You’re diabetic, and you want to have a baby. Is it dangerous for you or the baby? How can you avoid complications? Even before you conceive, don’t hesitate to talk to your doctor. It’s important to plan ahead for this event.
Pregnancy in diabetic women is considered a high-risk pregnancy. However, it can go ahead without a hitch, provided that glycemic control is as perfect as possible, both at the time of conception and during the pregnancy. This calls for rigorous blood glucose monitoring and regular medical follow-up.
Pregnancy worsens diabetes
During pregnancy, the mother’s body undergoes profound changes. In particular, the placenta secretes a hormone, placental lactogenic hormone (PLH), which increases the body’s insulin resistance. This hormone is produced from the fifth week onwards, and in increasing quantities over the course of 9 months.
In non-diabetic women, the pancreas adapts and insulin secretion increases as pregnancy progresses. In some cases, adaptation is insufficient, leading to gestational diabetes, which disappears after pregnancy. In diabetic women, of course, there is a worsening of disorders and a spontaneous increase in glycemic imbalance. Pregnancy aggravates diabetes
Risks if no treatment is given
If a diabetic woman doesn’t change her habits and treatment, she risks all the problems associated with poorly balanced diabetes (hypertension, hypoglycemia, artery damage….), but above all she puts her baby at great risk.
During conception and the first trimester, unbalanced blood sugar levels can cause malformations (incomplete neural tube closure, congenital heart disease, bone dysgenesis).
In the second trimester, the risks are macrosomia (an overly large child) or hydramnios (too much amniotic fluid), making delivery difficult or dangerous.
In the third trimester, the imbalance delays the maturation of the baby’s lungs, and above all, the baby risks hypoglycemia at birth.
Cases of death in utero have been described, the causes of which are not necessarily clear-cut. It is therefore vital to achieve optimal diabetes control.
A planned pregnancy
The ideal way to prevent malformations is to have a healthy blood sugar level for at least three months, and a normal glycosylated hemoglobin, at the time of conception. So plan your pregnancy with your doctor. Take the time to discuss it at length with your doctor, asking all the questions you deem necessary, and don’t leave any details in the dark. Your child’s health will depend on your involvement in balancing your diabetes!
As with all diabetics, balancing your diabetes is above all a matter of diet: calorie intake is normal, but carbohydrate intake meal by meal must be perfectly regular. If need be, it may be time to go back to see a dietician.
You will then need to review your treatment.
If you are a type 2 diabetic taking oral antidiabetics, these are in any case prohibited during pregnancy. You should therefore stop taking them before conception, if possible, and if not, as soon as you want to get pregnant. You’ll need to switch to insulin. To fully understand the treatment and how to adapt it, it’s best to spend a few days in a specialized hospital;
If you have type 1 diabetes, you are already taking insulin and are familiar with the treatment. You will probably need to modify your usual doses, and gradually increase them until you give birth. You may need to stay in hospital for a few days, if you’re not sure you’ve got your treatment under control.
In addition to advice on how to adjust the necessary doses in the light of the results recorded in the self-monitoring diary, it includes a blood test with HbA1c measurement, which reflects the average blood sugar balance over the last 2 months.
In general, treatment is based on 3 or even 4 insulin injections a day. If necessary, you can use an insulin pump (for example, if you have hypoglycemia in the middle of the night and hyperglycemia at the end of the night). This is a very good solution for fine-tuning your insulin doses. Of course, you’ll need to do your self-monitoring every day.
You’ll also need to monitor your eyes and kidney function. An ophthalmological examination is recommended every three months, as well as regular monitoring of blood pressure and renal parameters (microalbuminuria, creatinine).
A supervised delivery
Of course, your blood sugar levels will be closely monitored during delivery, as will those of your baby at birth.
Afterwards, you may need to reduce your insulin dose. Once the placenta has been expelled, there is no longer any placental lactogenic hormone. However, not everything returns to normal instantly, and your diabetes may remain unstable for a few weeks.
If you were taking oral antidiabetics, you can resume them immediately, unless you are breast-feeding. In that case, you’ll have to wait until your child is weaned. Breastfeeding on insulin poses no problem.
Sources :
- Ma grossesse avec un diabète, Fédération Française des Diabétiques
- Le grand livre du diabète, par le Pr Altman et les Drs Ducloux et Lévy-Dutel
