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DIABETES & PREGNANCY

Article by Dr Ilaria Saredi - MBBS, M.D (France) Family Medicine Specialist at Allied Medical Center, Dubai, UAE

There are 3 types of diabetes in pregnancy, Type 1, Type 2 and Gestational Diabetes. As a pregnant woman who also has diabetes you have an increased risk of miscarriage, an increase in the risk of eye and kidney problems and an increased risk of having a large baby, which can lead to complications with delivery. Risks for your baby include; increased risk of heart problems, spina bifida and other birth defects. Your baby has a higher risk of needing special or intensive care after birth. There is also an increased risk of stillbirth. For those of you who have Type 1 or Type 2 diabetes, pre-conception planning and tight control are essential. By planning ahead you can really improve your chances of having a healthy pregnancy and a healthy baby.

Diabetic Control: Some of the medications you may take to help manage your diabetes may not be safe to take in pregnancy. For example statins, ACE inhibitors and other blood pressure medication may be harmful to your baby. Many medications taken to help with your blood glucose control in Type 2 diabetes may also be harmful in pregnancy.

You are advised to visit your doctor before you become pregnant, or immediately if you discover you are pregnant and are taking any of these medications. Often, after the birth of your baby you will be able to go back on these medications, your doctor will be able to advise you further about this.

On waking 5–7 mmol/L.
Before meals and at other times of the day 4 – 7 mmol/L

Medications: Before you try to conceive you should get your HbA1c checked. Ideally you should be aiming for HbA1c of below 48mmol/mol. If it is over 86mmol/mol, experts advise you to avoid becoming pregnant at that time and work with them to reduce it before conceiving. Your chances of delivering a healthy baby greatly increase if you keep good control of your blood sugar levels before conception and throughout your pregnancy. According to NICE guidance (National Institute for Clinical Excellence, UK) your target blood sugar readings should be: .

Checks & Folic Acid: Pre-conception make sure you have retinal screening and kidney function tests. Pregnancy can sometimes make certain diabetic complications worse so it is important to know if these complications are already present so you can be managed appropriately during your pregnancy. Start taking folic acid 5mg as soon as you start trying to conceive and continue taking it right up until the end of your 12th week of pregnancy. This dose is higher than the usual recommended dose in pregnancy of 400mcg. It helps to prevent neural tube defects.

During Pregnancy:

• You should be managed from the beginning of your pregnancy by both your obstetrician and your diabetes specialist jointly.
• You should have close monitoring during your pregnancy, measuring your blood glucose levels regularly and frequent scans to measure the growth and development of your baby.
• If you suffer with any kind of illness or vomiting you should seek medical help immediately.
• In planning for your baby’s delivery your doctor may discuss earlier induction of labour or caesarian section.

Gestational Diabetes: Gestational Diabetes Mellitus (GDM) is diabetes that occurs during pregnancy. It is usually diagnosed in the second or third trimester. It is diagnosed by having an Oral Glucose Tolerance Test. This can be performed at any time during your pregnancy. Any woman may be at risk of developing GDM. However you may be more at risk if;

• You have already had GDM in a previous pregnancy so you should definitely be tested again in any subsequent pregnancies.

• If you are overweight. Particularly if your BMI was over 30 before you became pregnant.

• If you have had a large baby previously. – weighing 4.5kg or more.

• If you have a family member who has diabetes, particularly a parent or sibling.

• If you are from a South Asian, Middle Eastern, Black or African Caribbean background.

Inform your doctor if you think you may be more at risk so that testing can be arranged at the appropriate time for you.

For some women GDM can be managed with diet alone and for others they may need to take oral medication or insulin therapy.

After the birth if your blood glucose level returns to normal you should have either a fasting blood test performed between 6 – 13 weeks post delivery, or HbA1c blood test after 13 weeks.

Following this you should have HbA1c blood test every year to screen for the development of Type 2 diabetes.

Many women who have diabetes have healthy pregnancies and perfectly healthy babies. By being more aware of your condition and your risks you can be one of them.

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