Diabetes In Pregnancy

Diabetes is a condition that causes high levels of sugar in the blood. Some women have diabetes before they become pregnant. Others develop it during pregnancy, a form called gestational diabetes.

If you develop diabetes during pregnancy, you may need to start a special diet. In some cases you may need to take insulin shots.

If you had diabetes before you became pregnant, it may be harder for you to control your sugar levels during pregnancy. You may need to change your insulin dosage. If you were not using insulin before the pregnancy, you may need to use it while you are pregnant.

If diabetes is not treated before and during pregnancy, these problems might occur:
            *birth defects if diabetes is not controlled in the 1^st trimester, such as problems with the heart, kidney, spine, or brain.
            *excessive amniotic fluid (hydramnios)
            *large size that may cause baby not to fit into the birth canal and
             result in a c-section
            *fetal death
            *poor control prior to birth can cause hypoglycemia (low blood sugar) in the baby
            *hyperbilirubinemia (too much bilirubin in the liver which is also known as
              jaundice)
            *hypocalcemia (too little blood calcium which interferes with how the heart will 
              beat)
            *You might have high blood pressure during the pregnancy (preeclampsia),
              which can cause problems for both you and the baby.
            *You might go into preterm labor (before 37 weeks of pregnancy), or the baby
              might need to be delivered early.
            *After delivery the baby may have trouble breathing because the lungs are not
             fully developed.

If you have proper treatment before and during your pregnancy, there is a good chance you will deliver a healthy baby.

How does it occur?

Insulin is a hormone produced by the pancreas. It helps your body change sugar to energy. Pregnancy hormones can change the way insulin works, so during pregnancy the pancreas needs to release more insulin than normal. If the pancreas cannot make enough insulin to control the sugar level, you become diabetic.

No one knows why some people develop diabetes and others do not. It may be a problem you can inherit from your parents. Women with the following histories or conditions are particularly at risk for developing diabetes during pregnancy:
            * a family history of diabetes
            * overweight, especially over 200 pounds
            * a previous baby that weighed more than 9 pounds (4000 grams) at birth
            * a previous baby born dead
            * a previous baby with birth defects
            * previous miscarriages
            * age over 35 years

What are the symptoms?

Symptoms of diabetes include:
            *genital itching
            *excessive thirst
            *weight loss
            *eating too much
            *urinating a lot
            *unexplained fatigue.
            *more frequent urinary tract infections and yeast infections

How is it diagnosed?

Urine checks for diabetes are done during prenatal visits. There is a blood test that involves you drinking a sugar drink in the office and then an hour later, having your blood drawn to test it for the amount of sugar present. This test is called a 1 hr Glucola Test. It is typically performed at 28 weeks pregnant but may be done earlier depending on your risk factors.

If the result of the first blood test is not normal, you will need to have a 3-hour glucose tolerance test. For this test, a sample of your blood is taken in the morning, when you have not eaten anything since the night before. Then you drink a sugar drink, and your blood is drawn at 1 hour, 2 hours and 3 hours.

How is it treated?

If you develop diabetes during pregnancy, you may be able to control your blood sugar level by:
            *checking your blood sugar level at home with a glucose meter 4 times a day.
            *following a special diet
            *getting regular, moderate exercise

If your blood sugars are not controlled with the above measures, you will need to begin taking medication as well. There is an oral medication in pill form that can help control the diabetes called Glyburide. Some women will have to use a shot called insulin to help manage the diabetes.

If you are a diabetic planning to become pregnant, you should discuss preparing for pregnancy with your health care provider. It is very important to have good control of your blood sugar before you become pregnant. While you are pregnant you may need extra care such as:
            *more frequent checks of your blood sugar at home
            *a change in your diet
            *frequent changes in your insulin dosage as your pregnancy progresses
           
More tests may be done during the later stages of your pregnancy to check the health of your baby. Examples of such tests are ultrasound scans, electronic fetal monitoring, and amniocentesis. With ultrasound, we can see if the baby is getting too big to deliver vaginally, check the amniotic sac and the development of the baby, measure the amount of amniotic fluid and also check to make sure baby's umbilical cord is pumping blood back and forth without difficulty. Electronic fetal monitoring checks the heartbeat and activity of your baby and contractions of your uterus. Amniocentesis can be used to check the maturity of the baby's lungs if the baby needs to be delivered before the due date.

When you are in labor, Dr. Hardy will watch your blood sugar closely and test it often. During labor you may need to have sugar water and insulin given IV (into your veins) to control your blood sugar level.

Gestational diabetes usually goes away within a few weeks after birth. To make sure, a special test will be ordered at your postpartum appointment. It is a 2 hr glucola test.

How long will the effects last?

Most women who develop diabetes during pregnancy are not diabetic after the baby is born. The body's need for insulin usually decreases after delivery because the balance of hormones returns to normal. However, you have a good chance of becoming diabetic later in your life. In fact, 15% to 20% of women who were diabetic during pregnancy become diabetic again within the first year after delivery. To decrease this risk of becoming diabetic, you may need to lose weight after the pregnancy. Also make sure your diet is healthy and that you get enough exercise.

If you were diabetic before pregnancy, you will probably return to your previous condition and treatment. However, complications of diabetes may worsen during pregnancy. If you did not have good control of your blood sugar before pregnancy, your baby has a higher risk of birth defects, or the baby might die before delivery.

If you became diabetic in one pregnancy, you are more likely to be diabetic in future pregnancies. You should be tested early for diabetes the next time you are pregnant.

How can I take care of myself?

            *Follow the diet, medication, and exercise program recommended by Dr. Hardy
             and the Nurse Practitioner.
            *Keep your blood sugar level under control. You will need to check your blood
             sugar level 4 times a day.
            *Always follow your prescribed treatment.
            *Keep all of your appointments

How can I help prevent diabetes or complications from diabetes during pregnancy?

Stay at a healthy weight. Beginning a pregnancy at a healthy weight puts less strain on your body. This takes long-range planning. "Crash diets" are always unwise, and any weight loss can be dangerous during pregnancy.

If you have diabetes not caused by pregnancy, you should keep your blood sugar in the normal range for 3 months before you become pregnant and continue this good control throughout the pregnancy. The critical time to prevent birth defects is the first 8 to 10 weeks of pregnancy. Many women do not even know they are pregnant at this early stage. If you have diabetes, you need to plan the pregnancy and discuss your health with your health care provider at every step along the way.