How Diabetes affects pregnancy

crop1_240x240_6mar15 (1)GOT DIABETES? THINKING ABOUT PREGNANCY?
If you have diabetes, the best time to control your blood glucose, is before you get pregnant. If you are a woman who has diabetes, it is a decision that requires much more thought and careful planning. High blood glucose levels can be harmful to your baby during the first weeks of pregnancy—even before you know you are pregnant. Blood glucose targets are different for women who are trying to get pregnant.

Pregnancy and new motherhood are times of great excitement and change for any woman. Many women who have diabetes (Type 1, Type 2, and gestational diabetes) have healthy pregnancies and healthy babies. But this isn’t to say that it’s an easy experience – it requires a lot of work and dedication on your part.

Preconception care should start from adolescence. It is important to use some form of contraception until you decide you want to become pregnant.

Pre-pregnancy counseling will help educate you so that you can be physically and emotionally prepared — and healthy — for pregnancy.

Here’s what a preconception appointment usually includes:

  • Evaluation of your weight is very important. Try to reach your ideal body weight before becoming pregnant. This means losing weight if you are overweight to reduce your risk of diabetes complications, or gaining weight if you are underweight to reduce the risk of delivering a low birth-weight baby.
  • A discussion of your lifestyle: Lifestyle modification are essential. Smoking and drinking alcohol are two habits that must be stopped in order for you to have a healthy pregnancy and baby. Smoking during pregnancy affects you and your baby’s health before, during, and after your baby is born. The nicotine (the addictive substance in cigarettes), carbon monoxide, and numerous other poisons you inhale from a cigarette are carried through your bloodstream and go directly to your baby. These substances can lower the amount of oxygen available to you and your growing baby; increase your baby’s heart rate; increase the chances of miscarriage and stillbirth; increase the risk that your baby is born prematurely and/or born with low birth weight; and increase your baby’s risk of developing respiratory problems. Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders that includes mental retardation, as well as cardiovascular, skeletal, and facial abnormalities. No amount of alcohol is known to be safe while pregnant and there is not a safe time during pregnancy to drink.
  • Blood sugar screening: If you have diabetes, your doctor will check to see if your blood sugar is in control. Good blood sugar control is important before becoming pregnant, because many women do not even know they are pregnant until the baby has been growing for 2-4 weeks. High blood sugar levels early in the pregnancy (during the first13 weeks) can cause birth defects, and if not brought under control, can lead to miscarriage and increase your risk for more diabetes complications. All women should be screened for gestational diabetes after 24 weeks of pregnancy, regardless of whether they have symptoms of the condition.
  • Make medication adjustments: If you take insulin to control your diabetes, your doctor can tell you how to adjust your medication. Generally, your body will require more insulin during pregnancy, especially during the last 3 months of pregnancy. If you take oral medications to control your diabetes, your doctor may switch your medication to insulin during pregnancy, because certain oral medications could harm the developing baby.
  • Diabetes meal planning: During pregnancy, you and your health care provider should work together to adjust your diabetes meal plan. Changing your meal plan will help you avoid problems with low and high blood sugar levels.

DIABETES CAN HARM YOU AND YOUR BABY!
A woman who does not have control of her diabetes and gets pregnant has a greater chance of having a baby with a birth defect than a woman without diabetes.

Diabetes that is not controlled can:

  • Cause your baby to have serious birth defects. If your blood sugar is out of control, it can lead to health problems and serious birth defects, such as those of your baby’s brain, spine, and heart.
  • Increase your chances for stillbirth or miscarriage.
  • Cause your baby to be born early. A baby born too early can have breathing problems, heart problems, bleeding into the brain, intestinal problems, or vision problems.
  • Make your baby grow very large (weigh more than 9 pounds), which in turn can lead to problems with the delivery for you and your baby. A large baby born through the birth canal can injure nerves in his shoulder; break her collarbone; or, rarely, have brain damage from lack of oxygen. You might have to have a cesarean section (an operation to get the baby out through your abdomen), which usually means a longer recovery time for you after your baby is born.
  • Cause your new born to have quickly changing blood sugars after delivery. Your baby’s doctor will watch your baby for low blood sugar after birth and treat it if needed.

Other problems that sometimes happen with diabetes

  • You may also develop preeclampsia (pree-e-klampsee-ah). This means you have protein in your urine and high blood pressure. Preeclampsia can harm you by causing you to have seizures or a stroke. It also might cause your baby to be born early.
  • Very large babies are more likely to become overweight or obese during childhood and adolescence. Such obesity can lead to type 2 diabetes.

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Dr. Rajiv Kovil
Consultant Diabetologist, Dr. Kovil’s Diabetes Care Centre

Dr. Rajiv Kovil is a Consultant Diabetologist at Dr. Kovil’s Diabetes Care Centre, the first Preventive Diabetes Centre & Diabetic Foot Clinic in Mumbai, KLS Memorial Hospital and Holy Spirit Hospital among others. He is a founder member of United Diabetes Forum, a forum of practising diabetologists in India. He has also written various articles on diabetes for medical journals such as Asian Journal of Diabetology and Medical Image. His Preventive Diabetes Centre & Diabetic Foot Clinic is an initiative to provide preventive diabetic measures as well as to function as a specialized Foot Clinic for diabetic patients not only in terms of equipment but more importantly in terms of expertise.

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