Diabetes and Pregnancy

The prevalence of Type-2 diabetes mellitus is higher in women, partly related to obesity. The Type-2 diabetes typically doubles the coronary heart disease risk in men and triples in women.

Diabetes Mellitus in pregnant women poses problems for the mother and the fetus. Women with established diabetes may have menstrual problems and difficulty in conceiving. While, pregnancy itself worsens diabetic control and may cause certain diabetic complications to progress in mother. Maternal diabetes is also hazardous for the fetus and carries an increased risk for fetal loss and major congenital malformations.

However, nowadays most women of child bearing age can realistically expect to become mothers of healthy children with intensive glycemic control. Improvements have ranged from technological advances in fetal surveillance (ultrasound scanning) to home glucose monitoring and intensive insulin regimens, enabling women with multiple diabetic complications to have successful pregnancies.

Diabetes Mellitus in pregnancy is classified into pre-gestational and gestational diabetes; gestational diabetes is defined as diabetes that is discovered during pregnancy. Approximately 7% of all pregnancies are complicated by GDM. Normal pregnancy reduces insulin sensitivity because of diabetogenic effects of placental hormones. This effect is maximal in the late second and third trimester. Gestationaldiabetes resolves after delivery, but may recur in subsequent pregnancies and the lifetime risk for developing Type-2 diabetes is 30%.

Indications for detection of diabetes in pregnant women

• Family history of Diabetes

• Glucose in urine sample

• History of unexplained prenatal loss

• History of large baby

• History of congenitally malformation infant

• Maternal obesity

• Maternal age more than 25 years

• Members of ethnic/racial group with high prevalence of Diabetes Mellitus

To prevent excess spontaneous abortion and congenital malformations in infants of diabetic mothers, diabetes care and education must begin before conception. There are no contraceptive methods that are specifically contraindicated in women with diabetes. The selection of a method should focus on its proven high degrees of effectiveness. Once patient achieves stable sugar control then contraception can be discounted and hence, plan for a pregnancy.

Management during pregnancy

Quit smoking/alcohol
Home blood glucose monitoring
Diet control/Folate supplementation
Regular exercise
Fetal monitoring by ultrasound scan
Accurate insulin regimen