Dr. Bruce Rodgers Responds:
The majority of women with diabetes can expect to have a successful pregnancy and health baby. However, there are several important issues which must be addressed.
Care of diabetes and pregnancy actually should begin BEFORE the pregnancy. If you have diabetes and are contemplating pregnancy, it is strongly recommended that you have preconception diabetes care.
Physicians caring for women with diabetes and most endocrinologists are well versed in such care, which involves screening for diabetic complications and achieving optimal blood glucose control prior to pregnancy.
Prior to the pregnancy, your doctors should check for complications of diabetes such as eye, kidney, heart, and thyroid problems, as well as hypertension (high blood pressure).
Some authorities also recommend that women with Type 1 (juvenile) diabetes be checked for Gluten Enteropathy, which can be performed with a simple blood test. It is important that your blood glucose levels be controlled and that you achieve a Hemoglobin A1C Level as close to normal as possible. This significantly reduces the risk of birth defects and miscarriage, both of which are higher in women with diabetes. This risk is related to poor blood sugar control during the first 7-9 weeks of pregnancy when the baby’s organs are forming. If you delay optimizing your blood sugar control until you discover you are pregnant, it will be too late to avoid these risks.
In the pre-pregnancy period, your doctor should switch you to diabetic medications that are safe in pregnancy. This generally involves switching to Insulin, if you are not already on this medication. If your blood sugars are well controlled at the time of conception, and your diabetes is uncomplicated, then half the job is already done. If you have any complications of diabetes, you can still anticipate a successful pregnancy, but the management of the pregnancy may have to be more intensive. It is important to have treatment for these complications before you become pregnant.
The most common baby growth problem encountered with diabetes is an oversized baby (called Macrosomia, which means “big body”). In addition to causing problems with the birth process and increasing the need for Cesarean Section, excessive largeness is not healthy for the baby and may increase the risks of the baby having problems such as obesity and diabetes later in life.
The oversized baby problem is related to many factors, and include the mother's weight prior to the pregnancy, excessive weight gain during pregnancy, and failure to control blood sugars by pregnancy standards (these are more rigid then when you are not pregnant).
Keeping your weight down prior to conception, strict adherence to a low carbohydrate diet during pregnancy, and avoidance of excessive weight during the pregnancy go a long way towards preventing oversized babies. Daily blood sugar monitoring with good blood sugar control is also extremely important in this context.
– Dr. Bruce Rodgers
Dr. Rodgers is the Director of Maternal-Fetal Medicine at Catholic Health and Director of the Fetal Testing Unit at Sisters of Charity Hospital in Buffalo.
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