Problems that occur after delivery

Problems include:

• macrosomia - large and obese, which may have caused birth injury
• hypoglycaemia, particularly in neonates of mothers with poorly controlled diabetes. The chronically raised glucose in pregnancy leads to hyperinsulinaemia in the newborn child. Thus the glucose falls, and the normal response - a reduction in insulin - is poor. This can resulting in feeding difficulties from a tendency to hyperexcitability or jitteriness
• respiratory distress syndrome - the lungs are immature, with poor production of surfactant. This is because cortisol is important for lung maturation, and cortisol is reduced in diabetes
• jaundice - the reduced cortisol levels lead to reduced hepatic microsomal enzymes, thus increased bilirubin, which can lead to kernicterus
• plethora and polycythaemia - this may be caused by chronic foetal hypoxia
• the incidence of congenital abnormality is increased

Very careful control of the maternal blood sugar levels during pregnancy reduces the likelihood of development of many, if not all, of these problems.