Diabetes and Pregnancy

Diabetes does not spare anyone, let it be young or old, male or female, pregnant or non-pregnant female. Many years ago if a female was having many abortions, or was delivering abnormal or dead child it was presumed as God's will.

After many years of research and investigations the actual cause was identified. It is uncontrolled diabetes during pregnancy which is one of the causes of abortions.

Normally pregnant ladies have low levels of fasting blood sugar as compare to post prandial blood sugar which are little higher than normal. Usually in pregnancy Insulin secretion is more but due to deficiency or defective production of Insulin diabetes develops in pregnancy.

Growth of the organs of child usually takes place in 1st three months of pregnancy. I during this period Blood Sugar remains high child will have congenital defects, like valvular heart defects absence of some parts of body or organs.

In other words pregnancy should be planned only once you are sure that there is no diabetes.

Uncontrolled diabetes in 2nd and 3rd trimester of pregnecy can cause mental retardation of child, size of head would be bigger and overall size of child may be big. Then mother can't deliver such child normally and she has to go under Caesarian operation.

Therefore to avoid all this urine and blood tested for sugar. Which group of ladies should undergo screening for Blood Sugar.

• All females with family history of diabetes.
• If urine sample shows sugar.
• H/o repeated abortions or still birth.
• H/o delivery of abnormal size children.
• H/o delivery of child with congenital deformity.

Special blood test is available to detect the Blood Sugar Level pattern of last 2-3 months. This is done by estimation of Glycosylated haemoglobin. This test is specially helpful in planning motherhood and would indicate about the Blood Sugar Levels at the time of conception and before that.

Gestational Diabetes

What is gestational diabetes?

• Diabetes occurring for the first time in pregnancy.
• Onset is usually mid to late pregnancy.
• More common in those women:
  • whose relatives have diabetes
  • who are over 30 years
  • who are over weight

Why is it so important to maintain strict control of Blood Sugar?

• Poor diabetes control is associated with the risk of large babies with difficult labour.
• These babies may then have breathing problems and low Blood Sugar Levels at birth.
• Good diabetes control means a normal pregnancy and a normal delivery, with a healthy baby.

How will I know if my baby is doing well?

• Your Obstetrician will closely monitor your baby's progress. The baby's growth and development will be measured by Ultrasound.
• With good diabetes control you can expect a normal labour and delivery. Sometimes, it is necessary to induce labour a little earlier. If the baby is too big a Caesarian Section may be necessary.
• After the birth, your baby will be watched closely in the Special Care Nursery for 24 to 48 hours to ensure the Blood Sugar Levels stay normal.
• Your baby will not be born with diabetes.

Should I take any special precautions after my pregnancy?

• You should have a Glucose Tolerance Test after the birth of your baby, to ensure a return to normal has once a year.
• Have a Blood Sugar Level done at least once a year.
• Be aware that you have a greater risk of developing Gestational Diabetes in future pregnancies.
• You have a greater risk developing Diabetes later in life (usually non-insulin dependent diabetes).

Is there anything I can do to prevent diabetes in later life?

• Continue with your diet (after adjustment by a Dietitian).
• Maintain ideal body weight for your height.
• Exercise to stay fit.

How to Manage

One should plan delivery only in hospital in such cases so that life of both mother and child can be saved.

Ultrasounri examination will help to find out if there is any congenital defect so that appropriate precaution may be taken.

In Type II diabetes pregnant lady is aware about her being diabetic still she is reluctant to stop tablets. Pregnant ladies should not take any tablets for diabetes because these tablets are harmful to (Foetus) child. Only safe and best treatment available is regular injection of Insulin. Pregnant diabetic lady requires one or two injections of plane Insulin. Newer available humane insulins are safe. Patient may require one or two injections depending upon Blood Sugar Levels.

Other factors are also essential in the treatment apart from insulin injections.

About Diet

In pregnant lady there is increase in weight per week, in the range of 300-400gm.

• Food should provide proper nutrition to both mother and child for growth.
• Should not increase extra weight.
• Should keep Blood Sugar Levels under control.
• Should provide 30-40 calories per kg. of normal weight.