Diabetes and pregnancy
For pregnant women with diabetes, some particular challenges exist for both mother and fetus. If the pregnant woman has diabetes as a pre-existing disorder, it can cause early labor, birth defects, and larger than average infants. Therefore, experts advise diabetics to maintain blood sugar level close to normal range about 3 months before planning for pregnancy.[1]
When
Physiology
Pre-gestational diabetes can be classified as
Risks for the fetus
The negative effects of pregestational diabetes are due to high blood sugar and insulin levels primarily during the first trimester of pregnancy (in contrast to
Pre-existing diabetes can also lead to complications in the neonate after birth, including
Furthermore, when blood glucose is not controlled, shortly after birth, the infant's lungs may be under developed and can cause respiratory problems.[9] Hypoglycemia can occur after birth if the mother's blood sugar was high close to the time of delivery, which causes the baby to produces extra insulin of its own. A hyperglycemic maternal environment has also been associated with neonates that are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome.[10]
Diabetes pregnancy management
Blood glucose levels in pregnant women should be regulated as strictly as possible. During the first weeks of pregnancy less insulin treatment is required due to tight blood sugar control as well as the extra glucose needed for the growing fetus.
Diabetes mellitus may be effectively managed by appropriate meal planning, increased physical activity and properly-instituted insulin treatment. Some tips for controlling diabetes in pregnancy include:
- Cut down sweets, eats three small meals and one to three snacks a day, maintain proper mealtimes, and include balanced fiber intake in the form of fruits, vegetables and whole-grains.
- Increased physical activity - walking, swimming/aquaerobics, etc.
- Monitor blood sugar level frequently, doctors may ask to check the blood glucose more often than usual.
- The blood sugar level should be below 95 mg/dL (5.3 mmol/L) on awakening, below 140 mg/dL (7.8 mmol/L) one hour after a meal and below 120 mg/dL (6.7 mmol/L) two hours after a meal.
- Each time when checking the blood sugar level, keep a proper record of the results and present to the health care team for evaluation and modification of the treatment. If blood sugar levels are above targets, a perinatal diabetes management team may suggest ways to achieve targets.
- Many may need extra insulin during pregnancy to reach their blood sugar target. Insulin is not harmful for the baby.[13]
The National Institute of Health and Care Excellence now recommends closed-loop insulin systems as an option for all women with type 1 diabetes who are pregnant or planning pregnancy.[14][15][16]
Breastfeeding
In general,
In some cases, pregnant women with diabetes may be encouraged to express and store their colostrum during pregnancy, in case their blood sugar is too low for feeding the baby breast milk after birth.[18] There is no evidence on the safety or potential benefits when pregnant women with diabetes express and store breast milk prior to the baby's birth.[18]
Classification
The White classification, named after Priscilla White[19] who pioneered research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed before pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.[20]
There are 2 classes of gestational diabetes (diabetes which began during pregnancy):
- Class A1: gestational diabetes; diet controlled
- Class A2: gestational diabetes; medication controlled
The second group of diabetes which existed before pregnancy can be split up into these classes:
- Class B: onset at age 20 or older or with duration of less than 10 years
- Class C: onset at age 10-19 or duration of 10–19 years
- Class D: onset before age 10 or duration greater than 20 years
- Class E: overt diabetes mellitus with calcified pelvic vessels
- Class F: diabetic nephropathy
- Class R: proliferative retinopathy
- Class RF: nephropathy
- Class H: ischemic heart disease
- Class T: prior kidney transplant
An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.
See also
- Diabetes mellitus
- Gestational diabetes
- Pregnancy
Footnotes
- ^ a b "Pregnancy if You Have Diabetes | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2020-10-29.
- PMID 17596458.
- ^ "Home - Eastern Virginia Medical School (EVMS), Norfolk, Hampton Roads". www.evms.edu. Retrieved 2021-09-10.
- PMID 31454511.
- PMID 22213602.
- S2CID 11884127.
- PMID 16108452.
- ^ "First Trimester complications in pregnancy with diabetes". September 2016. Archived from the original on 2018-11-25. Retrieved 2018-11-06.
- ^ ISBN 978-1-884804-86-1.
- PMID 21684471.
- ^ ISBN 978-156924-436-4.
- ^ "Infant of Diabetic Mother". Children's Hospital of Philadelphia. 2014-08-24.
- ^ "Prenatal Care | ADA". www.diabetes.org. Retrieved 2020-10-29.
- ^ "Overview | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE". www.nice.org.uk. 2015-02-25. Retrieved 2024-01-31.
- ISSN 0028-4793. Archived from the originalon 19 October 2023.
- ^ "Closed-loop insulin systems are effective for pregnant women with type 1 diabetes". NIHR Evidence. 16 January 2024.
- ^ S2CID 26423226.
- ^ PMID 25074749.
- PMID 15396063.
- ISBN 0-443-06572-1