Before 5 decades, Women with Type 1 diabetes were advised not to have a baby. But these days the diabetes treatment as evolved so much that women can have a baby without complications if they plan well in advance and take proper care.
Though major improvements are made in treatments, the womb development doesn’t change.
According to gynaecologists the major organs like brain, spinal cord and heart are developed at an early stage during pregnancy, which is around 5 – 8 weeks after your last menstrual period. During this time most of the women are unaware about the fact that they are pregnant.
Symptoms
Women with gestational diabetes usually do not develop any symptoms or they are mild. The symptoms usually include abnormal blood glucose levels which include fatigue, feeling of thirty and increase frequency to urinate.
Risk factors
The risk factors for gestational diabetes include:
- Overweight
- Being prediabetic
- Have previously given birth to a baby that has weight more than 9 pounds
- Family member having type 2 diabetes
- Having gestational diabetes in previous pregnancies
Complications
There can be several complications. When the blood glucose levels spike up in the mother then more glucose gets delivered in the fetus which results in large size of the baby which is not a normal thing because that can lead to birth trauma for the mother. She would have to go for a caesarean delivery in such a case.
After the birth of the baby, it is at risk for having low blood glucose, jaundice and respiratory distress. There are also chances of obesity, diabetes and several other conditions to be developed in the baby.
If gestational diabetes is gone after the birth of the baby, there are still chances of type 2 diabetes that can occur later in life. So regular check-ups should be done.
Treatment
The foremost step that should be taken is to consult a dietician to see if there can be any changes made in the diet to control the risk of obesity by lowering down the blood glucose levels in the body and find out which exercise routine one needs to follow.
If this does not help in controlling the blood sugar levels then they will need to take medications to control it. In some cases there is a daily requirement of insulin to get their blood glucose under control. So one must consult a doctor for proper dosage and proper medication routine.
Preconception
During the early development, women should consult their doctors often because if A1C test number is 10% or higher there is a 1 in 5 chance of having a malformed baby.
It is very important to get your blood glucose in the target range before conceiving. But if your A1C is 6.5% or lower there are chances of having a baby with birth defects compared to a woman without diabetes.
No matter what your A1C is, it is advisable to take prenatal vitamins with folic acid to lower the risk of child’s birth defects.
During prepregnancy you should ensure your weight is within a healthy range as obesity can cause complications. You should get a thyroid test done because diabetic women have a higher risk of thyroid disorders.
If you have retinopathy, it is important to get your eyes re-checked every trimester as there are chances for retinopathy to worsen. Nephropathy which is diabetic kidney disease which has the chances to worsen so it is advisable to get screened for that before pregnancy.
You should make sure that your doctor has a lot of experience treating Type 1 diabetic pregnant women.
First trimester
Even if you are pregnant, you should not stop your diabetes medication unless it is changed by the doctor.
Even though they are not officially approved for use during pregnancy, but taking them does not cause any major malfunctions. If you stop it, it gets worse as your blood sugar levels will increase instantly.
According to ADA’s Standard of Medical Care, insulin is a foremost drug during pregnancy. It is safe as it does not cross the placenta. For Type 2 diabetes oral medications are not much useful so doctors switch to insulin even when the blood glucose levels are controlled.
You should always make changes to your insulin dosage to avoid risk of hypoglycaemia which is harmful to the baby’s brain.
According to the ADA, your fasting glucose level should be below 95 mg/dl, one hour after eating it should be 140 mg/dl and 2 hours after eating it should be 120 mg/dl. The notion of “eating for two” is not exactly true.
During the first trimester, you don’t need the extra calories. According to Gynaecologists, all diabetic women have a high risk of preeclampsia, but after 12 weeks if you take a baby aspirin daily than it lowers the risk.
Second trimester
In your second trimester, you stop getting morning sickness and you no more feel fatigue. You are able to eat a little more. In second and third trimester, you need to consume 300 extra calories but not more.
Now when you feel better, you will be able to move more so stay active which will help you to control your stress. Try to aim for 150 minutes of moderate exercise in a week. Do not do heavy lifting or exercises that have the risk of falling and increasing your temperature.
It is obvious you will gain more weight, but try not to gain more than 25-30 pounds to avoid obesity.
As the baby grows the insulin requirement will also increase because of hormones.
It is important to get an echocardiogram at 18 weeks to ensure the baby’s heart is fit. You should get a regular ultrasound and at 18-22 weeks get an anatomy scan done to get a detailed look at your baby’s parts.
Third trimester
At the beginning of 28 weeks, the doctor will suggest to get growth scans every 4 weeks. Diabetic women have a risk of having baby’s larger than the normal size so it is important to check the baby’s size.
Having baby larger than the normal size can complicate the vaginal delivery as the baby’s shoulder get stuck in the pelvis which forces for a C-section. Such babies have risk for heart diseases, stroke or Type 2 diabetes.
At 30-32 weeks, you need to start taking non-stress tests, twice a week.
Diabetic women are induced at 37-38 weeks which reduces the risk to the mother and the baby. It is strongly recommended not to go beyond 39 weeks.
Postpartum
After giving birth, paediatrician checks the baby for low blood glucose. If it is very loo a sugar solution is given to fix it.
Now your insulin needs decrease as the placenta is out which puts you at risk for hypoglycemia.
If you have a type 2 and you were not using insulin, you could switch back to oral medications, though some women stay on insulin for longer time.
It is recommended that you opt for breastfeeding as it lower down mother’s blood glucose and mothers with gestational diabetes have a lower risk of developing type 2 diabetes in the future. To prevent low levels you should check the level before breastfeeding and eating a snack if it’s not high.
It is very common to get postpartum depression in diabetic women. If you have thoughts of harming your baby or constantly feel sad and have mood swings, you should tell your doctor.
For diabetic women having a baby is lots of work compared to normal women but if you work you will get a good outcome from it. Working for getting a family is never a bad idea.
