Diabetes During Pregnancy

Diabetes is a condition in which
the body can’t make enough insulin, or can’t use insulin normally. Insulin is a hormone.
It helps sugar (glucose) in the blood get into cells of the body to be used as fuel.
When glucose can’t enter the cells, it builds up in the blood. This leads to high
blood
sugar (hyperglycemia).

High blood sugar can cause problems
all over the body. It can damage blood vessels and nerves. It can harm the eyes,
kidneys, and heart. In early pregnancy, high blood sugar can lead to birth defects
in a
growing baby.

There are 3 types of diabetes:

  • Type 1 diabetes. This is an
    autoimmune disorder. The body’s immune system damages the cells in the pancreas
    that make insulin.
  • Type 2 diabetes. This is when the
    body can’t make enough insulin or use it normally. It’s not an autoimmune
    disease.
  • Gestational diabetes. This is a
    condition in which the blood glucose level goes up and other diabetic symptoms appear
    during pregnancy in a woman who hasn’t been diagnosed with diabetes before. It
    happens in about 3 in 100 to 9 in 100 pregnant women.

Some women have diabetes before
they get pregnant. This is called pregestational diabetes. Other women may get a type
of
diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy
can change how a woman’s body uses glucose. This can make diabetes worse, or lead
to
gestational diabetes. 

During pregnancy, an organ called
the placenta gives a growing baby nutrients and oxygen. The placenta also makes
hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental
lactogen can block insulin. When insulin is blocked, it’s called insulin resistance.
Glucose can’t go into the body’s cells. The glucose stays in the blood and makes the
blood sugar levels go up.

The risk factors for diabetes in
pregnancy depend on the type of diabetes:

  • Type 1 diabetes often occurs in
    children or young adults, but it can start at any age.
  • Overweight women are more likely to
    have type 2 diabetes. 
  • Overweight women are more likely to
    have gestational diabetes. It’s also more common in women who have had gestational
    diabetes before. And it’s more common in women who have a family member with type
    2
    diabetes. Women with twins or other multiples are also more likely to have it.  

There are no common symptoms of
diabetes. Most women don’t know they have it until they get tested. 

Nearly all nondiabetic pregnant
women are screened for gestational diabetes between 24 and 28 weeks of
pregnancy. A glucose screening test is given during this time. For the test, you drink
a
glucose drink and have your blood glucose levels tested after 2 hours.

If this test shows a high
blood glucose level, a 3-hour glucose tolerance test will be done. If results of the
second test are not normal, gestational diabetes is diagnosed.

Treatment will depend on your
symptoms, your age, and your general health. It will also depend on how severe the
condition is.

Treatment focuses on keeping blood
glucose levels in the normal range, and may include:

  • A careful diet with low amounts of
    carbohydrate foods and drinks
  • Exercise
  • Blood glucose monitoring
  • Insulin injections
  • Oral medicines for hypoglycemia 

Most complications happen in
women who already have diabetes before they get pregnant. Possible complications
include:

  • Need for insulin injections more
    often
  • Very low blood glucose levels, which
    can be life-threatening if untreated
  • Ketoacidosis from high levels of blood
    glucose, which may also be life-threatening if untreated

Women with gestational diabetes are
more likely to develop type 2 diabetes in later life. They are also more likely to
have
gestational diabetes with another pregnancy.  If you have gestational diabetes you
should get tested a few months after your baby is born and every 3 years after
that. 

Possible complications for the baby
include:

  • Stillbirth (fetal death). Stillbirth
    is more likely in pregnant women with diabetes. The baby may grow slowly in the
    uterus due to poor circulation or other conditions, such as high blood pressure
    or damaged small blood vessels. The exact reason stillbirths happen with diabetes
    is not known. The risk of stillbirth goes up in women with poor blood glucose control
    and with blood vessel changes.
  • Birth defects. Birth defects are more
    likely in babies of diabetic mothers. Some birth defects are serious enough to
    cause stillbirth. Birth defects usually occur in the first trimester of pregnancy.
    Babies of diabetic mothers may have major birth defects in the heart and blood
    vessels, brain and spine, urinary system and kidneys, and digestive system.
  • Macrosomia. This is the term for a
    baby that is much larger than normal. All of the nutrients the baby gets come
    directly from the mother’s blood. If the mother’s blood has too much sugar, the
    pancreas of the baby makes more insulin to use this glucose. This causes fat to form
    and the baby grows very large.   
  • Birth injury. Birth injury may occur
    due to the baby’s large size and difficulty being born.
  • Hypoglycemia. The baby may have low
    levels of blood glucose right after delivery. This problem occurs if the mother’s
    blood glucose levels have been high for a long time. This leads to a lot of insulin
    in the baby’s blood. After delivery, the baby continues to have a high insulin level,
    but no longer has the glucose from the mother. This causes the newborn’s blood
    glucose level to get very low. The baby’s blood glucose level is checked after birth.
    If the level is too low, the baby may need glucose in an IV.
  • Trouble breathing (respiratory
    distress).
     Too much insulin or too much glucose in a baby’s system may keep
    the lungs from growing fully. This can cause breathing problems in babies. This is
    more likely in babies born before 37 weeks of pregnancy.

  • Preeclampsia.
    Women with type 1 or type 2 diabetes are at increased
    risk for preeclampsia during pregnancy. To lower the risk, they should take low-dose
    aspirin (60 mg to150 mg a day) from the end of the first trimester until the baby
    is
    born .

Not all types of diabetes can be
prevented. Type 1 diabetes often starts when a person is young. Type 2 diabetes may
be
prevented by losing weight. Healthy food choices and exercise can also help prevent
type
2 diabetes.

Special testing and monitoring of
the baby may be needed for pregnant diabetics, especially those who are taking insulin.
This is because of the increased risk for stillbirth. These tests may
include:         

  • Fetal movement counting. This means
    counting the number of movements or kicks in a certain period of time, and watching
    for a change in activity.
  • Ultrasound. This is an imaging test
    that uses sound waves and a computer to create images of blood vessels, tissues, and
    organs. Ultrasounds are used to view internal organs as they function, and to look
    at
    blood flow through blood vessels.
  • Nonstress testing. This is a test
    that measures the baby’s heart rate in response to movements.
  • Biophysical profile. This is a
    measure that combines tests such as the nonstress test and ultrasound to check the
    baby’s movements, heart rate, and amniotic fluid.
  • Doppler flow studies. This is a type
    of ultrasound that uses sound waves to measure blood flow.

A baby of a diabetic mother may be
delivered vaginally or by cesarean section. It will depend on your health, and how
much
your pregnancy care provider thinks the baby weighs. Your pregnancy care provider
may
advise a test called amniocentesis in the last weeks of pregnancy. This test takes
out
some of the fluid from the bag of waters. Testing the fluid can tell if the baby’s
lungs
are mature. The lungs mature more slowly in babies whose mothers have diabetes. If
the
lungs are mature, the healthcare provider may advise induced labor or a cesarean section
delivery.

  • Diabetes is a condition in which the
    body can’t produce enough insulin, or it can’t use it normally.
  • There are 3 types of diabetes: type 1,
    type 2, and gestational diabetes.
  • Nearly all pregnant women without
    diabetes are screened for gestational diabetes between 24 and 28 weeks of
    pregnancy.
  • Treatment for diabetes focuses on
    keeping blood sugar levels in the normal range.
  • Women with gestational diabetes are
    more likely to develop type 2 diabetes in later life. Follow-up testing is
    important.

Tips to help you get the most from
a visit to your healthcare provider:

  • Know the reason for your visit and
    what you want to happen.
  • Before your visit, write down
    questions you want answered.
  • Bring someone with you to help you ask
    questions and remember what your provider tells you.
  • At the visit, write down the name of a
    new diagnosis, and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you.
  • Know why a new medicine or treatment
    is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated
    in other ways.
  • Know why a test or procedure is
    recommended and what the results could mean.
  • Know what to expect if you do not take
    the medicine or have the test or procedure.
  • If you have a follow-up appointment,
    write down the date, time, and purpose for that visit.
  • Know how you can contact your provider
    if you have questions.