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HEALTH PLUS MEDICAL CORRESPONDENT

It is estimated that between 2% and 3% percent of pregnant women are affected by gestational diabetes during pregnancy. If the mother’s body cannot produce sufficient insulin to overcome this, diabetes in pregnancy can develop.

According to CDC, Diabetes can cause problems during pregnancy for women and their developing babies. Poor control of diabetes during pregnancy increases the chances for birth defects and other problems for the pregnancy. It can also cause serious complications for the woman.

This is why we choose to focus on proper health care before and during pregnancy and how you can help prevent birth defects and other health problems.

RISKS FOR YOUR BABY

The following risks are more common as a result of diabetes. These risks can be reduced with good diabetes control.

Abnormal development, particularly with the baby’s heart

Heart and breathing problems shortly after birth

Stillbirth or death shortly after the birth

Developing diabetes later in life

RISKS FOR A MOTHER FROM DIABETES IN PREGNANCY

Raised blood sugar levels during pregnancy increases your chances of having a larger baby, which could mean the need to have an induced labour or a caesarean section delivery. The chances of suffering a miscarriage are also higher with diabetes. Similarly, to the risks for your baby, the risks for you can also be reduced with well controlled diabetes.

BLOOD GLUCOSE CONTROL DURING PREGNANCY

Good blood glucose control is important all the way through your pregnancy but is especially important at the start of your pregnancy, in the first trimester.

Hypoglycemia (low blood sugar levels) and hyperglycemia (high blood sugar levels) are both likely to happen during pregnancy.

Keeping your blood sugar levels well managed is essential to reduce the chances of complications developing for you or your baby.

Keeping your blood glucose under control during your pregnancy requires dedication but you should be offered plenty of support from your healthcare team to help you achieve the target.

TARGET BLOOD GLUCOSE LEVELS BEFORE AND DURING PREGNANCY

The target HbA1c (a measure of long term diabetic control) for people with diabetes prior to and during pregnancy is 6.1% (or 43 mmol/mol). [NICE Clinical Guidelines, Diabetes in Pregnancy]

TYPE 1 DIABETES AND PREGNANCY

People with type 1 diabetes should aim to achieve tight control of their diabetes prior to and throughout their pregnancy. To help you to meet the target level of diabetes control, you may be put onto an insulin pump, if you are not on one already, and your health team should provide plenty of support.

TYPE 2 DIABETES AND PREGNANCY

Pregnancy typically places higher demands for insulin than normal and therefore it is quite common for people with type 2 diabetes to be put onto insulin during their pregnancy.

Whether you are put onto insulin or not, you should receive plenty of help from your health team to ensure your diabetes is well controlled through your pregnancy.

HORMONAL CHANGES AND INSULIN

It is the hormonal changes (hormones made by the placenta that resist insulin) in the second and third trimesters of pregnancy, along with the growth demands of the foetus, that increase a pregnant woman’s insulin needs by two to three times that of normal.

Insulin is needed to take the sugar from your blood and move it into your cells for energy. If your body cannot make this amount of insulin, sugar from the foods you eat will stay in your bloodstream and cause high blood sugars. This is gestational diabetes.

GESTATIONAL DIABETES AND PREGNANCY

Gestational diabetes usually develops in the third trimester (between 24 and 28 weeks) and typically disappears after the baby is born.

Women who develop gestational diabetes during pregnancy are more likely to develop type 2 diabetes later in life.

The first line of treatment for gestational diabetes is through diet and exercise, however, diabetes tablets and insulin may be needed if blood glucose levels remain high.

FOLIC ACID DURING PREGNANCY

You will be advised to take 5mg of folic acid for the first 12 weeks of your pregnancy.

This is higher than the general advice for women without diabetes, who are advised to take 0.4mg of folic acid a day.

ANTE-NATAL CARE

Ante-natal care should be hospital-based, from a multi-disciplinary team.

Individualise insulin regimens and daily glucose monitoring.

Aim to maintain glucose HbA1c within the normal non-diabetic range.

Remember insulin requirements increase progressively from the 2nd trimester until the last month of gestation, when a slight fall-off may be noted

Hypoglycemia and loss of awareness is common in early pregnancy.

DELIVERY

The timing of delivery is individualised; in women with good diabetes control and no complications, the pregnancy may be continued to 39-40 weeks. Caesarian section rates are often higher than in non-diabetic women.

POSTNATAL CARE

Insulin requirements fall dramatically after you have given birth, therefore reduce insulin doses immediately to pre-pregnancy levels, to avoid hypoglycemia.

All women should be seen by the diabetes pregnancy care team six weeks after delivery.

In breast-feeding mothers, reduce insulin dose further once lactation is established.

Discuss contraception while the patient is still in hospital.

PREVENTION

There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better. If you’ve had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future.

– Eat healthy foods. Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes.

– Keep active. Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity consistently and frequently.

– Start pregnancy at a healthy weight. If you’re planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits.

– Don’t gain more weight than recommended. Gaining some weight during pregnancy is normal and healthy, but gaining too much weight too quickly can up your risk of gestational diabetes.