You have diabetes, and you want a child (you’re planning a pregnancy). How dangerous it is for you and the baby? How to avoid complications? Before you even conceive (getting pregnant), talk to your your doctor. It is important to plan this event with him (involve him in this event).
Pregnancy for women with diabetes is considered as risky (really important). However, they can go safely through it, as long as the blood sugar levels are under control, during conception and pregnancy. It will therefore require a blood sugar strict monitoring, and a regular medical follow up.
Can Pregnancy affect diabetes? Can Diabetes affect pregnancy?
During pregnancy, the mother’s body undergoes many transformations. In particular, the placenta produces a hormone called Human placental lactogenic (hPL), which will increase the body’s insulin resistance. starting around the 5th week and keeps rising throughout the pregnancy.
In women without diabetes, the pancreas adapts and insulin secretion increases during pregnancy. Some women will develop a pregnancy diabetes (gestational diabetes) when the adaptation is insufficient, which disappears after deivery. In women with diabetes, that may have major effects on the mother and lead to an increase in glycemic imbalance.
Untreated diabetes, what are the risks?
If the diabetic woman does not follow proper health care and appropriate treatment, she may risk all unbalanced diabetes related disorders such as (High blood pressure, hypoglycemia, arteries damage, etc.), but above all, she puts her life and her baby’s at great risk.
During conception and the first trimester: the imbalance of blood sugar may cause malformations (incomplete neural tube closure, congenital heart disease, bone dysgenesis).
In the second trimester, the risks may be a possible macrosomia (newborn with excessive birth weight) or hydramnios (too much amniotic fluid) which will increase the risk of pregnancy and birth complications.
In the third trimester, the imbalance may be the cause of a delay in the baby’s lungs development, as well as a risk of hypoglycemia at birth.
Cases of fetal death in utero, with undetermined causes, have been reported. An optimal diabetes balance is therefore, vital.
A Planned pregnancy
The best way to prevent birth defects is to keep blood sugar level balanced and under control for at least three months, as well as a normal glycosylated hemoglobin, at the time of conception. You must therefore plan your pregnancy with your doctor. Take the time to talk to them at length, ask them as many questions as necessary and do not be afraid to go deeply into details. A strict control of your diabetes will increase the chances of a healthy pregnancy and thus, a healthy baby!
As for all diabetics, a diabetes balance is above all a matter of proper diet: it is important to eat the right amount of calories as well as a healthy low carb intake. If needed, please consult a dietitician!
You would need then to readjust your treatment
- If you have type 2 diabetes on oral diabetic treatment, these are anyway during pregnancy. They should therefore be stopped, if possible, before conceiving, and if not, as soon as you know you are pregnant. You will then need to switch to insulin treatment. A hospital admission within a specialized service might help, to fully understand the treatment and how to adjust it.
- If you have type 1 diabetes, you are already on insulin treatment and familiar with. You will probably need to change your usual dosage, gradually increasing it until delivery. A few days hospital admission might be necessary if you are unsure abou yout treatment control.
- Also, excpectant women with diabetes should consult their specialist monthly. It includes, it includes, in addition to the necessary doses adjustments as per the results recorded in the glycemic self-monitoring notebook, a blood testing with HbA1c dosage which reflects the average glycemic balance over the past 2 months.
In general, the treatment is based on 3 insulin injections per day, or even 4. If necessary, you will use the insulin pump (for example if you have hypoglycaemia in the middle of the night and hyperglycaemia at the end of the night). This is ideal to better adjust your insulin doses. Of course, you will need to perform your self-monitoring every day.
You will also need to monitor your eyes and kidney function. It is also really important and recommanded to have eyes exam every trimester and a regular monitoring of blood pressure and a regular monitoring of blood pressure and renal functions (Microalbuminuria, creatinine).
Labour and Birth under medical supervision
Obviously, your blood sugar will be closely monitored during delivery, as well as your baby’s at birth.
Afterwards, you may need to reduce your insulin dosage as. once the placenta is being expelled, there will be no human placental lactogenic anymore. However, everything does not go back to normal instantly, and your diabetes may remain unstable for few weeks.
If you were on oral antidiabetic’s treatment, you may even take them again right away, unless you are breast-feeding. In this case, you will have to wait until your child is weaned. Breastfeeding on insulin is alright.
- My pregnancy with diabetes, French Federation of Diabetics
- The Big Book of Diabetes, by Pr Altman and Drs Ducloux and Lévy-Dutel