There are two different issues concerning diabetes and pregnancy. The first involves the diabetic who wishes to conceive and carry a healthy baby to full term and delivery- pre-existing diabetes. The second is the development of gestational diabetes in a mother to be who showed no sign of the disease prior to her pregnancy.
It is important that any woman with diabetes, who either wants to conceive or finds herself pregnant, control her glucose levels strictly particularly in the early months of pregnancy. The risk of serious birth defects is thought to be increased by poor control of pre-existing diabetes and it is also thought to be the cause of an increased risk of miscarriage.
For those women who develop gestational diabetes there is no increased risk of birth defects although it is important that glucose levels are strictly monitored and controlled to reduce the risk of stillbirth.
Diabetics be they conditional gestational or pre-existing tend to deliver much larger babies than the average. 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 where insulin then converts it into fat stores. These large babies very often 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 problems occur and complications arise. These complications can lead to miscarriage, high blood pressure, premature delivery and stillbirth.
Women with pre-existing diabetes may be offered a blood test to measure the level of glycosylated haemoglobin before conception. This test provides an accurate measure of how well glucose levels have been controlled in the preceding months and 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.
Medication During Pregnancy
Currently, oral medications used to control type 2 diabetes are not approved for use during pregnancy so any woman who is using these drugs will need to switch to insulin before conceiving and during her pregnancy.
Most pregnant women are tested for gestational diabetes at some stage between the 24th and 28th week of pregnancy and those who develop this condition usually find that blood glucose levels return to normal after the birth of the baby.
Moderate exercise, with the approval of the obstetrician, is thought to assist cells make good use of available insulin and so is recommended during pregnancy.
It is important that blood glucose levels are monitored closely 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. If ignored a condition called ketoacidosis can develop and this can jeopardise the life of the baby.
For the sake of the mum-to-be and the baby it is important that diabetes be controlled during pregnancy to ensure the health of both.