Placental Insufficiency And Gestational Diabetes

Introduction

Pregnancy is such a memorable phase in all parents' lives, that families wait anxiously for months to see the apple of their eyes. However, many pregnancies can cause risky health problems for mothers and their unborn babies. Gestational diabetes and placental insufficiency are considered common complications of pregnancy, what could be the potential relationship between the two conditions? And what are the outcomes when both of them coexist? 

Placental insufficiency

Definition of placental insufficiency

The placenta develops during pregnancy to secure the growing baby inside the womb, it is the place where a solid bond is formed between a mother and her baby. Additionally, materials are exchanged through an umbilical cord between them like passing food, oxygen, and hormones essential during pregnancy. Also, carrying back wastes to the mother’s bloodstream so that they get cleared out of the body.¹ A healthy placenta requires beneficial and constant nutrition from the mother, any abnormalities in the placenta would lead to what is known as pre-eclampsia, causing a disruption in the blood and oxygen supply to the baby resulting in placental insufficiency or placental dysfunction.²

Causes 

The main causes of placental insufficiency are still unknown, but they can be related to maternal factors that risk the baby’s well-being. For example, pregnant women who consume alcohol, drugs, and smoke cigarettes will lead to lower amounts of blood passing through the umbilical cord to the baby. In addition, malnutrition, gestational diabetes, and increased levels of blood pressure in pregnant women will cause hypertensive disorders and disruption in the placenta. Mothers who bear babies at an advanced age or are overweight are also susceptible to pre-eclampsia.³

Complications

The impairment in exchanging nutrients and the restricted blood flow between pregnant women and their babies will have direct effects on the babies’ development and growth. As a result causing potential harm to babies, like premature birth, the loss of the babies during or before delivery, and giving birth to babies below their normal birth weight.³

Diagnosis 

Placental insufficiency can be diagnosed using Doppler ultrasound, by applying regular measurements of the placenta and baby during the routine doctor’s or midwife’s appointments and tests.³

Management and treatment

Close monitoring of the baby’s health and development by a specialist physician is the key step to managing placental insufficiency, the physician will keep an eye too on the mother's health situation.³ Despite the fact that there is no effective cure for placental insufficiency operating a c-section will probably be the optimum solution to save the mother and her baby.⁴

Gestational diabetes

Definition of gestational diabetes

Gestational diabetes is a temporary form of diabetes that some pregnant women go through, it is characterised by elevated levels of sugar in the blood, and it disappears right after giving birth. It could develop at any stage of the pregnancy and is usually diagnosed after performing a series of specialised blood tests called oral glucose intolerance tests (OGTT) between the period of 24th and the 28th weeks of pregnancy.⁵ If gestational diabetes wasn’t managed properly, it would put the mother and baby’s health at risk. Luckily, proper management of lifestyle modification and taking prescribed antidiabetic agents that are suitable for pregnant women could reduce the risk of further health deterioration.⁶

Risk factors

All women are susceptible to developing gestational diabetes throughout their pregnancy, however, the prevalence is higher when:

• There is a familial history of diabetes⁶
• Getting pregnant at an older age, like 40 years or above⁶
• Being overweight⁶
• Ethnicity⁶
• History of gestational diabetes in former pregnancies⁶
• Women had overgone weight loss procedures⁶ 

Outcomes reflection 

Having gestational diabetes could have several consequences during the journey of pregnancy, at birth, and in the future. Yet, a good percentage of women having gestational diabetes can continue to have smooth pregnancies, and deliveries, and give birth to healthy babies.⁶ 

Pregnancy complications

The baby inside the womb would be at risk if gestational diabetes isn’t managed accurately. Gestational diabetes could have a serious effect on the fluid known as amniotic fluid surrounding the baby, resulting in a condition called polyhydramnios which is an increased level of the fluid causing suffocation to the baby and making the pregnancy more challenging, leading to premature deliveries. Also, as discussed before gestational diabetes would be the cause of pre-eclampsia, due to elevated blood pressure.⁶

Birth issues

The chance of operating a cesarean section or induced labour is increased with gestational diabetes, because of a phenomenon known as macrosomia, where the size of the baby is larger than normal. In addition, there is always a fear of giving birth before the 37th week of pregnancy.⁶

Future considerations

After overcoming the birth complications, the baby will require additional treatment at the hospital if jaundice symptoms have evolved, for instance having yellowish skin and eyes and having decreased levels of sugar in the blood. Gestational diabetes could have long-term complications and implications on the well-being of the mother, like developing type 2 diabetes or becoming obese.⁶

Management and treatment

Various measurements are taken into consideration when dealing with gestational diabetes including:

• Checking sugar levels of the pregnant woman constantly throughout the day, before breakfast and one hour after each meal by a sugar monitoring device that uses a small drop of blood on a testing strip.⁷
• Be referred to a nutrition specialist to plan a healthy diet for the pregnant woman, making sure the diet includes wholewheat carbs, protein, and high portions of fruits and vegetables. Furthermore, avoid sugary foods, drinks, and unhealthy snacks.⁷
• Carrying out safe exercises like walking and swimming on a regular basis would help in managing gestational diabetes. It is recommended for pregnant women who have gestational diabetes to work out for 2 hours and a half weekly.⁷
• Taking certain medications like metformin or insulin injections, after consulting your GP or healthcare provider.⁷

Relationship between placental insufficiency and gestational diabetes

It is known that the placenta has high sensitivity towards any changes that might affect its stability and form. Higher blood sugar levels than the normal range can exert an effect on the structure, position, and functionality of the placenta.⁸

Gestational diabetes during pregnancy creates an unpleasant environment for the baby and the surrounding area, making the weight of the placenta heavier than usual causing obstruction to the comfort and development of the baby. Thus, causing a significant reduction in the oxygen supply to the baby and restriction in the flow of nutrients.⁹ As a result, an increased risk of adverse outcomes to the mother and baby’s health status will be observed when both conditions coexist.

Symptoms of placental insufficiency and gestational diabetes during pregnancy

• Alterations in the baby’s movement activity¹⁰
• An abrupt decrease in blood sugar levels is a key sign indicating placental deterioration¹⁰
• Facing issues with insulin therapy, like having multiple episodes of hypoglycemia, where the levels of sugar fall sharply. Or when the blood sugar levels don’t rise after consuming meals¹⁰
• Evidence of slow growth of the baby between ultrasound scans each month or the absence of development confirmed by regular doctor’s appointments¹⁰

Summary

It is really important to follow up with pregnant women on a regular basis, to check upon the mother and the growing baby inside her womb. If any abnormalities are found, it is important to provide comprehensive monitoring and management for pregnant individuals during pregnancy and after giving birth. Also, it is crucial to assess the long-term health risk factors for both the mother and her baby.

It is proven that gestational diabetes is one of the factors to have a negative impact on the placenta, causing placental insufficiency. After all, putting the mother and her baby at risk of death. For this reason, premature deliveries and c-section surgeries are the best solutions to save the mother and her baby’s lives.