical visits and tests Regular visits to a gynecologist and endocrinologist are an integral part of prenatal care in diabetic women. These referrals provide the possibility of evaluating the development of the fetus, checking blood sugar levels, blood pressure, and the function of kidneys and eyes. Diabetic women usually need more frequent ultrasounds than healthy mothers to check fetal growth in terms of weight, amniotic fluid, and placental health. Regular blood and urine tests, including HbA1c, kidney function tests, lipids, and more specialized tests if needed, are done to ensure the health status of the mother and fetus. Referring to a multi-specialty team including gynecologist, endocrinologist, nutritionist and even psychologist in some cases can provide the best support for the mother. In fact, regular monitoring acts as an alarm to detect and manage any changes or problems in time and minimize the risk of serious complications. ### Special care of the baby after birth Babies born to diabetic mothers, even if everything was under control during pregnancy, need special care in the first days and weeks of life. One of the most important actions is to control the blood sugar of the baby in the first hours after birth, because many of these babies suffer from hypoglycemia due to intrauterine hyperinsulinemia. Also, the child's respiratory condition, blood calcium and bilirubin should be monitored, because the risk of respiratory problems and jaundice is higher in these babies. Early feeding with mother's milk helps regulate the baby's blood sugar and reduces the risk of obesity and diabetes in later years. If there are serious problems, admission to the neonatal intensive care unit (NICU) may be required. After discharge, it is recommended that the child be regularly monitored by a pediatrician in terms of physical and metabolic growth and development. This post-natal care can play a vital role in preventing long-term problems. ### Mother's diabetes is not the inevitable fate of the baby Diabetes during pregnancy is without a doubt one of the most important health challenges for mother and baby. But contrary to popular belief, the mother's diabetes does not necessarily mean that the baby will have this disease. What determines the fate of the child's health is the quality of the mother's blood sugar control, healthy lifestyle, balanced diet and regular follow-up of medical care. Research shows that with proper management, not only can the risk of a baby developing diabetes or other complications be reduced, but it also provides the basis for normal growth and a healthy future for the child. Therefore, the main message for expectant mothers is this: diabetes is not an uncontrollable threat, but with awareness, adherence to treatment and continuous care, it can be turned into an opportunity to ensure the health of mother and child. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**