Gestational Diabetes Doesn't Discriminate: Even Normal Weight Mothers at Risk, with Long-term Health Consequences for Mother and Baby

Gestational diabetes is a silent threat that can develop in any pregnant woman, regardless of normal weight or body size. According to Kruekoi Natcha Loychusak, executive director of Baby and Mom Thailand, many women incorrectly believe that only overweight mothers risk gestational diabetes, but all pregnant women are susceptible due to hormonal changes from the placenta, not just weight factors.

Dr. Kamlapat Wijitpunpun, a maternal and fetal medicine specialist from Wichaiyaduth Hospital, explains that gestational diabetes occurs when the placenta produces Human Placental Lactogen, which reduces maternal insulin effectiveness, raising blood sugar levels. These elevated glucose levels pass through the umbilical cord to the fetus, causing excessive fetal growth and posing serious delivery complications.

Large babies risk abnormal body and shoulder growth, potentially causing shoulder dystocia—an obstetric emergency requiring multiple delivery techniques, including maternal position adjustments or shoulder rotation maneuvers. In severe cases, doctors may need to fracture the baby's clavicle. The baby also risks arm nerve injuries leading to Erb's palsy.

Newborns face dangerous low blood sugar after delivery, as the placental glucose source is cut off while insulin levels remain high, causing lethargy, poor feeding, or shock. Medical teams monitor closely and check blood sugar immediately after birth, providing either rapid breastfeeding or intravenous fluids if necessary.

Crucially, babies exposed to high glucose in the womb may develop a "sweet metabolism system" and face future diabetes risk. For mothers, gestational diabetes increases risks of difficult delivery, severe vaginal tearing, slow wound healing, preeclampsia, excessive postpartum hemorrhage (over 500cc), shock, and future diabetes.

Dr. Kamlapat notes that international guidelines consider cesarean delivery for babies weighing 4,000-4,500 grams or more, but Thai doctors typically use 3,300-3,500 grams criteria due to lower natural delivery success rates. The decision depends on individual risk assessment between doctor and mother.

Regarding treatment, not all gestational diabetes cases require insulin injections. Diagnosis begins with a 50-gram glucose drink test; if failed, a 100-gram test follows with four blood sugar checks at one-hour intervals to assess maternal glucose tolerance.