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Pregnancy in Women with Diabetes

Pregnancy in a woman with diabetes

The decision to have a baby is a big one for any woman. If you have diabetes, then this decision involves much more thought processing and planning. You can take some steps to prepare yourself for pregnancy and have a healthy baby.

RISKS

Uncontrolled diabetes during pregnancy can cause multiple issues. Some of the identified risks for the baby and mother include:

Risks for the baby

  • Miscarriage
  • Premature birth
  • Birth abnormalities
  • Large baby
  • Low blood glucose during delivery (hypoglycemia)
  • Longer duration of jaundice in newborn
  • Respiratory distress syndrome (a condition that makes breathing difficult)

Risks for the mother

  • Increase in the severity of diabetes complications when present (such as diabetic eye or kidney complications)
  • Frequent vaginal or urinary infections
  • Hypertension during pregnancy – Preeclampsia
  • Difficulties in delivery or higher chances of Caesarean section

HEALTHCARE MEASURES IN DIFFERENT STAGES

Before Pregnancy

The early weeks of pregnancy are important to the baby’s development and most of the organs are formed in the initial seven weeks after your last period. High blood glucose during this period can increase the risk of birth defects and miscarriages. Therefore, it is important to get blood glucose levels under control before getting pregnant.

Discuss with your doctor about your plan to get pregnant. Your doctor will help you in achieving your target blood glucose levels. Before getting pregnant, the target blood glucose recommended is 60-119 mg/dL (fasting) and 100-149 mg/dL (1 hour after meals). You may be asked to undergo assessments of HbA1c (glycosylated haemoglobin) to ensure that your diabetes is in good control.

In addition, you may be asked to undergo checks and laboratory tests for the presence of any diabetic complications such as high blood pressure, heart disease, kidney, nerve and eye damage. If you are overweight or obese, your doctor may suggest about losing extra weight before getting pregnant. Your current medications will also be reviewed to see if you have any drugs that are not recommended in pregnancy (such as ACE inhibitors, ARBs, statins and most oral anti-diabetes drugs).

During Pregnancy

You will have to keep a tight blood glucose control during pregnancy. For this, you will need to work with a team of doctors which will include the obstetrician who can handle high-risk pregnancy and a diabetes specialist/endocrinologist who can manage your diabetes. You may also need the services of a dietician to help with your diet plan. Also, a paediatrician or neonatologist (newborn specialist) may be part of your care team to handle the needs of the baby.

Monitoring and maintaining blood sugar control

During pregnancy, your blood glucose levels may fluctuate as your body undergoes pregnancy related changes and the baby grows in the womb. Controlling blood sugars during pregnancy can be a challenging task. The targets recommended by the American Diabetes Association for women with underlying diabetes who become pregnant include: 60-99 mg/dL (before a meal), 100-129 mg/dL (after a meal) and HbA1C < 6%. Your doctor will make the decision about your goals so as to decrease the risk of birth defects, miscarriage and having a big baby. Checking blood glucose levels frequently at home (using a glucometer) is an important aspect of your care. If you have difficulty in maintaining your target range or have frequent episodes of low blood glucose (hypoglycemia), then consult your doctor about adjusting your treatment plan.

Diet

Your doctor or the dietician will help you design a healthy meal plan to avoid problems with low and high blood sugars. The key is to eat a high-quality diet, which includes whole grains, non-fat dairy products, vegetables, beans, fruits, lean meats, poultry, fish, etc. Include a variety of food items and watch the portion sizes. When pregnant, your body requires around 300 calories more than the average requirement. You need not eat plenty more than what you usually eat to meet this requirement. Your doctor will keep a track of your weight gain and suggest if you are maintaining the ideal weight gain.

Exercise

Exercise is an important aspect of diabetes treatment. Discuss with your doctor about your current exercise regimen and whether it is safe to continue it or there is a need to modify it. It is not advisable to start a new regimen of strenuous exercise after pregnancy. If you have high BP or any other complications of diabetes in the eye, kidney, heart, blood vessels or nerves, then discuss with your care team if exercise is safe for you during pregnancy. Low-impact aerobics like walking, swimming or water aerobics are considered as good exercise options for pregnant women.

Insulin and other treatments

In women with pregnancy, the first choice of anti-diabetic treatment is insulin because it does not cross the placenta and get into the baby’s circulation. In women with type 1 diabetes, who are already on insulin, the dose requirement may increase during pregnancy and the doctor will adjust the dose accordingly. In women with type 2 diabetes, who are on treatment with oral tablets, the medication will be stopped as they can cross the placenta and affect the growing baby. Also, the effect of oral tablets will be reduced during pregnancy due to increase in tissue resistance to insulin and therefore the treatment will be switched to insulin.

During Delivery

When you are near your due date, your doctors will perform an examination of your health status and that of the baby (baby size, the quantity of fluid in the uterus, heart rate, etc.) to determine the best time and method to conduct the delivery.

Your labour (delivery process) may start on its own or the doctors may decide to induce it or take you up for Caesarean section based on the assessment they make at that time. As the insulin requirement decreases during delivery, you may not need any insulin for 24-72 hours after delivery. During delivery, your glucose levels will be monitored closely to keep it under control. Your treatment will be adjusted based your blood sugar levels.

After Delivery

After delivery, there may be wide variations in blood sugars as the body is undergoing quick changes after pregnancy. For some, this may mean better control of sugar levels after delivery. In the initial weeks, blood sugars may be monitored more frequently and insulin dose adjusted to match the changing needs. In women with type 2 diabetes, oral pills may be started again if they were working well before pregnancy. The pills may be modified to select drugs that do not cross into breast milk. Frequent checking of blood glucose is also important so that you can avoid low blood glucose, which constitutes a real danger during this time.

Some of the care measures that can be taken during this period include:

  • Follow a healthy diet and get proper nourishment (discuss with your doctor about the diet and the required amount of calories, proteins, vitamins and minerals)
  • Drink plenty of fluids
  • Adapt your exercise regimen based on the recommendation of the doctor to maintain the ideal weight
  • Be alert for symptoms of hypoglycemia (low blood glucose); if confirmed by low values, then eat some sugar or sweets and inform your doctor
  • Measure your blood sugars frequently, keep a record of the values and consult your doctor if sugar levels are high or low
  • Breastfeeding your child is good, in addition to providing nutrition to your baby, it helps you reduce the weight you gained during pregnancy
  • Plan to eat a snack before or during breastfeeding (as blood sugars may fluctuate during feeding)
  • Get adequate sleep; sleep when your baby is sleeping or when someone else is taking care of the kid
  • Take some time out to enjoy things you like such as watching TV or engaging in some relaxation activity
  • If you are feeling stressed due to childcare, talk to your partner, family or friends and take some help from them if needed
  • If you are feeling depressed, then discuss with your doctor about your symptoms

Focus your attention on taking care of your baby and yourself. Continue the healthy habits that kept you fit and helped you control your sugars before and during your pregnancy.

Consult a top Gynaecologist

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References

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  • American Diabetes Association. Living with Diabetes – Pregnancy. Accessed at http://www.diabetes.org/living-with-diabetes/complications/pregnancy on 11 May 2016
  • American Congress of Obstetricians and Gynecologists. A Healthy Pregnancy for Women with Diabetes. Accessed at http://www.acog.org/Patients/FAQs/A-Healthy-Pregnancy-for-Women-with-Diabetes on 11 May 2016
  • National Institute of Diabetes and Digestive and Kidney Diseases. (NIDDK). What I need to know about Preparing for Pregnancy if I Have Diabetes. Accessed at http://www.niddk.nih.gov/health-information/health-topics/Diabetes/preparing-pregnancy-diabetes on 12 May 2016.
  • NHS choices. Diabetes and Pregnancy. Accessed at http://www.nhs.uk/conditions/pregnancy-and-baby/pages/diabetes-pregnant.aspx on 11 May 2016.

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