There are two important issues regarding diabetes and pregnancy. The first concerns the diabetic who wants to conceive and carry a healthy baby to full term and delivery (pre-existing diabetes). And the second issue involves the development of gestational diabetes in a woman who previously showed no sign of the disease.
For the first issue: It is important that any woman with pre-existing diabetes, who either wants to conceive or finds herself pregnant, strictly control her glucose levels, this is particularly important in the early months of pregnancy. The risks of serious birth defects are increased by poor control of pre-existing diabetes, and it is also suggested to be a major cause of miscarriage.
Those women who develop gestational diabetes usually have no increased risk for birth defects although it is important that glucose levels be carefully monitored and controlled to reduce the risk of stillbirth.
All female diabetics who are pregnant tend to deliver much larger babies than the average. It is known that the babies grow larger because some of the additional sugar from the mother passes through the umbilical cord into the blood stream of the baby. Insulin then converts this sugar into fat cells. In many cases, these large babies have to be delivered by caesarian section as they are too large for a vaginal delivery.
Provided diabetes is properly controlled there is no reason why diabetic women should not enjoy uncomplicated pregnancies and deliver healthy babies. It is when the diabetes is not controlled that complication can happen. Unfortunately, these complications can lead to miscarriage, high blood pressure, premature delivery, and stillbirth.
Pregnant women who have pre-existing diabetes are given a blood test to measure the level of glycosylated haemoglobin before conception. This blood test provides an accurate measure of how well glucose levels have been controlled in the preceding months, and it can indicate the safest time to conceive. This test can also be used throughout the pregnancy to measure how well the diabetes is being controlled.
The current recommendation is for all women to take folic acid before conceiving to avoid the baby developing with neural tube defects. This advice is particularly important for diabetic women as diabetes can increase the risk of this type of birth defect.
Currently, oral medications used to control type 2 diabetes are not approved for use during pregnancy. For this reason, women who are using these drugs will need to switch to insulin before conceiving and during pregnancy.
Most pregnant women are tested for gestational diabetes at some stage between the 24th and 28th week of pregnancy. Those who develop this gestational diabetes normally discover that blood glucose levels return to normal after the birth of the baby.
Moderate exercise is believed to help cells make better use of available insulin and is recommended during pregnancy.
Blood sugar levels must be monitored carefully during pregnancy as insulin requirements can vary significantly from those required before conception. Urine can also be checked for ketones as the presence of these can be an indication that the diabetes is not being adequately controlled.
