Getting ready for baby -diabetes and pregnancy

For the next few weeks, I would like to talk a bit to those of you who are women, with diabetes, and planning on pregnancy sometime in the future. Here in the US, I am getting ready to start a specialty Gestational Diabetes clinic that will serve women who had diabetes diagnosed during their pregnancies, as well as women who had diabetes prior to becoming pregnant. This week, I would like to talk first to those of you who already had the diagnosis of diabetes PRIOR to your pregnancy.{{more}}

For the sake of simplicity, I am going to combine both those with Type 1 and Type 2 diabetes. Many years ago when we did not have as many treatments available, becoming pregnant when a diabetic was considered very dangerous. Many women with Type 1 diabetes were advised against pregnancy in the past; however, more recently it is well accepted that, with good control over blood sugar levels, women with diabetes can have a safe pregnancy and delivery of a healthy infant.

Why the concern in the first place? For one thing, in people who have poorly controlled diabetes (meaning blood sugars are high), there is a higher chance of having a baby that is large for gestational age. We all like cute, chubby babies, but a baby that is large for dates often has difficulties during delivery, higher chances of complicated birth, and also chances of blood sugar problems after the birth. One of the biggest concerns in women with poorly controlled diabetes is that there is a higher chance of having a child with birth defects. If your blood sugars are WELL controlled, this is not much of a risk above the non-diabetic population. But if your blood sugars are usually high and stay high through your pregnancy, your chances are higher of having a child with birth defects.

For the women themselves, pregnancy has the risks of worsening certain diabetes-associated complications. If you have kidney problems prior to pregnancy, those can worsen during the nine months. Diabetic eye disease can also progress. If you have high blood pressure, this tends to get worse during pregnancy. For all women, pregnancy places stresses on the body; so, if you think about this on top of a body stressed by badly managed diabetes, it can truly cause damage during those nine months.

Deliveries are something to note also: for women with poorly controlled diabetes their chances of having a complicated delivery, or other obstetric complications are higher then those with well controlled diabetes or those without diabetes at all.

All of this info should lead you to one big conclusion: for women with diabetes it is best to 1) have your blood sugars well controlled BEFORE you get pregnant in the first place and 2) keep them well controlled DURING the pregnancy. Be sure your weight is as optimal as possible, not overweight, not underweight, when you start thinking about becoming pregnant. See your doctor (general doctor or GYN) for pre-pregnancy counselling when you start thinking about this. This is especially important also in regard to our medications, because some medications used by people with diabetes (such as some blood pressure agents) are not safe to use during pregnancy. Once you get pregnant, you will need to be monitored carefully, more than a woman without diabetes, to ensure your baby is rowing normally, that your kidneys and eyes are okay, that you are not developing problems along the way.

The first step is to let your doctor know you are thinking about pregnancy, and he/she will start ensuring you are on the right path, and what needs to be changed/tightened up in preparation for baby and you.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com

Medical Director Endocrine Care Group

www.endocrinehelp.com

Tel: 843-798-4227