Gynescope Specialist Hospital

DIABETES IN PREGNANCY

Diabetes is one of the commonest medical conditions that can affect pregnancy. Diabetes can be simply defined as a disease condition in which the level of blood sugar is too high. This poses a lot of problems for both the mother and the baby.

Diabetes in pregnancy can be classified as Type 1, Type 2 diabetes, and gestational diabetes mellitus (GDM). The first 2 classes develop before pregnancy while gestational diabetes mellitus develops only in pregnancy and goes away after the baby is born.

Incidence

Worldwide prevalence of diabetes in pregnancy is 3-7 per 1000 pregnancies. Of these 90% are GDM, 7% are previously diagnosed type 2 and 3% are type 1.

There is an increase in the incidence of diabetes among the populace. This may be linked to changes in lifestyle which have led to an increasing percentage of obese individuals. As such, women of child bearing age also have an increased tendency to develop diabetes.

Risk factors

There are several factors that can predispose a woman to developing diabetes in pregnancy. Some of these include

  • Polycystic ovarian syndrome
  • Previous diagnosis of gestational diabetes, or impaired glucose tests
  • Diabetes in a 1st degree relative
  • Maternal age; risk factor increases with increasing age, especially above 35 years
  • Hypertension or preeclampsia
  • Ethnicity; African American, Afro Carribean,Native American,Hispanics, pacific islanders, south Asians
  • Overweight and obese individuals
  • Previous poor obstetric history(unexplained stillbirth, recurrent miscarriages)
  • Smoking increases the risk by 2
  • Persistent finding of glucose in urine

Pathophysiology

The precise mechanism is unknown though the hallmark of diabetes in pregnancy is insulin resistance. Some hormones that are released in pregnancy have what is regarded as a diabetogenic effect. That is, they have the tendency to cause increased blood sugar levels. Some of these hormones include cortisol, progesterone, human placental lactogen among others. It is believed that these hormones interfere with the binding of insulin to its receptors. As such, the body cells cannot take up glucose adequately, causing increased blood sugar and leading to the production of more insulin.

The effects this has on pregnancy can be profound. Likely complications may include

  • Increased abortion rates
  • Congenital anomalies
  • Fetal weight >4kg
  • Unexplained fetal death
  • Growth restriction of the baby in the womb
  • Increased maternal infections such as candidiasis,urinary tract infections
  • Hypertension in pregnancy
  • The baby may be born with reduced blood sugar(hypoglycemia)

Screening

Apart from those who already had diabetes prior to pregnancy, all pregnant women ideally should be screened especially after the first 3 months of pregnancy. In those with risk factors for diabetes, this screening should be done earlier.

There are screening tests that your health provider will ask you to undergo.

According to the WHO, gestational diabetes should be diagnosed if a woman has a fasting blood sugar level of 5.6 mmol/l and above, or a 2 hour blood glucose level of 7.8mmol/l and above.

Note that this is somewhat different from diagnosing diabetes in the general populace.

MANAGEMENT

In women with type 1 and type 2 diabetes the best approach would be preventive. That is there should be adequate control of blood sugar levels before planning for a pregnancy

In ideal cases, the management of diabetes in pregnancy is multidisciplinary and does not depend on only the obstetrician. Other professionals work in tandem to bring forth a healthy baby and mother.

Treatment should be adjusted during pregnancy to meet the woman’s needs, and there should be proper surveillance of the baby

Labour and delivery should be supervised in a hospital with adequate facilities. Most women with diabetes can deliver vaginally except in cases where the baby is more than 4.5kg and the mother has other contraindications to vaginal delivery. In such cases an elective caesarean section should be planned.

The baby should also be properly examined for complications.

Conclusion

Although diabetes predisposes women to a high risk of complications, many diabetic mothers have healthy babies with the proper management.