Diabetes and Pregnancy

Pregnancy may be the time when women undergo screening for various common illnesses and may discover issues like diabetes and thyroid disorders that need serious consideration, keeping in mind the effect they have on both mother and child.

Why do I need to know about Diabetes ?

Upto 17%  pregnant women in India may have diabetes during their pregnancy (as per 2002 data).

Interaction between diabetes and pregnancy can be in two ways:

• somebody who is diabetic gets pregnant or
• somebody who is pregnant develops new onset diabetes (called as gestational diabetes).

What precaution is needed before planning pregnancy in a Diabetic Lady?

Diabetes affects formation of different body parts of the baby. Most of foetus’ organs take shape in first 12 weeks of pregnancy. So, it is prudent that diabetes is optimally controlled even before planning a pregnancy. 

Hence, it is important to screen for diabetes before planning for pregnancy. 

In case, patient is found to be diabetic, the target HbA1c ( blood test that tells us about the mean blood glucose in the last 3 months) should be as near to 6% as possible at time of conception.

Pregnancy can be a testing time for a woman. Some of the pre-existing complications of mother may get worsened during this time, so it is advisable to have a baseline check-up done before planning for pregnancy, for example : eye check-up & tests to assess your kidney functions. 

Even a pre-pregnancy dental examination and good dental hygiene would go a long way to keep your sugars under control while being pregnant, in case a pregnant lady is found to be a diabetic. 

What is gestational diabetes (GDM)?

Gestation is pertaining to prgenancy and gestational diabetes is a term reserved for diabetes detected first during pregnancy. Most of the pregnant ladies would be found to be positive for dibets screening in their second trimester (i.e. 4^th to 6^th month of pregnancy). 

Gestational diabetes usually happens in people who are already predisposed towards diabetes e.g. people with positive family history, with high BMI etc.

How common is GDM?

GDM is more common in India than in western countries. In India, 7-13 out of 100 pregnant women develop GDM.

What are the risk factors for Gestational Diabetes?

• Age >25 years (risk is even greater after age 35)
• Body weight: Especially BMI >30 kg/m²      (Which is a modifiable risk factor)
• Family history of diabetes
• Past history of GDM
• Past history of having delivered a baby weighing >4 kg

How would you know if you have gestational diabetes?

Gestational diabetes is generally a milder form of diabetes and one may not experience typical symptoms associated with diabetes (polyuria, weight loss, increased thirst etc.). So, SCREENING is our best tool to detect diabetes in pregnancy.

In cases of planned pregnancy, every woman should be tested for diabetes prior to conception and if it is an unplanned pregnancy, diabetes should be screened for at very first visit to doctor’s clinic post confirmation of pregnancy.

As GDM is detected in second trimester most of the times, an OGTT (oral glucose tolerance test) is recommended at 22-24 weeks of pregnancy.

Why should we care about diabetes in pregnancy?

Uncontrolled blood sugar levels may affect health of both mother and child.

Mother has higher chance of developing pregnancy-induced high blood pressure and pre-existing complications can worsen if mother had pre-existing diabetes.
 Baby has higher chances of having disordered growth. Baby may grow out to be a big baby and may necessitate caesarean section for delivery or its growth may be compromised leading to low birth weight.

Post Delivery also, the baby is at risk for developing low blood glucose (a potentially dangerous condition), prolonged jaundice and breathing difficulty.
 

How should I manage my pre-existing diabetes in Pregnancy?

For women with pre-existing diabetes, it is always advised that they should be shifted to Insulin well before planning pregnancy and their sugars should be stable at time of conception.

How should I manage my GDM?

Lifestyle modification in form of well-balanced healthy diet and regular exercise form the cornerstone of therapy in any form of diabetes including GDM. Selected women with mild disease may not require medications to control their diabetes, if they do diet control and exercise well ( within the limits and type that pregnancy allows e.g. brisk walking).

But, in majority of cases medications would be required to control blood sugars.

Insulin is preferred and safest medication to be used in pregnancy. Though, some selected cases can be managed with oral drugs like metformin.

Where should I seek help for my diabetes care in pregnancy?

Treating diabetes in a pregnancy requires highest professional qualifications and commitment. So, we strongly recommend that every pregnant women with diabetes should be under care of an endocrinologist to optimize the pregnancy outcome for both mother and child.

Contributed By:

Dr Rajiv Singla

Consultant Endocrinology

MD, DM - Endocrinology & Metabolism.

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