Maternal Factors Contributing to Birth Injuries: Understanding the Role of Obesity, Diabetes, and More

Maternal obesity, which is obesity during pregnancy, applies to women with a body mass index of 30 or more ( ≥ 30 kg/m2). Body mass index measurements are based on a person’s weight relative to their height. Excessive weight gain is defined as gaining 1.5 pounds or more per week during pregnancy. This extreme rate can have an adverse impact on the pregnancy by increasing the risk of complications during gestation and during the labor and delivery process. Due to this, mothers who are obese prior to pregnancy or who gain an undue amount of weight while pregnant are considered high-risk and must be monitored closely. 

Common Complications Caused By Maternal Obesity

Maternal obesity increases the risk of multiple pregnancy complications that could harm both the mother and her baby. Those most commonly associated with maternal obesity are:

Gestational Diabetes

Gestational diabetes is a specific type of diabetes that can develop in pregnant women who do not already have the condition. Women who are obese are more likely to have pre-existing diabetes, and therefore more likely to experience gestational diabetes. The more overweight a woman is, the higher her risk is developing diabetes. Doctors are required to use a glucose challenge test to screen all expectant mothers for gestational diabetes and pre-existing diabetes during prenatal checkups. Diabetes during pregnancy, gestational or otherwise, could result in neonatal hypoglycemia, macrosomia, premature birth, and other harmful complications.

Macrosomia

Obese women are also more likely to develop fetuses that are larger than average (4,000 grams) or “macrosomic”. Macrosomia typically develops when a fetus has elevated blood sugar levels, which are more common in babies with mothers who have diabetes and/or are obese. Macrosomia can lead to damaging complications such as uterine rupture, shoulder dystocia, cephalopelvic disproportion, prolonged labor, and increased need for mechanical devices like vacuum extractors or forceps. 

Neonatal Hypoglycemia 

Maternal obesity, particularly when combined with gestational diabetes, can result in a condition called neonatal hypoglycemia. When a baby is in utero, he or she can become accustomed to receiving a certain level of blood sugar from the mother. This causes the baby’s tiny pancreas to manufacture a correspondingly increased level of insulin to help it metabolize the sugar. Once the baby is born, they no longer receive high blood sugar from their mother, but will continue to produce the same high level of insulin. If this happens, the infant’s blood sugar can plummet to dangerously low levels, causing neonatal hypoglycemia. This condition increases the possibility of brain damage since glucose is the brain cells' only source of energy. Without sufficient glucose, the cells will start to die. Infants whose mothers have diabetes and/or are obese require close monitoring and more frequent postnatal feedings to prevent potentially fatal blood sugar crashes.

Intrauterine Growth Restriction  

Although it seems counterintuitive, some cases of maternal obesity can lead to intrauterine growth restriction, meaning the baby is growing more slowly than anticipated. When in utero, babies of obese mothers can undergo physical and hormonal changes that can result in low birth weight. Infants with IUGR are less developed, more fragile, and more prone to oxygen deprivation, especially during labor and delivery. An undersized baby might be unable to tolerate the delivery process. Most are safely delivered through C-section before term.

Preeclampsia/High Blood Pressure

Obese mothers also have a heightened risk of hypertension (high blood pressure) as well as preeclampsia (high blood pressure brought on by pregnancy). The amount of blood that passes between the baby and the mother via the placenta hinges on several factors, one of which is the mother’s blood pressure. If her blood pressure is high, resistance is increased while the blood flow to the baby is decreased, which is a disorder known as reduced uteroplacental perfusion. Since the placenta delivers oxygen and other nutrients, hypertension could lead to reduced amounts of both to the infant. High blood pressure and preeclampsia need to be closely managed and monitored to prevent birth injuries and other complications like IUGR, premature birth, placental abruption, and others.  

Birth Injuries and Maternal Obesity 

Obesity raises the odds of multiple health problems like hypertension and diabetes in everyone, not just pregnant women. However, during pregnancy, obesity, diabetes, and their associated conditions can pose a threat to the baby, necessitating diligent monitoring throughout the pregnancy and the delivery process, along with a significantly increased number of follow-up appointments. If maternal obesity is not properly managed, the result is likely to be one or more of the above-listed complications. If complications develop and are not properly managed, serious infections and birth injuries can arise. Additional problems commonly caused by maternal obesity are:

• Cerebral palsy
• Hypoxic-ischemic encephalopathy
• Respiratory distress syndrome
• Neonatal sepsis
• Epilepsy/seizure disorder

The failure to identify or the mismanagement of pregnancy complications constitutes medical negligence. When medical negligence results in a disability or birth injury to the baby, medical malpractice has occurred.

How to Ensure a Healthy Pregnancy and Delivery

As far as birth injuries go, maternal obesity is a considerable risk factor, and doctors must treat it as such. Mothers and their newborns are entitled to medical care that accounts for their specific needs throughout their pregnancy, labor, and delivery. This includes:

• Evaluation and counseling before pregnancy 
• Appropriate monitoring throughout pregnancy
• Appropriate treatment of underlying medical problems
• Ongoing monitoring and evaluation of the baby’s growth and health

One of the most essential elements of ensuring a healthy pregnancy is antenatal testing. During gestation, the doctor should perform multiple tests to ensure that both mother and baby advance through pregnancy as expected. These monitoring tests should include:

• Non-stress tests: The use of fetal ultrasound and electronic fetal monitor to record the baby’s heartbeat, movement, and vigor
• Biophysical profiles: This measures the baby’s muscle tone, heart rate, breathing, movement, and the volume of amniotic fluid. Often used in conjunction with a non-stress test.
• Amniotic fluid index: Usually part of the biophysical profile measures the amniotic fluid surrounding the baby.  
• Doppler flow monitoring: This test determines whether there is adequate blood flow to the baby’s extremities, organs, and brain.

In most cases, an early scheduled C-section is recommended when the mother’s due date is approaching or any of the above tests show abnormalities. If an obese mother is going to attempt a vaginal delivery, the birthing team must have the ability to perform an emergency C-section should it become necessary.

If your child experienced a birth injury and you would like to speak with someone about filing a claim for compensation, call the qualified Dallas birth injury lawyers at Rasansky Law Firm at (214) 651-6100. We provide free consultations and can advise you on the best way to move forward with your birth injury case.