The Challenges of Diabetes & Pregnancy

There was a time when women with diabetes were discouraged from having children entirely, but with the advances in the use of insulin and management of diet - including exercise - there have been significant improvements in the chances a woman with diabetes has to both conceive and carry a baby to term.

Fail to Plan and You've Planned to Fail

You've no doubt heard it said that if you fail to plan, you plan to fail. The medical profession says that for the woman with diabetes, the key is in the planning and in a system which protects both mother and child. Pre-existing diabetes and gestational diabetes both require strict blood-sugar control all through the pregnancy.

There's a Difference

Gestational diabetes differs from Type 1 and Type 2 diabetes in that it is contracted after a woman becomes pregnant and the baby is already well developed. A woman who has diabetes before pregnancy must maintain strict control of her blood-sugar before she conceives and maintain it throughout the pregnancy while the baby's organs and systems are developing and also in later pregnancy to ensure the baby does not gain too much weight and grow too big.

Robert Meloni, MD, fellow of the American College of Endocrinology, recommends, "Plan on achieving excellent blood-sugar control by six months before conception. It takes time to get everything together - diet, exercise, insulin - in the proper proportion for continuous, excellent control."

Diabetes is Dangerous to Babies

Diabetes is very dangerous to unborn babies and most diabetic-related fetal birth defects occur before a woman even knows she's pregnant. The defects are caused by exposure of the baby to a diabetic mother's high blood sugars in the first two weeks of development. Dr. Meloni says, "If severe defects occur, they cannot be ‘fixed' by good sugar-control later."

Women with poorly controlled diabetes also run the risk of miscarriage in the early weeks of pregnancy. Those with uncontrolled diabetes experience twice the number of miscarriages compared to those with properly controlled diabetes. There are other severe concerns as well. The complications of neuropathy and retinopathy can become much worse during pregnancy if there is poor sugar control. A woman could lose her sight through neglecting her blood-sugar levels.

There's Good News!

The good news is that there are ways to get control of blood sugar before you become pregnant. Dr. Meloni recommends that women reach their near-ideal body weight and that they follow a diet that provides good sugar control. They should avoid hyper- and hypoglycaemia. "This requires multiple injections of regular or lispro insulin per day before meals," he says. "At bedtime and/or in the morning, intermediate-acting insulin is used to smooth out the ‘bumps' in blood sugar. Adding snacks to the diet and reducing meal size is often necessary."

A Team Includes Your Mate As Well

Women with diabetes must pay special attention to virtually everything they do in planning for pregnancy. This is where, along with the medical team, your partner or spouse can be of great assistance - an invaluable part of the team. When you both work together with the doctors and health specialists, everyone stands to benefit.

There's great value in good planning.

 

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