Diabetes is a condition that results when there is too much glucose, a sugar that is the body’s main source of fuel, in the blood. At one time, women with diabetes were advised not to become pregnant because of the health risks posed to both mother and baby. Today, however, more is known about diabetes and how to control it, so that pregnancy is safer for most diabetic women.
This article will help you understand about diabetes during pregnancy—what it is, what the risks are, and what you and your doctor can do to keep it under control. Discuss any questions you have with your doctor. You will need to work closely together throughout your pregnancy to make it healthy and safe for you and your baby.
What Causes Diabetes?
Diabetes occurs when there is a problem with the way in which the body makes or uses insulin. Insulin is a hormone that converts the glucose obtained from food into energy. When the body doesn’t make enough insulin, or when insulin is not being used properly, the level of glucose in the blood (blood glucose) becomes too high.
Some women develop diabetes when they become pregnant. This is called gestational diabetes. It results from the effects of hormones made by the placenta (tissue in the uterus that connects mother and fetus) during pregnancy. These hormones can alter the way in which insulin works. Usually, gestational diabetes subsides after delivery, but a woman who has had diabetes during pregnancy is more likely to develop diabetes again later in life.
Who Is Likely to Get Diabetes during Pregnancy?
Women have a greater risk of gestational diabetes when certain factors are present:
- Pregnancy with a very large baby (weighing more than 9 pounds at birth)
- Prior stillbirth (delivery of a dead infant)
- One or more family members with diabetes
- Age over 25 years
Not all of these women develop gestational diabetes, but it is more likely to occur if one or more of these factors exist. For this reason, your doctor may decide to test you for diabetes during your pregnancy. This test is safe and simple. Samples of your blood are taken after you drink a sugar solution, and the blood glucose level is measured. A high level suggests that there may be a problem with glucose control.
Problems During Pregnancy
Both kinds of diabetes—the kind that exists before pregnancy and gestational diabetes—carry some risks to the health and well being of the mother and baby. Not every pregnant diabetic woman has these problems, but diabetes makes it more likely for them to occur. Some of the health risks that are more common in a diabetic pregnancy are described here:
- Preeclampsia, or high blood pressure during pregnancy, can require the baby to be delivered early. A woman with a mild form of preeclampsia may need to stay in the hospital so that she and her fetus can be monitored.
- Hydramnios occurs when there is too much amniotic fluid in the sac surrounding the fetus. This can make it difficult for the mother to breathe, because the large volume of fluid inside the uterus prevents proper expansion of her lungs. It may also result in premature labour and delivery.
- Urinary tract infections are infections of the bladder. A urinary tract infection can occur with no symptoms, but if not treated it may spread from the bladder to the kidneys and can be harmful to mother and baby.
- Macrosomia occurs when a high blood glucose level allows excess sugar to cross the placenta to the fetus. This can cause the baby to grow too large, making delivery difficult and dangerous.
- Birth defects are more common in babies of diabetic mothers. They may result in miscarriage (delivery of the fetus before it is able to survive outside the uterus) early in pregnancy.
- Respiratory distress syndrome (RDS) may severely affect the baby’s ability to breathe after it is born. The risk of RDS is greater in premature babies (those born before 37 weeks) of diabetic mothers.
- Stillbirth, although uncommon, also occurs more frequently in babies of diabetic mothers. A stillborn baby is one that is born with no signs of life.
What You Can Do
Although there is no cure for diabetes, it can be controlled to keep the blood glucose at a normal level. Controlling diabetes offsets the risks that are present during pregnancy. If you have diabetes, it is important to gain this control before your pregnancy. This is because the organs and limbs of the fetus begin to develop very early in pregnancy, and there is a greater risk of birth defects when blood glucose levels are high early in pregnancy.
It may take weeks or months to get your blood glucose to a normal level and keep it there throughout the day. This is why, if you have diabetes and are thinking of having a baby, it is very important for you to discuss your plans with your doctor before you become pregnant. Once you are pregnant, see your doctor. Get early and regular prenatal care.
Prenatal care is a program of care for a pregnant woman before the birth of her baby. This is important in any pregnancy, but especially for pregnant diabetic women. These women usually need many more regular doctor visits throughout pregnancy than women without diabetes. For this reason, you should be sure to schedule and keep regular visits to your doctor.
You are very much a partner with your doctor in controlling your diabetes during pregnancy. Your doctor will give you regular check-ups and tests as needed. You may need to monitor your blood glucose on a day-to-day basis to keep it at a normal level as much of the time as possible.
Controlling Your Blood Glucose
There are a number of ways in which you can measure and control your blood glucose level. All are safe and simple to use on a daily basis. You and your doctor will decide together on the best method or combination of methods for you.
Blood glucose meters or strips can be used to measure blood glucose levels. In either method, a simple device is used to obtain a small drop of blood, usually from the tip of the finger. The blood glucose level is then read with the meter or strip. Both of these methods provide reliable results when used properly.
Because it is normal for the blood glucose level to change throughout the day, it must be checked often, usually several times a day. Your doctor will advise you as to how often you will need to check your blood glucose.
When blood glucose levels are not controlled, the body uses fats for energy. Certain acids produced as a result of this process may be found in the urine. The presence of too much of these acids may indicate that glucose levels are too high.
Your doctor may give you a kit to test your urine on a regular basis during your pregnancy. The test is simple to perform and takes only a few minutes.
Some diabetics need to use injections (shots) of insulin to keep their blood glucose at normal levels. Insulin injections can be safely used during pregnancy to control diabetes. The amount of insulin needed to control blood glucose levels throughout the day varies from woman to woman and depends on many factors. Usually, the need for insulin increases throughout pregnancy until the last month, when it may decrease. Often the insulin dose needs to be changed slightly from time to time for good control of blood glucose levels. This is where home monitoring of blood glucose levels plays an important role.
The use of pills to control diabetes is not advised during pregnancy. Women who control their diabetes by taking these pills usually need to switch to insulin shots during pregnancy.
In most cases, insulin must be taken twice a day or more often. Your doctor will tell you about how to use insulin and how many daily injections you’ll need.
Nothing can replace the importance of a balanced diet during pregnancy. The fetus depends on the food you eat for its growth and nourishment. This even more important if you have diabetes because not eating properly can cause blood glucose levels to vary.
In many diabetics, insulin is not needed and blood glucose levels can be controlled by eating a special diet. When insulin is needed to control diabetes during pregnancy, the diet and the insulin dose must be balanced at all times to prevent harmful highs and lows in blood glucose levels.
The number of calories in your diet will depend on both your weight and the stage of pregnancy. Your doctor may adjust your diet from time to time to improve blood glucose control or to meet the needs of the growing fetus.
Usually, the diet consists of several small meals and snacks spread throughout the day. A bedtime snack is very important to maintain blood glucose levels during the night.
Regular exercise also plays an important role in the control of diabetes. It reduces the amount of insulin needed to maintain normal blood glucose levels. The amount of exercise that is right for each woman varies. It depends on, among other things, the stage of pregnancy. You and your doctor will decide on how much and what type of exercise you need.
Care During Pregnancy
There are several ways in which the progress of your pregnancy can be monitored to make it as safe and healthy as possible. Your doctor may perform tests on a regular basis and may consult with other experts in handling any problems that arise.
A woman with diabetes usually needs to have certain tests done more often during her pregnancy. These tests can help the doctor become aware of any problems that may occur and take steps to correct them, if possible. Your doctor can answer questions and give you more information about these tests:
- Hemoglobin A1C is a substance that can be measured in the mother’s blood. This substance may be elevated when the mother’s blood glucose level has been too high. Regular checking of haemoglobin A can tell the doctor how well the blood glucose levels have been controlled during the past 4 months.
- Alpha-fetoprotein (AFP) is a substance normally made by a growing fetus. In a normal pregnancy, some AFP passes into the amniotic fluid in the mother’s uterus. Certain types of birth defects may cause abnormal amounts of AFP in the amniotic fluid and in the mother’s blood. It is these amounts that the AFP test measures.
- Ultrasound is a test in which pictures of the fetus are created with sound waves. This allows the doctor to evaluate the growth and development of the fetus
- A kick count is simply a record of how often you feel your baby move. Healthy babies tend to move about the same amount each day. A decrease in the movement should be reported to your doctor right away because it could require more tests and even early delivery of your baby.
- Electronic fetal monitoring helps your doctor detect signs of fetal distress (problems the fetus may be having). Electronic instruments are placed on the mother’s abdomen late in pregnancy. They may also be placed on the fetus’s scalp during labour. The heartbeat and activity of the fetus, as well as contractions of the mother’s uterus, are then measured and recorded.
- Amniocentesis is a procedure used to detect certain birth defects in pregnancy. A small amount of amniotic fluid is taken from the sac surrounding the baby in the mother’s uterus and tested. This procedure can also help assess how mature the fetus’s lungs are late in pregnancy, which is important in preventing respiratory distress syndrome.
A team of healthcare experts may help your doctor care for you during your pregnancy. Each person on this team has a certain background and role to play in managing your pregnancy. Your doctor may consult with these specialists from time to time in handling special medical problems.
You may need to stay in a hospital for a time early in your pregnancy so that your blood glucose can be controlled and the progress of your pregnancy can be watched. Additional hospital stays may be needed, depending on your blood glucose levels, as well as on any other health problems you may be having.
Delivery and Postpartum Care
At one time, almost all women with diabetes had cesarean births, in which the baby is delivered through an incision (cut) made in the mother’s abdomen and uterus. This was because the potential problems of a diabetic pregnancy could be made worse by the added stress of labour and vaginal delivery. Today, though, with special tests and monitoring methods, many women with diabetes are able to give birth safely through the vagina.
There are many factors that will be weighed when your delivery is being planned. If a vaginal delivery is felt to be safe, your doctor may induce (bring on) labour by giving you a drug to start uterine contractions.
After birth, your baby may need to spend several days in an intensive care nursery—a special nursery for the care of high-risk newborns—to be watched and treated for some temporary problems. Some of these problems are:
- Low blood glucose
- Low calcium and magnesium levels in the blood
- An excess of red blood cells
- Neonatal jaundice (yellow discolouration of the skin)
None of these problems is usually life-threatening, and all are fairly easily treated soon after birth.
If you have diabetes, you must plan your pregnancies very carefully. Because you can become pregnant soon after childbirth, you should promptly seek counselling for family planning. Several methods of contraception are available, and your doctor can help you make a choice that will be safe and effective.
Although weight loss during pregnancy is not recommended, if you are overweight, you and your doctor should set up a balanced program of diet and exercise for you to follow after delivery. For gestational diabetics, this may minimize the risk for complications in later pregnancies and may actually decrease the risk of developing diabetes later in life.
The outlook for diabetic pregnancies gets better each day. With careful planning, control of diabetes and expert care, the chances for a successful pregnancy and a healthy baby and mother are increased.
You and your doctor should work together before and during your pregnancy to achieve this goal.
If you need advice regarding diabetes during pregnancy, please do not hesitate to make an appointment to see Dr.Gan here.