Diabetes

High-Risk Pregnancy - Diabetes

What is diabetes?

Diabetes is a condition where sufficient amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel. When glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.

What are the different types of diabetes?

There are three basic types of diabetes including:

Diabetes is a serious disease, which, if not controlled, can be life threatening. It is often associated with long-term complications that can affect every system and part of the body. Diabetes can, among other things, contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage.

What happens with diabetes and pregnancy?

During pregnancy, the placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. In early pregnancy, hormones can cause increased insulin secretion and decreased glucose produced by the liver, which can lead to hypoglycemia (low blood glucose levels). In later pregnancy, some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, a condition called insulin resistance.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results or there may be worsening of pregestational diabetes.

Why is diabetes a concern in pregnancy?

Diabetes in pregnancy can have serious consequences for the mother and the growing fetus. The severity of problems often depends on the degree of the mother's diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control. Diabetes that occurs in pregnancy is often listed according to White's classification:

It is very important for a mother to maintain very close control of her diabetes during pregnancy. Generally, the poorer the control of blood glucose and the more severe the disease and complications, the greater the risks for the pregnancy.

Maternal complications of diabetes on a pregnancy

Complications for the mother depend on the degree of insulin need, the severity of complications associated with diabetes, and control of blood glucose.

Most complications occur in women with pregestational diabetes and are more likely when there is poor control of blood glucose. Women may require more frequent insulin injections. They may have very low blood glucose levels, which can be life threatening if untreated, or they may have ketoacidosis, a condition that results from high levels of blood glucose. Ketoacidosis may also be life threatening if untreated. It is not clear whether pregnancy worsens diabetic related blood vessel damage and retinal changes, or if it causes changes in kidney function.

Complications for fetus and baby

Infants of mothers with diabetes are at greater risk for several problems, especially if blood glucose levels are not carefully controlled, including the following:

How is diabetes diagnosed?

Women with diabetes before pregnancy have already been diagnosed. Depending on the severity of their disease, they may need continued care by their medical physician along with their obstetrician.

Nearly all non-diabetic pregnant women are screened for gestational diabetes between 24 and 28 weeks of pregnancy. In addition to a complete medical history and physical examination, a glucose screening test is given, which involves drinking a special glucose drink followed by measurement of glucose levels after a one-hour interval.

If this test shows an increased blood sugar level, a three-hour glucose tolerance test will be performed after a few days of following a special diet.

If results of the second test are in the abnormal range, gestational diabetes is diagnosed.

Treatment for diabetes

Specific treatment for diabetes will be determined by your physician based on:

Treatment for diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

Managing diabetes during the pregnancy

Special fetal testing and monitoring may be needed for pregnant diabetics, especially those who are taking insulin (because of the increased risks for stillbirth). These tests can include the following:

Infants of diabetic mothers may be delivered vaginally or by cesarean, depending on the estimated fetal weight and the mother's health. Because infants of diabetic mothers tend to be large compared to fetuses of the same gestational period, they may need to be delivered a few weeks early. This can often help prevent difficulties in labor and birth that can happen when a baby is very large. An amniocentesis may be performed in the last few weeks of pregnancy to check the amniotic fluid for fetal lung maturity. If the lungs are mature, some mothers may have labor induced or a cesarean delivery.

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