Diabetes in pregnancy – pre-existing and gestational diabetes

Diabetes in pregnancy is the most common medical problem affecting pregnant women. This can either be pre-existing or gestational diabetes. Difficulty in conceiving, miscarriages and an overall poor outcome in pregnancy, are some of the major impacts of diabetes faced by women.

According to the International Diabetes Federation (IDF), one in seven births worldwide is affected by gestational diabetes. In the UAE, that number is unfortunately higher, with studies showing that one in three women will develop this form of diabetes.

Therefore, it is imperative that women be educated on the risks of developing the condition during the most sensitive period of their life. Diabetes in pregnancy can increase the risk of hypertension, preeclampsia, thromboembolism, premature labour, spontaneous abortion and increased risk of caesarean section

The actual cause for gestational diabetes in not clear. However, there are risk factors like obesity, family history of diabetes, ethnicity (more in Asian and Middle Eastern populations), diabetes in previous pregnancy and macrosomia in previous pregnancy. Below are a few symptoms of gestational diabetes:

•    Increased thrust and urination
•    Constant hunger
•    Blurred vision
•    Fatigue

A diabetic mother’s baby has a higher risk of developing diabetes. Diabetes can also affect the baby by increasing the risk of congenital abnormalities, neurological and cardiac abnormalities, foetal macrosomia, hypoglycaemia, respiratory distress syndrome, jaundice and birth injury. Late intrauterine death is also a risk.

Here are a few ways diabetic women can prepare for pregnancy:

•    Obtaining advice about good glycaemia control before conception and during pregnancy to reduce the risk of complications. Additionally, regular blood sugar checks as well as checking of HbA1c and keep the target of 48 mmol/mol (6.5%)
•    Obtaining lifestyle advice: heathy diet and exercise especially when the body mass index is 27 kg/m2
•    Retinal and kidney assessment should be undertaken prior to pregnancy
•    Take part in counselling sessions regarding potential risks of neonatal complications such as the baby developing obesity and diabetes in later life
•    Take folic acid daily prior to pregnancy to reduce risk of neural tube defect
•    Register with a preconception diabetes clinic
•    Due to the pregnancy symptoms such as vomiting and appetite changes there is risk of hypoglycaemia and hyperglycaemia therefore the sugar levels should be monitored regularly, and doctor’s advice followed regarding the dose, type and administration of the insulin

After birth, it is still important for diabetic mothers to continue taking care of themselves and ensuring a healthy lifestyle. Below are a few recommendations on how you monitor and keep your diabetes in check:

•    Blood sugar should be monitored postnatally (at 6 and 12 months) as there is risk in women with gestational diabetes developing diabetes in later life
•    In women with gestational diabetes rarely need to continue diabetes medications
•    Lifestyle advice should be given regarding diet and exercise.
•    Women with pre-existing diabetes should be monitored by a multidisciplinary team and her insulin dose should be adjusted according to the blood sugar as they are at increased risk of hypoglycaemia
•    Breast feeding should be encouraged

Written by Dr. May Ali, Specialist Obstetrics and Gynecology at Valiant Clinic

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