Pregnancy and diabetes | Everything you need to know

Posted on November 3rd, 2014

Any type of diabetes during pregnancy poses a risk to both mom and baby. But here’s how you can manage it in your stride. By Licia Selepe

If you have either type 1 or type 2 diabetes mellitus, your pregnancy is considered high risk. This means you are more prone to complications during pregnancy and when giving birth. It also means you need to pay special attention to your health and lifestyle, and may need to consult a doctor who specialises in diabetes. Stace Rowe, a type 1 diabetic, was told by various doctors that it would be difficult to conceive and that she would need to be prepared for a diabetic pregnancy. “It was a huge shock when I found out I was pregnant,” says Stace.

Plan your pregnancy

If you’re diabetic, it’s critical to plan ahead. So talk to your doctor about having a baby. They can help you make sure your blood glucose levels are on target and give you the care and information you need to prepare for your pregnancy. Dr Mapendo Ndekwe, a Pretoria-based obstetrician and gynaecologist in a private practice, says a diabetic patient needs to make sure her blood sugar levels are under control before falling pregnant.

Dr Adri Kok, a Gauteng-based specialist physician, says that it’s crucial for the mother-to-be to control her blood sugar levels as carefully as possible before falling pregnant. “It is best to plan the pregnancy with your obstetrician to ensure the best possible outcome. We prefer the Haemoglobin A1c level (a standard tool to determine blood sugar control for patients with diabetes) to be below 6,5%, normal kidney function and an eye consultation to ensure there is a low risk of deteriorating vision as a result of the pregnancy,” he says.

Managing diabetes during pregnancy

Research shows that when women with diabetes keep blood glucose levels under control before and during pregnancy, the risk of birth defects is about the same as in babies who are born to women who don’t have diabetes.
Stace says that, in order to keep her sugar under control, she had to inject small amounts of insulin four times a day. She also had to inject herself with two acting insulin shots at night. “I had to limit my salt, sugar and fat intake, but I still needed to make sure baby got all the nutrients she needed,” she adds.

Dr Ndekwe says managing diabetes during pregnancy is a multidisciplinary exercise. The mom-to-be needs to visit her gynaecologist, physician and dietician regularly to monitor her kidney function, blood pressure, amniotic fluid and baby’s growth.
“As pregnancy advances, diabetes might be more difficult to manage, so patients will need a blood glucose monitoring device and test themselves regularly. It’s not easy, but it’s absolutely critical,” Dr Ndekwe stresses.

* It’s important to keep stress under control. Too much stress can interfere with your blood sugar levels.

 

Medication

Most types of insulin are considered safe to use during pregnancy but you should always check with your obstetrician and physician. Dr Kok points out that some types of analogue insulin aren’t registered for use when you’re pregnant. “Metformin can be used but other oral agents may be contra-indicated,” he adds.

Staying healthy

Eating a well-balanced diet and being physically active help ensure that you and your baby stay healthy.

  • Diet: A healthy eating plan will help you manage your blood glucose levels and weight. Get a dietician to help you with a meal plan. Dr Ndekwe says a dietician will advise you with the do’s and don’ts of a good diet. “Diet should include three meals and three healthy snacks a day, which includes an adequate ratio of carbohydrates to protein and fat,” he adds.
  • Staying active: Daily physical activity will help to maintain healthy blood glucose levels. It can also help control your blood pressure, cholesterol and stress levels. Talk to your doctor about regular exercise, such as walking, swimming and stretching.

Labour and birth

Stace had to have an emergency C-Section at 36 weeks because her blood pressure was very high, but pregnant women with diabetes also have the option of giving natural birth. You’ll want to talk with your healthcare team about your options well ahead of time. Dr Ndekwe says normally if a vaginal delivery is planned, labour will have to be induced to reduce the risk of a stillbirth.
Dr Kok says that the mom must be monitored carefully during the labour; glucose levels should be slightly higher to avoid hypoglycaemia. Usually the baby would be delivered via C-Section around 36 weeks. However, this will depend on the obstetrician and factors such as the mom and baby’s health, as well as the baby’s weight.

Risk factors

  • Baby: There are significant risks to the baby. According to Dr Kok, the baby can be affected by persistently high sugar levels and develop macrosomia, where the newborn is significantly larger than average. Genetic abnormalities, such as heart defects, poor intra-uterine growth and the risk of still birth (often in the third trimester) are more common where the mom’s diabetes wasn’t kept in check, adds Dr Kok. The baby may also be hypoglycaemic (low blood sugar) and will need to be monitored. This was the case with Stace’s daughter, Skylar-Rose. She was born with very low blood sugar and had to be monitored until her blood sugar was normal.
  • Mom: The mom could develop kidney dysfunction or even failure, oedema (swelling), protein in the urine indicating kidney damage and eye complications (especially worsening of existing retinopathy.)

“A day after giving birth, my blood pressure skyrocketed to 202/110. Doctors began treatment straight away but unfortunately damage had already been done and it caused blood vessels in my left eye to burst, detaching the retina,” says Stace. She was left temporarily blind and needed surgery. After surgery, she could only see with one eye.

Breastfeeding

Stace says she wanted to breastfeed, but she was unable to because she didn’t have any milk. As result, her daughter was bottle-fed immediately after birth. Her blood sugar started to drop but after the feed she fine, recalls Stace. “Today my daughter is almost two years old and she’s as healthy as can be,” says Stace.
Babies who are born to diabetic moms benefit greatly from being breastfed.
According to a study published in Diabetic Care, being breastfed for six months or longer may reduce the babies’ risk of becoming obese later in life.

Click here to read more about Gestational Diabetes.

*Originally published in July 2014

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Our experienced editors work with trained journalists and qualified experts to compile accurate, insightful and helpful information about pregnancy, birth, early childhood development and parenting. Our content is reviewed regularly by our panel of advisors, which include medical doctors and healthcare professionals.