Post-delivery baby hypoglycemia?

This question is in preparation for my next baby. My endo didn’t seem too concerned with keeping me under 5.5 A1C during my pregnancy – under 6.0 was good enough for him. I was able to get my A1C to 5.6 throughout pregnancy with very few readings above 150. Everything went great during my c-section with BGs right at 80 to 100mg/dl, and I delivered a beautiful and healthy baby girl with a very healthy set of lungs on her! However, she did have hypoglycemia at birth, and the pediatricians kept asking me if I was well controlled. After the fifth doc assumed that I did not control my BG during pregnancy, my sarcasm flew and I said, “Yeah, I was all about eating candy, cake, cookies and ice cream while I sat on the couch.” Seriously?! When i told my endo about the comments, he was put out that the docs would ask that, and he said that even with perfect control, baby hypoglycemia can happen. Anyway, back on topic: who had a non-hypo baby and what was your A1C and BG delivery range? I think I want to aim for 5.0 A1C and 60 to 80 mg/dl during the next pregnancy and delivery, respectively, but I’d love all of your input! Oh, also, do most c-sections result in jaundice?

Both of my daughters had post-delivery hypos... one 'bolus' of glucose into their stomachs corrected the issue.  This is normal and very common.   Like you, I had A1C in low 5's throughout pregnancy.   One 'bolus' corrected and they did not require any more.  

I would say the risk to you & any future babies would be greater if you walked around between 60 & 80 for 9 months.

Thanks, Katie! It's good to hear that hypoglycemia at delivery does happen when very well controlled.

To clarify, though, I would aim for my readings in pregnancy to be 80 to 120. In a c-section delivery only, my goal would be 80 mg/dl, but I wouldn't be concerned about correcting until I reached 60. I read this is ideal, but my doc wanted me right at 100 during my daughter's entire one hour delivery. What did your doc tell you for the ideal range during delivery?

I had a 5.1 A1c with few lows and none severe.  I did eat ice cream and whatever else I wanted, but carb counted and bolused for it.  During delivery I kept my blood sugar between 90 - 120.  My son had a normal blood sugar when born.  Have to admit it made me gleeful (maybe it was the drugs too) that my son didn't need all the specialists who were standing by to whisk my son to NICU just because he was born to a mom with diabetes.  He was born strong, healthy and passed his apgar tests with no problems.  

But hypoglycemia in newborns isn't that straight forward.  There are multiple causes of it.  In my own circle of friends, my co-worker's little girl was born with hypo blood sugar and on further testing was lacking a thyroid hormone and will have to take supplements her whole life.  A friend from church is tiny and her baby was very petite (the little girl is 4 now and is the size of a 2-yr-old) and also had hypoglycemia at birth.  Found the info below on this link

"Neonatal hypoglycemia occurs when the newborn’s glucose level is below the level considered safe for the baby's age. It occurs in about 1 to 3 out of every 1,000 births.

Low blood sugar levels are more likely in infants:

•Who were born early, have a serious infection, or needed oxygen right after delivery

•Whose mother has diabetes (these infants are often larger than normal)

•With low thyroid hormone levels (hypothyroidism)

•Who have certain rare genetic disorders

•Who have poor growth in the womb during pregnancy

•Who are smaller in size than normal for their gestational age"

You obviously had great health in your pregnancy and the doctors were wrong to assume you had screwed up.  I hate this bias in the medical community.  Realistically even if your diabetes is responsible for your daughter's hypo blood sugar at birth, the problem was easily fixed with intravenous glucose in about 10 minutes.  Is a petite woman with a small baby blamed for her child's hypo?

I'm not sure about the link between jaundice and c-section.  It seems like most babies today have jaundice, whether they were delivered by cesarean or vaginally.  My son had jaundice, but I did too and was born vaginally, so I assume it's more genetic.  

Every mom feels guilty about something.  We feel like our children would be perfect if we do everything right.  But unfortunately that's not how the world works.  I think your 5.6 A1c was great and you obviously have a beautiful and healthy daughter now.  I would caution you not to have such a low blood sugar during deliver because it won't give you any leeway if you drop lower.  Just be reasonable and don't be influenced by some yahoo doctor's opinion.

Thanks, Jenna -- your response is very helpful! I was concerned because it took the doctors two entire days of glucose drip and monitoring with nursing supplementation (donor breast milk until mine came in) in the NICU to get her back to normal. I didn't know that injecting glucose directly into the stomach was an option (Katie's post) -- I'll have to check into that. When Haley was born, I barely got to see her and to bond because she was in NICU for those two days. So if there is an option to fix the hypo more quickly, I'd prefer to go for my 5.6 A1C with the quick baby hypo fix on delivery, if necessary. I guess I just needed to hear from others who are knowledgeable (besides my endo) that I didn't harm my baby! BTW,when given the choice on pediatricians, I went with the only one who didn't accuse me of being a terrible mother!

I'd suggest you see a perinatalogist or high-risk pregnancy doctor.  They controlled my pregnancy, labor & delivery and had prepared us for the fact that our newborns may need a dose of glucose.   We had told them explicitly that we did not want them bottle fed so they did the tube into stomach approach.  

The key is to start the conversation about what happens after delivery early in the pregnancy.     I had conversations with my doctor about my newborns before going into delivery - i.e. I told them specifically that as long as the baby was not having difficulty breathing or anything life threatening, I wanted them to stay with me as long as possible.   I low blood sugar is not life or death - their BGs were fine 15 minutes after birth, but started going lower as time wore on.  We were out of labor & delivery room and they were checking them for the 3rd time before they said they wanted to put the tube down for glucose.    I guess I'd talk with your OB doctor and now your pediatrician (since you have one!) about what you expect, and what you want to happen.    You are now equipped with way more knowledge and won't have the new-mom fear.

I also had 22 hour labors for both pregnancies so keeping my BG in any tight range was near impossible.   I was low, I was high, hospital nursing staff freaking out at anything over 120 and anything under 80.  (gotta love 'em but no hospital staff nurse/doctor is going to understand diabetes).

Katie, I'll definitely have to check on the stmach tube glucose. My birth plan was small. All I wanted was no formula. I was open to them fixing any potential low with donor milk, an IV, or a sugar pacifier, but now that I know a little more, I'll be sure to ask questions!

my two also had post delivery hypos which were brought up quickly with sugar water/formula. both had apgar scores of 9.  never heard of the shot... sounds interesting.

regarding bs during labor- i took charge of it and did my best to keep nurses and docs un-involved. if i though i was going low- my husband gave me a juice box. i aimed to keep it around 130 though because i did not want to bottom out while laboring or pushing. i dont see the need to have stellar blood sugar for that particular day!

Fraida, my docs didn't want to use sugar water because they said it would make my baby bottom out later. It's so interesting the different tactics that docs use.

For the BGs during delivery, I had a scheduled c-section. If I delivered, I would have changed my numbers. I am curious whether I really needed a c-section though. My daughter weighed 8 lbs 10 oz, and she had big shoulders. But I wonder if it would have been possible. Oh well, it all ended well, and she's perfect :-)