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All your pregnancy questions answered

Diabetes and pregnancy

Diabetes is a condition where your body is unable to maintain the blood sugar within the upper limits of normal. This may be either because your body is unable to produce the required quantity of insulin, or because even though your body may be producing adequate insulin your body may have developed a degree of insulin resistance.

Diabetes involve pregnancy in 3 ways:

1. You may be a known diabetic who is planning a pregnancy

2. You have diabetes and not know it and it may be picked up after you become pregnant

3. You may develop diabetes in the later part of pregnancy and this is known as gestational diabetes or pregnancy diabetes

• Known diabetics

If you are a known diabetic what should you do before pregnancy?

Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk for birth defects. High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.

For this reason, good blood glucose control before you get pregnant is very important. Most women do not know they are pregnant until the baby has been growing for two to four weeks. During the first six weeks of pregnancy, the baby's organs are forming. Your blood glucose levels during these early weeks affect the baby's growing organs. High blood glucose levels can lead to birth defects.

Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in good control, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control three to six months before you plan to get pregnant. You'll want to keep excellent blood glucose control during pregnancy, and after as well.

You therefore must meet and consult with both your diabetologist as well as your gynaecologist about 3-4 months before you get pregnant. This is for many reasons:

1. To check your levels of control with both fasting as well as post prandial [after meal] sugars

2. To check your level of control over the last 4 months with a test called 'glycosylated Hb'

3. If you are on oral medication you will need to be switched to insulin before you get pregnant as oral medication can cause harm to your baby

4. Counseling regarding the possible risks of your pregnancy

5. To chart out the plan of management

You would also need to consult a dietician for your dietary advise.

How do high blood glucose levels cause problems? When extra sugar is in your blood, the baby is "fed" extra sugar, too. All this excess sugar can make the baby too big and fat. Delivery of big babies is harder on mom and baby.

Because your baby is getting extra sugar, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out extra insulin. The baby must be watched, and treated if the blood glucose level drops too low.

For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of old red blood cells that the body can't process fast enough. This problem goes away rapidly with treatment.

• Gestational diabetics

Gestational diabetes is a type of diabetes that starts during pregnancy. If you have diabetes, your body isn't able to use the sugar (glucose) in your blood as well as it should, so the level of sugar in your blood becomes higher than normal.

Gestational diabetes affects about 3% of all pregnant women. It usually begins in the 20th-24th week of pregnancy. Most often, gestational diabetes goes away after the baby is born.

• How does diabetes affect my baby?

Diabetes could cause a number of problems for your baby:

1. Macrosomia-large babies leading to difficult deliveries
2. Low blood sugars in the baby after delivery
3. Polycythemia-excess Hb in the baby
4. Congenital abnormalities in the baby
5. Increased levels of jaundice after delivery
6. Increased risk of sudden fetal loss later in pregnancy
7. Hydramnios-excessive liquid in the uterus

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