Research Canadian Health Care Mall: Pregnancy
CanadianHealthCareMalll took a little research and a survey, which examined some issues related to pregnancy. Let us look at what happened in the end!
Modern antenatal care is usually shared between the diabetes specialist and the obstetrician, preferably at a joint clinic. Admission to hospital is rarely necessary as long as the pregnancy progresses normally and control remains good, in which case the pregnancy should continue close to its natural term. Any antenatal complications will be treated in the same way as they would be in women without diabetes. Once spontaneous labour begins, the only difference from the normal process is the need to keep the mother’s blood glucose normal to prevent hypoglycaemia in the baby after delivery. Although the aim should always be for a normal delivery, mothers with diabetes do have a higher chance of needing a Caesarean section, particularly if the baby is large or needs to be delivered early.
Most women are able to make the great effort required to keep tight control during pregnancy but it is very difficult to keep this up once they are faced with the demands of a new baby and the need to avoid hypoglycaemia.
Avery comprehensive pregnancy magazine is available from Diabetes UK.
PREGNANCY
The man I am going to marry has Type 2 diabetes. Will any children we may have be at risk of diabetes?
Type 2 diabetes certainly runs in families and your children would be at risk of developing this later in life. Although this type of diabetes generally occurs in adults, you may have seen publicity about Type 2 diabetes affecting children. This is most likely to occur if the child is overweight and you can reduce the risk by encouraging healthy eating and an active lifestyle.
There is a rare form of Type 2 diabetes in which there is a strong hereditary tendency. This is called maturity onset diabetes of the young, commonly known as MODY. Were you or your fiance to have this, the risk of your children getting diabetes of this unusual kind would be rather high. It is often a relatively mild form of diabetes and runs true to type throughout the generations.
The study of inheritance of diabetes is a complicated subject and you would be well advised to discuss this further with your specialist or a professional genetic counsellor.
I am 29 years old and have Type 2 diabetes. My husband and I plan to start a family but first I would like to complete a three-year degree course at university. By the time this finishes I will be 32. Can you tell me if I shall then be too old to have a baby?
There is a trend nowadays for women to delay starting a family until they are well into their thirties. Thirty-two is not too old to have a child but if you have diabetes, there are some advantages in having children earlier rather than later. The main reason for this is that the longer you have had diabetes, the greater the risk of developing complications, which may have a significant effect on the pregnancy.
Having said this, many women with diabetes have successful pregnancies in their thirties and even forties. It is difficult to give exact personal advice to individual people and the right person to talk to is your family doctor or diabetes specialist, who will know both you and your diabetes.
I am worried that, if I become pregnant while my husband’s diabetes is uncontrolled, the child will suffer – am I right?
No. There is no known way in which poor control of your husband’s diabetes can affect the development of your child.
I have diabetes treated by tablets, which I chose to take rather than insulin, and I want to become pregnant. I have had a previous miscarriage and am worried about the chance of this happening again. Both my husband and I smoke and enjoy the occasional glass of wine. How can I make sure that this pregnancy is successful?
The control of your diabetes will certainly affect the outcome of your pregnancy – better control leads to more a successful pregnancy. As you are planning your pregnancy, you can make sure that you establish good control before conception. Your control is probably best maintained either by diet alone or, if this fails, by diet with insulin. Until recently, we did not advise women to take tablets for diabetes but there is now evidence to suggest that metformin is safe and does not affect the baby. So if you are taking metformin you can continue to take it but none of the other tablets used to treat type 2 diabetes are regarded as safe during pregnancy. If your diabetes can be controlled by metformin alone, that is fine, but you will need to stop any other tablets and that could mean that you need to change to insulin. You should discuss this with your doctor or nurse. As pregnancy progresses, an increasing amount of insulin is required to keep the blood glucose normal and even if you have been well controlled on metformin in the past, it is likely that insulin injections will be necessary at some stage. The most important thing is to make sure your diabetes is well controlled before you become pregnant and if your HbA1c is above 6.5% on metformin you should consider starting insulin.
You obviously know already that smoking affects the baby and that heavy smoking is associated with more miscarriages and smaller babies. We suspect that you already know the answers to your question – you need to take insulin and give up smoking.
There is also more recent evidence to link even modest regular alcohol intake in pregnancy with an unfavourable outcome as far as the baby is concerned, so we suggest that you should stop drinking alcohol until the pregnancy is over.
Why must I ensure that my diabetes control is perfect during pregnancy?
This is to ensure that you reduce the risks to yourself and your baby to an absolute minimum. If you are able to achieve this degree of control from before the time of conception through to the time of delivery, the risks to your baby are only slightly greater than those for babies born to women without diabetes. On the other hand, if your diabetes is poorly controlled, the risk to your baby increases dramatically.
I have Type 2 diabetes and am thinking of a pregnancy in the next year or so. I read recently that women with Type 2 diabetes have an increased risk of abnormal babies and stillbirths. Is this true?
We have known for a long time that babies of women with Type 1 diabetes had an increased risk of congenital abnormalities and of stillbirth. A lot of work has gone into trying to prevent these complications by ensuring excellent blood sugar control during the pregnancy and monitoring the baby closely to determine the optimum time for delivery. In the past it was unusual for women to develop Type 2 diabetes before the age of 40 and so pregnancy was not common in this group. We are now seeing Type 2 diabetes in a much younger age group, including school children, and it is no longer unusual for women with Type 2 diabetes to become pregnant. A recent audit of pregnancy in England, Wales and Northern Ireland (CEMACH, see the introduction to this chapter) has found that the risks to the babies of women with Type 2 diabetes are exactly the same as those for Type 1. It is therefore just as important for women with Type 2 diabetes to make sure that their diabetes is very well controlled before they conceive.
You should discuss your plans for a pregnancy with your doctor as it may be necessary to change your diabetes treatment from tablets to insulin before you become pregnant. You will need to ensure that your diabetes is very well controlled and if you are taking any tablets for blood pressure or cholesterol these will need to be stopped. Provided good control is achieved there is no reason why you should not have a successful pregnancy.
I have diabetes and would like a pregnancy soon. I have heard that women who are planning a pregnancy should take tablets called folic acid. What are these for and should I take them?
Folic acid is a naturally occurring vitamin which is present in many foods. There is good evidence that if women take extra folic acid in the early stages of pregnancy, the risk of abnormalities of the nervous system, such as spina bifida, are reduced. For women without diabetes the recommended dose is 400 pg, but women with diabetes, who are at higher risk of having a baby with an abnormality, are advised to take the higher dose of 5 mg. Your doctor will be able to prescribe this for you.
PREGNANCY MANAGEMENT
I am married to a man who takes insulin to control his diabetes. I have just become pregnant, so what special things do I need to do during pregnancy to ensure that it goes smoothly and without complications?
You need take no special precautions other than those taken by all pregnant women, as the fact that your husband has diabetes does not put your pregnancy at any particular risk. It is only when the mother has diabetes that strict control and careful monitoring of blood glucose become essential.
When I was seven months pregnant, I developed diabetes. I had 8 units of insulin a day. After my baby was born, the tests were normal and I stopped taking insulin. I would now like another baby. My CP says I could develop permanent diabetes but another doctor has told me that this is very unlikely – please could you advise me?
You have had gestational diabetes (diabetes developing during pregnancy). This usually goes away when the pregnancy ends but it is very likely that diabetes will occur again in any future pregnancy. It is possible that diabetes may persist after a subsequent pregnancy, leaving you with permanent diabetes. Even if you do not have any further pregnancies, you are at high risk (greater than 1 in 2) of developing Type 2 diabetes in the future. This is because although your pancreas can produce enough insulin to cope with everyday life, its reserves are low. The extra demands of pregnancy are more than it can manage, hence the need for insulin injections and the increased risk of running out of insulin in the future. If you want to avoid diabetes in later life, you should pay particular attention to your diet and fitness, and keep your weight down to the ideal weight for your height.
Is it all right for me to breastfeed my baby if my blood glucose is too high?
All women are encouraged to breastfeed as breast milk provides their babies with the best possible nutrition and protection against infection. There is no reason why diabetes should prevent you from breastfeeding and your baby will not be harmed in any way if your blood glucose is high. However, persistently high sugar levels may cause you to become dehydrated, which can reduce milk production. For the best results with breastfeeding, keep up a high fluid intake and try to keep a check on your blood glucose to make sure it is neither very high nor very low. It is probably best to relax your diabetes control a little to make sure that you avoid hypos as it can be very difficult to cope with a new baby if you are constantly hypo.
Breastfeeding takes a lot of energy in terms of nutritional requirements, so try to make sure that you eat regular amounts of carbohydrate. You will probably find that you need to increase your calorie intake and take less than your usual pre-pregnancy dose of insulin. Do not try to breastfeed while having a hypo: feed yourself first, so that you can feed and look after your baby safely. Always seek medical advice if you are in any doubt. If you find breastfeeding too difficult, it is perfectly all right to bottle-feed.
