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)

Making Lifestyle Changes for Better Health…

Changing old lifestyle habits related to one’s diet and physical activity is not an easy task and it gets harder if there are lots of changes to be made.

The best way to achieve one’s goal of reducing weight and preventing Type 2 diabetes is by making the change one step at a time.

Get Started

1. Find out how focussed you are by asking yourself if you are willing to change your habits.

2. Find out what lifestyle changes you need to make. The changes must be important enough to motivate you. Break them up into smaller steps.

3. Choose a few areas for improvement that are easy to do, you want to do the most, and that will make the biggest impact.

4. Make your goals SMART

Specific - Your goal must be clear and well defined. Vague or generalized goals are not helpful.

Measurable - Include precise amounts, dates, and so on in your goals so you can measure your degree of success.

Attainable - Make sure that it's possible to achieve the goals you set.

Relevant - Goals should be relevant to your requirement. This will help you to develop the focus you need.

Time Bound - Your goals must have a deadline.

For example

1. Setting diet related goals : 

How long?… For the next month

How often?... four days each week

Realistic and Specific?… I will eat two pieces of fruit a day — one at breakfast and one as an afternoon snack. 

2. Setting activity  related goals: 

How long?... For the next month

How often?... four days each week 

Realistic and specific?... I will take a 15  a minute- walk after lunch 

5. Pin up your goals where you will see them often and practice them.

6. At the end of the specified period see if you were successful.

If you weren't successful, try again. Revise your goals or choose easier ones.

Were you successful? CONGRATULATIONS! Now choose some new goals to work on.

A Healthy Habit: Read Food Labels

Shelves in the supermarket are stocked with a variety of ready to eat, instant or processed foods and in today’s fast paced life there are choices that we make because we just don’t have the time or the energy to start from scratch. For instance most people buy packaged wheat flour and choosing a good brand is a dilemma, as there are so many available, each one professing to offer the best! Most processed foods and instant foods come with nutrition fact labels. Learning how to interpret food labels can help educate people with or without diabetes about how to make better food choices for better health.

Food labels provide a lot of information.  Understanding the information   that food labels provide allows people to compare foods, make better choices, and understand serving sizes in relation to carbohydrate content.

The Serving Size

The first place to start when you look at the Nutrition Facts label is the serving size and the number of servings in the package. Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams.

Calories 

Calories provide a measure of how much energy you get from a serving of this food. The calorie section of the label can help you manage your weight .

Total carbohydrate tells us how many grams of carbs there are in a serving. It includes sugar, complex carbohydrate and fibre. Do not concentrate only on sugar content as you may miss out on foods that are naturally high in sugar but also have other necessary nutrients.

The value under sugar shows the amount of natural or added sugar.

Avoid unhealthy ingredients such as hydrogenated or partially hydrogenated oil and refined sugar. Look for foods with less fat, sugar and salt.

However, there are some facts one must be aware of in order to choose wisely.
Sometimes sugar, salt and fats come under different names

 Did you know?

   ‘Sugar free’ does not mean ‘Carbohydrate free’

   ‘No added sugar’ does not mean ‘no carbohydrate’

READ FOOD LABELS CAREFULLY.