Before the discovery of insulin, the chances of having a baby with diabetes was really slim, but thanks to Banting and Best, the discovers of insulin, this century has seen better outcomes for mothers living with diabetes and their children. In Nigeria 1.7 percent of pregnant women have diabetes out of which 61 percent is gestational diabetes.
Pregnancy in itself is a diabetogenic state i.e pregnancy raises blood sugar levels in normal conditions . Diabetes may complicate pregnancy because a woman had diabetes before pregnancy (pregestational diabetes which can be type 1 or type 2)or she developed diabetes during the course of her pregnancy (gestational diabetes). Gestational diabetes usually resolves few weeks after the baby is born. However, in about 60-70 percent of women, there is a recurrence in subsequent pregnancy.
The body is more resistant to insulin during pregnancy to allow more glucose available to sustain the growth of the baby. This makes the body require more insulin production. In people with gestational diabetes, the pancreas can’t keep up with the production of insulin required and so the blood has excess glucose.
The main effects of diabetes in pregnancy is that it increases the risk of miscarriages in early pregnancy it increased risk of babies with congenital malformations e.g with cardiac problems . This is in people with poorly controlled diabetes. It is not uncommon to see people with diabetes developing hypertension and infections in pregnancy.
Too much glucose gets into the baby’s blood and causes accelerated growth of organs especially in the middle and late stages of pregnancy. This results in big babies, too big to enter the birth canal and can cause the baby’s shoulder to be stuck (shoulder dystocia) making caesarean section necessary in some cases.
Shortly after birth, your baby may have low blood sugar (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose.
The baby is at risk of hypoglycemia immediately after birth because the baby was used to having excessive insulin action while in the womb. It is recommended that the mothers breast feed their babies shortly after birth to help reduce this.
There is also a a higher risk of having breathing problems because the lungs do not mature well enough and the baby might have neonatal jaundice.
Who should be more concerned?
Women above 35 years
People whose immediate relatives have diabetes
People who have had big babies (4.5kg and above) in the past.
People who weigh beyond 90kg or have a BMI above 30.
People who have had stillbirths without a known cause.
People who have had babies with birth defects
People with polycystic ovarian syndrome.
What to do?
Mums-to-be need to check their sugar levels early in pregnancy during their first trimester.
A woman with diabetes or impaired blood sugar levels should consult with a doctor- both an obstetrician and a physician- even before the start of pregnancy. A dietician also plays a role of helping to maintain a healthy diet.
A diet of someone with gestational diabetes should be between 1500-2000 calories and there should be good combination of carbohydrates with protein and fats. An HbA1c of between 4-6 is the usual target.
It is also important to take folic acid (5mg) before aiming at pregnancy for people at risk.
People living with diabetes before pregnancy would need to really monitor their sugar levels closely has pregnancy can alter their feeding patterns and they might require higher levels of insulin.
A woman who has had diabetes in previous pregnancy is advised to have yearly medical checks as she’s at risk of developing type 2 diabetes in the future.
The pre-pregnancy states are very important. A woman with good glycemic control before pregnancy is more likely to have a better outcome.