Managing Diabetes During Pregnancy

Dr. Rajeswari Janakiraman, Senior Consultant ­ Endocrinology, Columbia AsiaAn alumnus of Bangalore Medical College, Dr. Rajeswari obtained her MD in Internal Medicine from PGIMER, Chandigarh and postdoctoral fellowship in Endocrinology (DM) from SGPGI, Lucknow, and worked at various reputed international centres in Singapore, Australia and Canada.

Pregnancy can be a time of excitement and anticipation but few women may experience health problems during pregnancy. These complications can involve the mother's health and the foetus's health leading to a high-risk pregnancy. Diabetes is the most common medical complication during pregnancy, representing 3.3 percent of all live births. Diabetes in pregnancy can have serious consequences for the mother and the growing foetus. The severity of problems often depends on the degree of the mother's diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control. If blood sugars are high in pregnancy (gestational diabetes), risks of large baby and excess fluid around the baby, lead to premature delivery. Delivery may be difficult with risk of trauma to the baby especially shoulder.

If a women had diabetes from early pregnancy or even prior to pregnancy, risk of birth defects may be high and also risk of miscarriage. Controlling blood sugars be-fore conception and throughout pregnancy gives the best chance of having a trouble-free pregnancy, birth and a healthy baby. While one takes good care of herself already, pregnancy is a time when you need to take even more care. It is very important for the expecting
mother's health and for the baby's health that the blood sugar levels are kept stable.

Staying in your target range during pregnancy, which may be different than when you aren't pregnant, is also important. High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant.

High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth. High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby.

Stillbirth is more likely in pregnant women with diabetes. The foetus may grow slowly in the uterus due to poor circulation or other conditions, such as high blood pressure or microvascular disease, which can complicate diabetic pregnancy. The risk of stillbirth increases in women with poor blood glucose control and with blood vessel changes.

Treatment for diabetes
If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting check-ups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stop smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.

Specific treatment for diabetes will be determined by the doctor based on age, overall health, medical history, extent of the disease, your tolerance for specific medications, procedures, or therapies, expectations for the course of the disease, and your opinion or preference.

Treatment for diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include special diet with controlled amounts of carbohydrate, exercise, blood glucose monitoring, insulin injections, and certain oral diabetes tablets.

Hormonal and other changes in your body during pregnancy affect your blood glucose levels. So, you might need to change how you manage your diabetes. Even if you've had diabetes for years, you may need to change your meal plan, physical activity routine, and medicines. If you have been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to your due date, your management plan might change again. Medically managing your diabetes is key for your health and the success of future pregnancies.