Diabetes in Pregnancy

by Dr. Ronnie Nelson

octor's Advice

Diabetes is a permanent change in your internal chemistry, which results in your having too much glucose in your blood. The cause is a deficiency of the hormone insulin produced by the pancreas to control glucose levels. If the body stops producing insulin, there is nothing to stop your glucose levels from rising out of control. Glucose in high levels becomes toxic to most of the organs in the body over time resulting in heart, brain, kidney, blood pressure and eye disease. High glucose levels spill out of the blood into the urine, making you feel thirsty and wanting to pass urine all the time.

Type 1 diabetes usually occurs at a younger age and is treated by insulin injections to control blood sugar levels. If there's simply a reduction in insulin production, or your body doesn't respond properly to the insulin produced, you would be diagnosed with Type 2 diabetes, a problem more common in pregnancy and the elderly.

HAVE YOU HAD A DIABETIC PREGNANCY?
The hormonal changes experienced in pregnancy increase blood sugar levels, and most pregnant women produce extra insulin to cope with these changes. However, in some women especially those who are overweight this is not effective, and blood sugar levels rise as the pregnancy progresses leading to complications. Doctors always say: "Diabetes is bad for pregnancy and pregnancy is bad for diabetes".

The best way to avoid these complications is to stick to a healthy diet. If doing so is not enough to bring your blood sugar back down to under 7 mmol/L you may need a course of insulin injections for the remainder of your pregnancy.

The risk of high blood sugar (hyperglycaemia) during pregnancy

Not only are there risks to the baby, but medical research has shown significant health risks for diabetic women many years after a pregnancy complicated by gestational diabetes. These risks include:

Predictors of developing Type 2 diabetes are obesity, the severity of gestational diabetes during the pregnancy, persistence of the problem after birth and the duration of gestational diabetes.

Glucose levels after meals are the best predictors of poor outcome
Research studies have shown that it is most important to measure peak blood sugar levels 1 hour after beginning a meal. If the levels are below 120 mg% (6.6mmol/L) then there is no risk to the foetus, but if the level is elevated ABOVE this the consequences for the baby may be very serious indeed as indicated below. To minimize these ultra high postprandial glucose levels in the mothers blood, the meal plan has to allow 40% or less of calories from carbohydrates. As most patients are able to monitor their own glucose levels this is not an onerous ask. Any episodes of hyperglycaemia during the day such as after a very sweet snack may increase the hazards/risks of macrosomia to the foetus.

Glucose the 'poison'
If blood glucose levels are maintained within normal limits there is no risk to mother or baby during pregnancy. However, it is very important to understand that glucose becomes poisonous in abnormally high concentrations with disastrous effects, including spontaneous abortion, foetal malformations, intra-uterine death stillbirth and/or excessively fat babies (macrosomania) with birth complications such as shoulder dystocia. The newborn is at great risk of being born with biochemical imbalance, low blood sugar and hyaline respiratory disease.

The medical management
During pregnancy a woman is more likely to develop a disorder of glucose control, in the absence of previous diabetes. A glucose challenge test will reveal those patients at risk. An abnormal result means careful attention to diet: meticulous monitoring of glucose levels following all meals and insulin thereapy or glucose-lowering tablets where indicated and regular antenatal visits. The famous American Diabetologist, Prof. Lois Jovanovic says: "When the maternal glucose is normalized, the outcome of pregnancy is normalized".

Prevention is better than cure
It is vital for all mothers to watch their weight gain carefully during pregnancy. It is now clear that any baby's genes can be reprogrammed, so that if a baby is exposed to excessive levels of sugar or fat during the pregnancy, it becomes at much higher risk of developing obesity and without diabetes in later life even if there was no genetic predisposition in the first place.

Regular ante-natal care is vital to identify those patients at risk. Common risk factors for developing gestational diabetes include: