Diabetes not a barrier to pregnancy
For women with diabetes, pregnancy requires much more planning because diabetes poses major health risks for mother and baby. But with proper healthcare before, during and after pregnancy, these risks could be greatly reduced. Many women with diabetes experience normal pregnancies and deliver healthy babies. Potential problems for mother and baby Whether a diabetic woman has just discovered she is pregnant or is planning to have a child, it is important for her to be aware of these difficulties. She should discuss with a doctor preferably a diabetologist to prevent the risks. Risks to mother: A pregnant woman with diabetes is much more likely to —
- Delivere early
- Need labour to be inducted by other means
- Need to be delivered by Caesarean section
- Three times as likely to die in their first months of life
- Twice as likely to have a major abnormality at birth
a) Improve blood sugar control: While the chance of problems in pregnancy and at birth are higher for diabetic women than that of women without diabetes, studies prove the risk could be reduced by tight blood sugar control — less than 5.6 mmol/l before meals rising no higher than 7.8 mmol/l two hours after eating. By strictly control of blood sugar, the chance of a healthy pregnancy and birth are the same as that of a normal women. Women who have tight control of blood sugar during the early weeks of pregnancy greatly reduce the risk of malformations of their babies. The chance of a healthy baby is increased by strict control before conception and during pregnancy. Blood sugar should be checked properly if possible four times a day. Women should not get worried about the occasional high and low blood sugar level, as perfect blood sugar control is nearly impossible for anyone with diabetes. b) Avoid hypoglycaemia: Women with diabetes who try to achieve strict control of blood sugar during pregnancy risk severe and frequent hypos (hypoglycaemia i.e. low blood sugar level). Nighttime's hypos are more common in pregnancy. Symptoms usually occur suddenly and may include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or weakness, confusion, difficulty in concentration, excessive hunger, temporary vision changes, headache, nausea and palpitations. Some women lose awareness of their early warning symptoms of low blood sugar during pregnancy and so family, friends and colleagues should know how to spot, manage and treat a hypo, which, if severe, can lead to loss of consciousness. Hypos can be prevented by eating regular meals and snacks, testing blood sugar at least four times daily and adjusting food intake or insulin levels as advised by the doctor. c) Avoid acidic blood: High blood sugar can lead to high levels of ketones, acidic compounds in the blood. If not treated with extra insulin, the blood becomes too acidic. This is called ketoacidosis and can kill a baby at any stage in pregnancy, sometimes even before the mother feels seriously ill. Modern insulin for the use in pregnancy
Insulin Aspart (which is available in the market as NovoRapid) is rapid-acting modern insulin, that gives flexibility and convenience, fitting in with the patient's lifestyle and can be taken just before or soon after eating. It can be easily used in pregnancy. The shorter duration of action of this type of insulin reduces the risk of nocturnal hypoglycaemia. During a trial of 322 women with type-1diabetes, there were fewer pre-term deliveries and reduced risks to the unborn baby compared to traditional human insulin. Strict control of blood sugar is the main challenges of pregnant women with diabetes. With the early consultation with a diabetologist, every diabetic woman can pass a normal pregnancy and give birth healthy babies. The Writer is a Consultant Endocrinologist and Center Director of Nayapaltan Executive Center, National Healthcare Network.
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