*1.5.2.3 Birth defects*

There is also a higher likelihood of such babies being born with birth defects and also having a higher risk of congenital heart diseases compared to the rest of the population [21].

#### *1.5.2.4 Obesity and DM in future*

The effects of being born to a mother with GDM can very well linger beyond infancy and childhood, predisposing the individual to a risk of obesity and DM later in life.

#### **2. Social determinants and effects of gestational diabetes outcomes**

DM as a leading cause of NCD morbidity and mortality, especially in the vulnerable state of pregnancy has varying effects on the mother and developing child. Furthermore, as one of the most common metabolic disorders in pregnancy, its effects transcend into different aspects of maternal and neonatal health and wellbeing, including the public health space.

Some of these effects on mothers' health and physical wellbeing are hyperglycaemia, possible preeclampsia, high-risk delivery of a macrosomic baby; and if unmanaged, altered sensorium, eclampsia, obstetric problems and possible mortality. Likewise, different health complications of diabetes worsened by pregnancy include diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, and diabetesinduced heart disease, i.e., cardiomyopathy, heart failure, ischemic heart disease and coronary heart disease. Some of these effects and complications are irreversible and take a strain on the financial and mental well-being of the pregnant woman and family involved. These complications can increase the direct or indirect cost of adequate care—with more time spent in the health care facility—which might have a poor prognosis among LSE women in rural areas, also worsening the maternal morbidity and mortality indices [21, 22].

Effects on foetal growth in-utero such as intrauterine growth retardation, and malformation of developing organs and systems in babies (also referred to as diabetic embryopathy), usually occurring in the first and second trimester, can lead to anxiety, depression and different types of miscarriage for the pregnant women. These foetal malformations are mostly found in the central nervous and cardiovascular systems, and sometimes with craniofacial defects. Common examples are Microcephaly, Meningomyelocele, Tetralogy of Fallot, persistent truncus arteriosus, Hypoplastic left or right heart syndrome, septal defects (Atrioventricular), Microphthalmia, Cleft lip/ palate, Hemifacial microsomia and other neural tube defects [21].

Other effects surrounding delivery or occurring postnatally are preterm delivery, prematurity, low birth weight, other perinatal morbidities, neurodevelopmental abnormalities causing mental and psychomotor disabilities such as increased chances of Attention Deficit Hyperactivity Disorder (ADHD), gross and fine motor anomalies, learning difficulties (especially in speech and language), Autism Spectrum Disorder with possible brain damage, as well as perinatal mortality in the delivered neonates. The underlying metabolic processes that result in these effects could be associated with maternal hyperglycaemia causing increased oxidative stress, hypoxia, apoptosis, and epigenetic or metabolic changes in developing foetuses [21].

The socio-economic, health-economic, and psychosocial cost of these outcomes on the new mother, caregivers, healthcare professionals, family, society, and the entire population at large, is significantly wide and demanding with features of reduced productivity and preventable resource allocation for more judicious use. These also contribute to neonatal or under 5 morbidity and mortality figures. However, other cumulative factors that contribute to the actualization of these effects and their progress into complications for both mother and child vary from genetics

#### *Diabetes in Pregnancy DOI: http://dx.doi.org/10.5772/intechopen.108564*

to diet, or nutrition (especially breastfeeding infants for positive effect and development), compliance and environmental exposure [21].
