Planned Pregnancy with Diabetes

Dr. Mitalee Barman

Consultant Diabetologist 

• Women with diabetes face the risk of developing obstetric complications and diabetic complications as well as congenital defects in their babies.  They have to monitor blood glucose levels more frequently throughout their term and they often need more frequent interventions and visits to the doctor. 
• Women with diabetes also face the risk of having big babies. This happens when the blood sugar level of the mother is high and   the foetus gets too much sugar through the placenta. The baby's pancreas senses the high sugar levels and produces more insulin to use up all the extra sugar. That extra sugar is converted to fat and as a result the baby may become too large to be delivered normally and a Caesarean delivery becomes necessary.
• Sometimes babies of women with diabetes develop   dangerously low blood glucose levels as soon as they are born. This is because the uncontrolled levels of blood sugar of the mother during pregnancy and especially 24 hours before delivery makes the pancreas increase secretion of insulin in the baby to cope with the extra sugars. After delivery, when the source of sugar is suddenly taken away, the blood sugar levels drop.

Good blood sugar control means keeping blood glucose levels within the ideal range (70 to 100 mg/dL before meals, less than 120 mg/dL two hours after eating, and 100-140 mg/dL before the bedtime snack) by balancing meals, exercise, and diabetes medications.

So, a planned pregnancy is essential for women with diabetes as good sugar control before conception is vital as many women do not realize they are pregnant until they are well into two to four weeks of pregnancy. 

For healthy off- spring and a complication -free pregnancy 

1. Avoid pregnancy till HbA1c  is in good control (< 6.5 %)  because high blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects as the first 8 weeks of pregnancy are very important for  the baby’s physical development. There is also an increased risk of miscarriage and diabetes-related complications. 
2. Eat a well - balanced diet
3. Exercise and be active
4. Keep blood glucose at optimum levels
5. Get eyes and kidneys checked, 
6. Stop smoking and avoid alcohol.
7. Let your doctor know about your medications as some of them such as statin, ACE inhibitor or similar blood pressure medications should not be taken by pregnant women.

(Ref: Diabetes Balance)