Diabetes in pregnancy

Diabetes during pregnancy encompasses several conditions, including pre-existing type 1 and type 2 diabetes, as well as gestational diabetes. While gestational diabetes is a common concern, it's equally important to address how pre-existing diabetes affects pregnancy, the potential risks involved, and how proper management ensures the health of both mother and baby.

How does diabetes affect pregnancy?

Pregnancy places extra stress on the body, and for women with diabetes, managing blood sugar levels becomes even more critical. Uncontrolled blood sugar can lead to complications such as:

• Large baby (macrosomia): High glucose levels may cause the baby to grow larger than average, increasing the likelihood of delivery complications or the need for a Caesarean section.
• Congenital abnormalities: Pre-existing diabetes, if poorly controlled, increases the risk of abnormalities in the baby’s heart, spine, or kidneys.
• Preeclampsia: This pregnancy complication, marked by high blood pressure and organ damage, is more common in women with diabetes.
• Preterm birth: Poorly controlled diabetes increases the likelihood of premature delivery, which can lead to additional health challenges for the newborn.
• Low blood sugar (neonatal hypoglycaemia): Babies born to mothers with diabetes may experience low blood sugar levels shortly after birth.

Pre-existing diabetes in pregnancy: Key considerations

Women with type 1 or type 2 diabetes should receive pre-conception counselling and tightly manage blood sugar before and during pregnancy to reduce complications. Factors to consider include:

• Medication adjustments: Some diabetes medications, such as certain oral tablets, may not be safe during pregnancy and need to be replaced with insulin or other alternatives.
• Frequent monitoring: Blood glucose levels must be checked regularly to maintain a healthy range.
• Dietary guidance: A tailored meal plan designed by a dietitian can help manage carbohydrate intake without compromising the baby’s nutrition.
• Specialist care: Obstetricians, endocrinologists, and diabetes nurses work together to provide holistic care throughout the pregnancy.

Gestational diabetes: How is it different?

Gestational diabetes develops during pregnancy, typically in the second or third trimester. It occurs when hormonal changes cause insulin resistance. While it usually resolves after delivery, it carries risks for both the mother and baby, including:

• Increased risk of type 2 diabetes later in life for the mother.
• Higher likelihood of the child developing obesity or diabetes later in life.

Management strategies include regular exercise, dietary changes, blood glucose monitoring, and, if necessary, insulin therapy.

How can diabetes during pregnancy be managed effectively?

Proper management of diabetes in pregnancy is crucial for reducing risks. Key strategies include:

• Frequent antenatal visits: Regular appointments allow close monitoring of both mother and baby, including ultrasound scans and blood tests.
• Maintaining healthy blood sugar levels: Target ranges may be stricter during pregnancy to protect the baby. Continuous glucose monitoring (CGM) devices can help track levels.
• Folic acid supplementation: Higher doses of folic acid are often recommended to reduce the risk of neural tube defects.
• Delivery planning: A carefully devised plan for labour and delivery, including considerations for early delivery if complications arise.

Postpartum care: Why it’s essential

The care of women with diabetes doesn’t stop after delivery. Postpartum follow-up ensures both the mother and baby remain healthy. For women with gestational diabetes, a postnatal glucose tolerance test is essential to check for the resolution of diabetes.

Women with pre-existing diabetes may need adjustments to their medications and monitoring to prevent complications like hypoglycaemia while breastfeeding. Educating new mothers about managing their diabetes effectively helps ensure long-term health for both them and their child.

With expert medical care and vigilant self-management, women with diabetes can experience healthy pregnancies and deliver healthy babies.