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Diabetes and Pregnancy

Types of diabetes

The 2 major classifications of diabetes are Type 1 and Type 2 diabetes mellitus. Type 1 diabetes normally develops in childhood or young adulthood and is characterized by the body’s inability to produce insulin. Type 1 diabetes is typically treated with insulin.

On the other hand, Type 2 diabetes is the most common form of diabetes and occurs in older individuals. Resistance to insulin and lack of insulin production are the hallmarks of Type 2 diabetes. Type 2 diabetes can be treated with oral anti-diabetic agents and insulin.

Gestational diabetes

Gestational diabetes is a type of diabetes that is first recognized during pregnancy. It affects 18% of all pregnancies and usually occurs between the 24th and 28th week of pregnancy. Although gestational diabetes normally recedes after pregnancy, there is a 2 in 3 chance that it will recur again in future pregnancies. Many women who had prior gestational diabetes also go on to develop Type 2 diabetes.

Diabetes may affect you and your baby during pregnancy

Having diabetes during pregnancy can affect both you and your child and this risk is higher with uncontrolled diabetes.

Women who have well controlled, uncomplicated diabetes before and during pregnancy have about the same chance of having a successful pregnancy as women without diabetes. However, pregnant women with uncontrolled diabetes have a higher chance of developing the following:

  • Pre-eclampsia (a dangerous increase in blood pressure that is associated with protein in the urine)
  • Diabetic eye problem (damage to the retina)
  • Diabetic kidney disease
  • Severe hypoglycaemia (low sugar level that can cause confusion or unconsciousness)
  • Miscarriage
  • Infections of urinary bladder or vaginal area

The baby will also be affected by uncontrolled diabetes during the pregnancy and these include:

  • Larger sized babies (this can result in difficulties during pregnancy and delivery via Caesarean may be required)
  • Baby may develop hypoglycaemia (low blood sugar) after birth
  • Baby may develop jaundice (yellowing of skin)
  • Baby may have difficulty breathing
  • Baby may have low levels of calcium and magnesium

If you are diabetic and wish to get pregnant

High blood glucose and ketone levels pass through the placenta and can cause birth defects. Organ formation occurs during the first trimester of pregnancy. Seven weeks after your last menstrual period, the organs are completely formed. Hence it is important that your blood sugar is controlled before conception. It will be good to get your diabetes under control 3 to 6 months before getting pregnant.

Other than getting your sugar levels under control, it is essential to have healthy lifestyle habits. These include appropriate food choices, physical exercises and maintaining a healthy weight. These can be done with the help and advice of a diabetic nurse educator, dietician and obstetrician.

You should also schedule a pre-pregnancy consultation with your doctor. Pre-pregnancy examinations may include checking your HbA1c levels and eye and kidney functions; as pregnancy can worsen these complications. You should also take the opportunity to discuss the suitability of your medications in pregnancy. Certain medications used in the care of diabetic patients, for e.g. cholesterol medications, may be unsuitable for use during gestation.

If you are pregnant and have diabetes

There are a couple of things you should do during your pregnancy. You will need to follow the advice of your obstetrician, gynaecologist and dietician as they’ll be able to advise you on your medication and diet choices.

Optimal blood glucose levels are essential in preventing birth defects and miscarriage. Your doctor will probably advise you on Home Glucose Monitoring (HGM). HGM is recommended to be carried out before each meal, 1-2hours after your meal and prior to bed time.

Besides HGM, your diet plays an important role as well. Remember to follow the Healthy Diet Pyramid guidelines and include folic acid supplementation. During the course of pregnancy, your dietician and doctor may alter your meal plans to avoid fluctuations in your sugar levels. As such, HGM provides an important key in assisting your doctor and dietician in their decisions. Most women believe that since they are now eating for two people, they need to eat more. But do remember that the emphasis of a good meal during your pregnancy is the quality of the food, not the quantity of the food. Seek your dietician’s advice on an appropriate, healthy diet that is suitable for you.

Exercise will also help to keep your diabetes in check. Besides helping with diabetes, exercise can also offset problems such as varicose veins, leg cramps or fatigue. Suitable exercises for pregnant women include swimming or walking. Remember to discuss your exercise plans with your doctor to understand the risks of exercise with pregnancy, especially if you have high blood pressure, eye, heart, kidney problems or nerve dysfunction.

Last but not least, compliance to your medications is important. During the course of your pregnancy, the doses of your diabetic medications may change due to altering hormone levels. So remember to take your medications according to the prescribed doses. In conjunction with a healthy diet and exercise routine, your diabetic condition can be managed and the chances of a problem free pregnancy are as good as that of a non-diabetic woman.

Treatment for women who are pregnant and diabetic

Insulin is normally the treatment of choice during pregnancy. Insulin, unlike oral anti-diabetic medications, does not cross the placenta. While Type 1 diabetics would probably already be on insulin, Type 2 diabetic women could be on oral anti-diabetic medications or insulin in some cases. As the safety data regarding the use of oral anti-diabetic agents in pregnancy is not well-established, some doctors may decide to switch to insulin if you are currently on oral anti-diabetic medications. Remember to discuss your options with your doctor.

Post-delivery care

Some mothers experience an improvement in their blood glucose control after birth while others do not. In some women with gestational diabetes, the diabetic condition may recede after giving birth. This chance is higher if your condition was previously managed solely by diet and exercise during gestation. Hence, it is still vital to do HGM frequently as per your doctor’s instructions.

The choice of medications to control your diabetes will be decided by the doctor and you may be able to revert to the medications you were on prior to pregnancy. However, some medications may not be suitable if you’re breastfeeding.

During the first few weeks after delivery, mothers are normally tired and stressed, which can lead to low sugar levels. Thus, remember to continue to monitor your blood glucose during this period.

Even after delivery, a healthy diet and exercise is still essential and you should adopt the habits that you took up during gestation to keep your diabetes in check. Focus on having a good BMI instead of solely losing weight gained from your pregnancy.

Breastfeeding

You should continue to breastfeed even if you’re diabetic. A woman who had gestational diabetes lowers her risk of developing Type 2 diabetes with breastfeeding. The risk of the child being obese and subsequently developing diabetes is also lowered. Breastfeeding will also help in losing the weight that was gained during gestation.

Insulin and oral anti-diabetic agents are used in the treatment of Type 1 and Type 2 diabetes. It is important to find out the safety of these medications while breastfeeding. While most of the anti-diabetic medications can be used safely during breastfeeding, you should always consult your doctor or pharmacist.

Home blood glucose monitoring is still important and a good control of your diabetic condition should be maintained. As breastfeeding diabetic mums have a higher tendency to suffer from low sugar symptoms, remember to take a light snack before, during or after breastfeeding and ensure adequate hydration.

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