Diabetes – What happens to diabetes related complications during pregnancy?
Diabetes – Motherhood with diabetes
In our previous article we shared about Diabetes – how diabetes is diagnosed? How to prevent diabetes, we even discussed about what is diabetes different types of diabetes,Symptoms of diabetes,controllable factors of diabetes,What is the treatment for diabetes etc..,
In this article we will take a look at Motherhood with diabetes – What happens to diabetes related complications during pregnancy?Planning pregnancy when you have diabetes
As we all know,type 2 diabetes is increasing worldwide, especially in children and adolescents and the number of women with diabetes in the reproductive age group is increasing. Hence it is important that all young women need to know the importance of preceptional counselling
Diabetes – What happens in pregnancy?
Pregnancy by itself is a diabetogenic state due to the effects of multiple glucose raising hormones produced by the placenta. Organ formation in the fetus is almost complete by 8 weeks of pregnancy. Therefore, poorly controlled diabetes during early weeks in many cases even before women knows that she has conceived can result in abortion and many other congenital anomalies in the baby
What happens to diabetes related complications during pregnancy ?
Eye changes – Sudden improvement in sugar control can worsen eye changes during pregnancy in a known retinopathic patient. Hence, preconceptional eye evaluation should be done to look for severe retinopathic changes
Kidney diseases – Pregnant women with diabetic kidney disease have high risk of hypertensive related complications in the mother and can lead to worsening of kidney function,which can worsen their blood pressure. This can harm the fetus and can result in fetal distress,fetal growth restriction and preterm labour
Planning pregnancy when you have diabetes
If you are planning pregnancy, it is important to talk to your doctor beforehand. This is because good blood sugar control is an important at the time of conception,which happens before you know that you are pregnant. Good glucose control will reduce risks both to the mother and the baby.
Tips to follow
- Your long term sugar control is monitored by HbA1c. You should attain an HbA1c of <7% before planning pregnancy
- Be sure that your blood glucose levels are as near to normal as possible ie,premeal <90 mg/dl.2hr post meal <140 mg/dl.
- It is important to take regular folic acid supplements at least 3 months before pregnancy and to continue it during pregnancy. This is to prevent development of neurological disorder called spina bifida
- Aggressive control of blood pressure to less than 130/80 should be encouraged
- Patients should also be screened for thyroid problems while planning pregnancy. This is because changes in thyroid levels can have harmful effect on the baby. Levels of TSH should be kept between 1-2.5IU/ml
- If you are on tablets for blood pressure,it has to be changes to alternative ones as per the advise of the doctor
- Those who have high cholesterol and are on statins, should stop their medication as it has harmful effects on the baby
- Should be encouraged to quit smoking
- Should receive good psychological support from her partner
- Need to be seen by a dietician, for good nutritional for and diabetic counselling’ Meticulous self monitoring of blood glucose is needed
- If you are on diet alone,then you may need to be started on insulin at some point of time based on blood sugar
- If you are on OHA,it is advisable that some of these need to be stopped and replaced with insulin before pregnancy happens
- If you are already on insulin, you may need to change the dose, the type and the number of injections for better control of your diabetes as pregnancy advances
- If patient is severe kidney disease or proteinuria, the could must be referred to a nephrologist. They must be counseled about the risk to both the mother and the baby and also the risk of progression of kidney diseases.
- Preconceptional eye evaluation should be done
- Preconceptional cardiac evaluation needs to be done to assess the cardiac function. Couple must be advised not to conceive in case of severe cardiac dysfunction
Hence, pregnancy must be planned only after attaining good blood sugar control. Until then,proper contraceptive methods must be adopted to prevent pregnancy.