Diabetes In Pregnancy
Affecting about one in 200 women in the U.S, pre-existing diabetes can be a significant challenge for any woman trying to conceive as well as increase your risk for complications during pregnancy.
Diabetes is a metabolic disorder in which the body does not produce enough of the hormone insulin in the pancreas. Insulin provides our body's cells with energy to function. If you are diabetic, you will need to have your blood sugar levels closely monitored and maintain a specific diabetes diet and exercise regimen.
Types of Diabetes
Type 1 Diabetes is when the body's immune system eliminates pancreatic cells that make insulin. Previously known as juvenile onset diabetes, Type 1 diabetes usually occurs in children and adolescents and accounts for 5% to 10 % all diabetes cases. People with this type of diabetes will need to use an insulin pump or have insulin injections.
Type 2 Diabetes typically begins with insulin resistance, meaning the pancreas produces insulin but the body becomes resistant to it. Type 2 diabetes was previously known as adult-onset diabetes and accounts for 90% to 95% of all diabetes cases.
About 5% to 10% of women who have had gestational diabetes go on to develop Type 2 diabetes after pregnancy. Although type 2 diabetes is commonly associated with obese people, who may be more at risk of developing it, anyone can be affected by this type of diabetes.
Signs and Symptoms of Type 1 Diabetes
The symptoms of diabetes type 1 can include:
- Excessive thirst
- Excessive hunger
- Weight loss
- Blurring of vision
- Feeling tired
Signs and Symptoms of Type 2 Diabetes
Type 2 diabetes symptoms may include:
- Weight loss or gain
- Blurring of vision
- Repeated infections, wounds are slow to heal
- Tingling sensations in hands and feet or loss of sensation
- Searing pain in legs, arms, hands, feet
- Swollen, sensitive gums
A recent study showed that both types of diabetes greatly increase the risk of complications during pregnancy. The study revealed that baby deaths were four times greater for women with Type 1 and Type 2 diabetes. Also, babies born to diabetic women had twice the rate of major birth defects, like defects in the heart and nervous systems, than in the average population.
Consult a Physician and Plan Your Pregnancy
Women with Type 1 or Type 2 diabetes should consult their doctor soon after deciding to become pregnant. Your doctor may assemble a team of specialists to work with you throughout your pregnancy, like a diabetes specialist, obstetrician, pediatrician, dietitian and neonatologist.
Although you may feel it is unnecessary to visit the doctor before you are pregnant, it is important to note that a baby's organs are formed within the first eight weeks of pregnancy.
Your diabetes needs to be under control and properly managed before you become pregnant, otherwise your baby could suffer from serious health conditions, such as spina bifida and heart defects. Women with poor diabetic control have a 6% to10 % risk of giving birth to babies with birth defects.
Monitoring Your Pregnancy
To make sure you stay healthy, pregnant women with diabetes will have their blood glucose levels monitored by their health care provider throughout their pregnancy. This will be done through frequent blood tests.
Your blood sugar levels are important because they can cause birth defects, miscarriages, stillbirths, hypoglycemia, hyperglycemia, and high blood pressure. Furthermore, high blood sugar can cause your baby to be born very large, have low blood sugar, or have jaundice.
To be sure that your blood sugar levels stay within the desired range, you will be taught how to use a glucose meter to check your own blood sugar levels.
High blood sugar levels are not the only issues to be concerned with, though. If your body is not producing enough insulin, then acid levels will begin to build in your blood. This can also lead to a miscarriage.
Care and Conditions to Watch Out For
Your diet and exercise plan, the fluctuation of your hormones, and morning sickness will all be considered in your health treatment during the course of your pregnancy. In addition to blood sugar monitoring, ultrasounds of your baby will be conducted, your weight gain will be supervised, your eyes will be examined and your blood pressure regularly checked to detect any health conditions or problems.
For diabetics, there are three important health problems you should watch out for during your pregnancy: hypoglycemia, hyperglycemia and diabetic ketoacidosis.
Hypoglycemia refers to low blood sugar levels in the body. Due to the fact that it is difficult to regulate blood sugar, occasionally during your pregnancy they may fall below the normal range and you may feel dizzy and disoriented. Therefore it is important to take precaution in various situations, such as operating any heavy machinery, driving, or any activity that could be potentially dangerous.
Hyperglycemia refers to when your body does not have adequate insulin that can occur in a variety of situations. Your body will lack insulin if you consume too many calories, do not exercise when you are supposed to or miss a dose of insulin.
Lack of insulin can also be induced by stress or sickness. During the second trimester of your pregnancy, you will begin to need more insulin. If you do not meet your insulin requirements, you will have high blood sugar.
Diabetic Ketoacidosis (DKA)
If your body does not get enough insulin over a period of time, chemicals called ketones will accumulate. Ketones are dangerous because they can change your body chemistry and have ill effects on your health as well as your babyï¿½s health and may cause a miscarriage or stillbirth.
Changes in Medication
If you are on oral medications, your doctor may switch you to insulin injections as injections are thought to be safer for the baby's health. However, not all oral medications are known to adversely affect a baby's health.
Therefore, the need to change your medication will depend on the specific medication you are taking. Speak with your health care provider about what is best for you.
Diet and Exercise Regimen
To ensure a healthy pregnancy you will work with a dietician to make a carefully controlled diet plan. It is important that you monitor your meals so you know how many carbohydrates and sugars you are consuming.
- Make sure to get enough folic acid, either through vitamins or food sources, as this can reduce your risk for birth defects.
- You diet plan will need to increase by 300 calories a day for your baby to get proper nutrients.
- You will need to have 30 grams of protein every day.
- You will need to eat carbohydrates in the morning to regulate your blood glucose levels.
- You should have plenty of snacks throughout the day with complex carbohydrates and protein.
- Never skip meals as this can lower your blood glucose levels.
Delivery Options: Vaginal or Cesarean?
Women with diabetes may be advised to have a cesarean birth because they are at increased risk of having larger babies weighing over 10 pounds. Additionally, since pregnant women with diabetes have many health risks, any problem could be cause for pre-term delivery.
However, so long as there are no major health complications present, a woman should be able to deliver a baby vaginally.
After your baby is born, the pediatrics team will monitor him for low blood sugar for the first few hours. Your body will not need as much insulin after the birth of your baby. Talk with your doctor about lowering your medication dosage.