Diabetes and Pregnancy
Diabetes is a disease state in which the body loses the ability to convert sugars and carbohydrates into energy. This is a result of the body’s inability to either produce enough insulin to move the sugar into the cells to be used as energy or the body can not utilize the insulin that it produces. Consequently, the high levels of sugar in the blood can result in damage to the heart, nervous system, eyes, kidneys and blood vessels. There are three types of diabetes that have to be considered:
- Type 1 diabetes – a condition in which the body makes either no insulin or so little insulin that the body can not utilize the sugars. It usually occurs in childhood or teenage years.
- Type 2 diabetes – a condition in which the body cannot utilize the insulin that it does produce and occurs during the adult time of life.
- Gestational diabetes – diabetes diagnosed during pregnancy. Studies show that it occurs in the range of two to ten percent of women who are pregnant. A large percentage of women who develop gestational diabetes will develop type 2 diabetes later in life. During pregnancy, the hormonal changes can make the cells less sensitive to insulin. This causes the pancreas to produce more insulin, which is not a problem with most pregnant women. But in women with gestational diabetes, the pancreas cannot keep up with the demand and the sugar in the blood increases.
For women who have been diagnosed with diabetes before becoming pregnant, the main goal is tight blood sugar control. They should be under the care of an obstetrician before conception in order to work out a program of control, and this responsibility may be shared with a family physician or endocrinologist. With tight control of blood sugars, there is a decreased risk of miscarriages and stillbirth, premature labor and birth, excessively large babies, birth defects and preeclampsia. There are also studies revealing that good sugar control reduces the risk of low blood sugars in the baby after birth, controls magnesium and calcium levels and may decrease the risk of jaundice in the baby.
What are the patterns of gestational diabetes?
Gestational diabetes is usually silent and can be diagnosed with blood sugar screening between 24-28 weeks of gestation. If the first test is positive, then a more extensive test is needed before gestational diabetes is diagnosed. You may be at risk if you are overweight with a body mass index over 30, have had gestational diabetes with a previous pregnancy, have a strong family history of diabetes or have glucose in the urine sample. Women who develop gestational diabetes can have a higher risk of preeclampsia, premature birth, need for cesarean section, kidney disease, stillbirth and large babies.
What can be done to prevent health problems during pregnancy in a woman with diabetes or with history of previous gestational diabetes?
The first approach if possible is to plan your pregnancy and work toward having tight control of your blood sugars prior to conceiving. Talk to your obstetrician about getting and keeping control of blood glucose, changing medications if needed and planning frequency of office visits for the pregnancy. One point of discussion with your physician should be the frequency of blood sugar checks per day. You cannot avoid monitoring your blood sugars during pregnancy and should take the list of glucose levels to the obstetrician each visit. Discuss how to control and avoid low blood sugar levels with your physician and do not miss a visit with your obstetrician if at all possible. In the gestational diabetic woman, blood sugars should be monitored after pregnancy every one to two years to diagnose risk of developing type 2 diabetes at an early stage.
What plan of action should be taken during pregnancy?
Discuss the best course to follow during the pregnancy with an obstetrician. The following are some points that should be considered:
- Reduction of miscarriage and stillbirth, birth defects and premature labor – best accomplished by having good blood sugar control, not only prior to conceiving, but also throughout the pregnancy.
- Be willing to adjust your insulin levels or diabetic medications depending on your blood sugar levels. Be willing to adjust your eating habits according to the blood sugars and whether nausea and vomiting are present. Include plenty of fruits, vegetables and grains in your diet and you may need to see a dietician experienced in working with diabetics and pregnancy.
- Physical activity is a must in your daily routine. Talk to your obstetrician about the type and level of exercise that you may do during the pregnancy. It is always helpful to choose a type of exercise that is enjoyable such as walking, swimming or stationary biking. The Department of Health and Human Services recommends 150 minutes of exercise per week while monitoring the sugar levels to see how the exercise affects the level.
- Keep up with regular prenatal visits, as this is the only way for your obstetrician to monitor you closely throughout the pregnancy.
During labor and delivery, your obstetrician will probably check your blood sugars frequently and adjust medications if needed. After delivery, continued monitoring is needed especially if breast feeding, as fluctuations in the blood sugar levels are often exaggerated. Keeping yourself healthy is the best thing you may be able to do for your infant.