Before discovery of some drugs for diabetes, women with diabetes mellitus were at very high risk of complications during pregnancy. Today, most women with diabetes can have a safe pregnancy and delivery, similar to that of non-diabetic women. This improvement is largely due to good blood glucose (sugar) control, which requires adherence to diet, frequent daily blood glucose monitoring, and timely diabetes medicine adjustment.
Glucose in the mother’s blood crosses the placenta to provide energy for the baby; thus, high blood glucose levels in the mother lead to high blood glucose levels in the developing baby as well.
Women with poorly controlled high blood sugar levels are more likely to have problems during pregnancy and child birth, but the risk of developing these problems is greatly minimised to as much as non-diabetic pregnant mothers with proper diabetes control.
Early on, high blood sugar levels can increase the chance that a woman has a miscarriage. A miscarriage is when a pregnancy ends on its own. High blood sugar levels early on can also increase the chance that a baby will be born with a birth defect, such as a spine or heart problem.
Later on, high blood sugar levels can increase the chance that a baby gets too big and that is a problem, because a big baby can get hurt if it cannot easily fit through birth canal. A big baby can also damage its mother’s body during a normal delivery. Sometimes, the mother has to have a c-section (surgery to get the baby out).
A diabetic pregnant mother may need monitoring and follow up by different doctors, depending on the availability of these doctors and their expertise in diabetes control. One doctor might take care of your pregnancy although this doctor might also be able to take care of your diabetes. If not, one will see a diabetes doctor during pregnancy.
The doctor will advise on how the blood sugar levels should be and how often to check them – Many women need to check their blood sugar levels every day before and after meals, and the doctor will help in making changes to one’s diet and medicines so that one’s blood sugar levels stay under control.
Even for women who were already on management for diabetes before they became pregnant need to seek medical care once they are pregnant. This is because; women who take insulin might need more insulin during pregnancy, some diabetes pills are not safe to take during pregnancy. Women who take these pills might need to start using insulin or take a different pill during pregnancy. Your doctor will advise on which medicine is right for you, and women who don’t already take medicine for their diabetes might need to start taking a diabetes medicine during pregnancy.
Pregnancy can also affect the effects of diabetes on one’s health in various ways, and hence diabetes needs more close observation and monitoring to prevent worsening of diabetes and diabetes associated complications during pregnancy. Sometimes, pregnancy worsens the eye and kidney problems that people with diabetes can get. Pregnancy can also make high blood pressure worse. Your doctor will check you for these problems by; doing blood and urine tests to check your kidneys, doing eye exams and checking your blood pressure at each visit
Once diabetes has been managed well throughout one’s pregnancy, chances are good that you will have a normal pregnancy, delivery and that one’s baby will be healthy.
It is important that your baby’s doctor keeps a close eye on your baby after birth. That’s because babies whose mothers have diabetes can have problems, including low blood sugar or breathing problems in the first hours of life which might need intervention, although most of these problems go away on their own within 1 to 2 days.
Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital