Pregnant Women With Diabetes
There are two different
considerations regarding diabetes and pregnancy. The first concerns
the diabetic who wants to conceive and carry a healthy baby to full
term and delivery (pre-existing diabetes). The second involves the
development of gestational diabetes in a mum to be who showed no
sign of the disease prior to her pregnancy.
|
It is important that any
woman with diabetes, who either wants to conceive or finds
herself to be pregnant, should control her glucose levels
strictly – particularly in the early months of pregnancy.
The risk of serious birth defects is thought to be increased
by poor control of pre-existing diabetes and it is also
thought to be the cause of an increased risk of
miscarriage.
For those women who develop
gestational diabetes there is no increased risk of birth
defects although it is important that glucose levels are
strictly monitored and controlled to reduce the risk of
stillbirth.
Diabetics – be the
conditional gestational or pre-existing – tend to deliver
much larger babies than the average. The babies grow larger
because some of the additional sugar from the mother passes
through the umbilical cord into the blood stream of the baby
where insulin then converts it into fat stores. |
|
These large babies very often
have to be delivered by caesarian section as they are too large
for a vaginal delivery.
Provided diabetes is properly
controlled there is no reason why diabetic women should not enjoy
uncomplicated pregnancies and deliver healthy babies. It is when the
diabetes is not controlled that problems occur and complications
arise. These complications can lead to miscarriage, high blood
pressure, premature delivery and stillbirth.
|
Women with pre-existing
diabetes may be offered a blood test to measure the
level of glycosylated haemoglobin before conception.
This test provides an accurate measure of how well
glucose levels have been controlled in the preceding
months and can indicate the safest time to conceive.
This test can also be used throughout the pregnancy to
measure how well the diabetes is being controlled.
The current
recommendation is for all women to take folic acid
before conceiving to avoid the baby developing with
neural tube defects. This advice is particularly
important for diabetic women as diabetes can increase
the risk of this type of birth defect.
Currently, oral
medications used to control type 2 diabetes are not
approved for use during pregnancy so any woman who is
using these drugs will need to switch to insulin before
conceiving and during her pregnancy. |
|
Most pregnant women are tested
for gestational diabetes at some stage between the 24th
and 28th week of pregnancy and those who develop this
condition usually find that blood glucose levels return to
normal after the birth of the baby.
Moderate exercise, with the
approval of the obstetrician, is thought to assist cells make
good use of available insulin and so is recommended during
pregnancy.
It is important that blood
glucose levels are monitored closely during pregnancy as insulin
requirements can vary significantly from those required before
conception. Urine can also be checked for ketones as the
presence of these can be an indication that the diabetes is not
being adequately controlled. If ignored a condition called
ketoacidosis can develop and this can jeopardise the life of the
baby.
For the sake of the mum-to-be
and the baby it is important that diabetes be controlled during
pregnancy to ensure the health of both.
|
