Pregnancy is a transformative and often joyful period in a woman’s life. However, for women with diabetes, it presents unique challenges that require careful management and attention. Pregnancy with diabetes type 1 or type 2 diabetes, can be categorized as either pregestational diabetes (diabetes present before pregnancy) or gestational diabetes (diabetes that develops during pregnancy). Both forms require close monitoring to ensure the health of both the mother and the baby. 

 

Let’s understand the types of diabetes, before going into diabetes with pregnancy treatment

There are two main types of diabetes that can affect pregnancy: pregestational and gestational diabetes. Pregestational diabetes includes both type 1 and type 2 diabetes, which means that the woman had diabetes before becoming pregnant. Type 1 diabetes is an autoimmune condition where the pancreas produces little or no insulin, while type 2 diabetes is characterized by insulin resistance or insufficient insulin production. Women who plan on pregnancy need careful glucose control, optimal HbA1c levels below 6.5% to reduce fetal complications and multi-disciplinary medical management with their gynaecologist and physician.

Gestational diabetes, on the other hand, develops during pregnancy, typically in the second or third trimester. It occurs when the natural insulin resistance induced by the placenta of pregnancy to increase free blood glucose levels for the baby’s nutritional needs goes above a set limit resulting in high blood glucose levels and consequently, diabetes in the mother.  Gestational diabetes usually resolves after the baby is born, but it can increase the risk of developing type 2 diabetes later in life by 50% for the mother.

It is important that you talk to the best doctor for pregnancy in Mumbai, if are pregnant and have been informed of being diabetic.

 

 Why you might need pregnancy with diabetes treatment

 

Diabetes during pregnancy poses several risks for both the mother and the baby. Poorly controlled blood glucose levels in the first trimester in pre-gestational diabetes patients can lead to a higher rate of neural tube birth defects in the baby like anencephaly where the baby’s skull does not develop. This results in increased rate of terminations of such pregnancies and added physical and emotional stress on the mother. 

In the second trimester, uncontrolled blood sugars cause nervous system, heart and kidney anomalies in the unborn baby. These are often major anomalies, not compatible with a healthy outcome for the baby and can necessitate a termination of such pregnancies.

Uncontrolled diabetes in the mother can lead to macrosomia, a condition in which the baby grows too large. Sudden fetal death of such large macrosomic babies is also known to occur around the third trimester and is a major risk in all pregnancies complicated with diabetes.   Macrosomia can cause complications during delivery, such as shoulder dystocia, which occurs when the baby’s shoulders become stuck during birth. This leads to nerve injuries, paralysis of the hands and sometimes even early neonatal death. Babies born to mothers with diabetes are also at an increased risk of hypoglycemia (low blood sugar) shortly after birth, respiratory distress syndrome, and jaundice.

 

How to handle pregnancy with diabetes type 1 or type 2 – Points to ponder

 

Effective management of diabetes during pregnancy is crucial to minimize the risks to both the mother and the baby. The primary goal is to maintain blood glucose levels within the target range to avoid complications. This requires a combination of lifestyle changes, medical interventions, and regular monitoring.

 

1. Blood Glucose Monitoring: 

 

Regular blood glucose monitoring is essential for pregnant women with diabetes. This is called Self Monitoring of Blood Glucose or SMBG. The post prandial upper normal ranges for blood glucose levels in pregnancy are between 120-125 mg%  while those for fasting are between 90-95 mg% , which is lower than those of non-pregnant diabetic patients. By checking their blood sugar levels frequently, they can make informed decisions about diet, exercise, and medication to keep their levels within the desired range. Women with type 1 diabetes may need to check their blood sugar levels more frequently, while those with type 2 or gestational diabetes may need to do so less often, depending on their treatment plan.

 

2. Diet and Nutrition: 

A well-balanced diet, also called medical nutrition therapy (MNT) is the first line of treatment in diabetes in pregnancy. It plays a critical role in managing diabetes during pregnancy. Pregnant women with diabetes should work with a registered dietitian to create a meal plan that helps maintain stable blood sugar levels, understand what to eat with pregnancy diabetes and what not to eat. The diet should include a variety of nutrient-dense foods, such as whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables. It is also important to distribute carbohydrate intake evenly throughout the day to prevent spikes in blood sugar levels. While maintaining blood sugar levels is important, it is equally essential to ensure that these patients don’t end up in a caloric deficit and end up with fetal growth restriction. Due to this, working with a team that regularly communicates with the patient and with each other is essential for the treatment to succeed. 

Portion control is key for managing blood glucose levels, especially for women with gestational diabetes. Eating smaller, more frequent meals can help regulate blood sugar and reduce the risk of hyperglycemia (high blood sugar). Additionally, women should avoid foods high in added sugars and refined carbohydrates, as these can cause rapid increases in blood sugar levels.

 

3. Exercise

Physical activity and exercise is the other key component of MNT. It is extremely beneficial for managing diabetes during pregnancy, and it also helps reduce the requirement of insulin and other medicines to control blood sugar.  It helps improve insulin sensitivity and control blood sugar levels. Women with diabetes should aim for at least 30 minutes of moderate exercise most days of the week, unless otherwise advised by their healthcare provider. Walking, swimming, and prenatal yoga are all good options for pregnant women. Those used to resistance training from pre-pregnancy can also do mild to moderate weighted work-outs to help control the diabetes.

 

4. Medications and Insulin Therapy:

Some women with diabetes may need medication or insulin therapy to manage their blood sugar levels during pregnancy. For women with type 1 diabetes, insulin therapy is always required, while women with type 2 or gestational diabetes may need insulin or oral medications if lifestyle changes are not sufficient. Insulin is considered safe during pregnancy, and healthcare providers will work with the patient to determine the appropriate dosage based on blood glucose levels and the stage of pregnancy. The most common type of insulin during pregnancy is Rapid Acting Insulin and its dose is determined by the pre and post meal sugar levels throughout the day. Insulin requirements usually go up as pregnancy progresses and those on insulin require more frequent monitoring of sugar levels than others not on Insulin.

Oral drugs used is Metformin, usually in those patients diagnosed with Gestational Diabetes without a prior history of diabetes. Dose is determined by the glucose levels along with the BMI of the patient. Insulin may or may not be added to this regimen as pregnancy progresses.

 

5. Prenatal Care and Monitoring

Frequent prenatal visits are crucial for women with diabetes to monitor the health of both the mother and the baby. This will allow you to monitor any pregnancy risks with gestational diabetes and manage them properly.

Ultrasounds may be performed more frequently to monitor the baby’s development and detect any potential complications. As the risk of fetal macrosomia, increased liquor around the baby and sudden fetal death is present, more frequent monitoring and increased doctor visits are usually the norm.

In addition to regular prenatal care, women with diabetes may need specialized testing, such as fetal echocardiograms, to assess the baby’s heart health. Non-stress tests and biophysical profiles may also be conducted in the later stages of pregnancy to ensure that the baby is receiving adequate oxygen and nutrients.

 

Outcomes and Postpartum Considerations

With proper management, many women with diabetes can have healthy pregnancies and deliver healthy babies. However, the postpartum period also requires careful attention, especially for women with gestational diabetes, as they are at an increased risk of developing type 2 diabetes in the future.

 

1. Postpartum Blood Glucose Monitoring

Women with gestational diabetes should have their blood glucose levels checked shortly after delivery and again at a follow-up appointment, usually six to twelve weeks postpartum, to ensure that their levels have returned to normal. If blood sugar levels remain elevated, the woman may be diagnosed with type 2 diabetes and will need ongoing treatment.

 

2. Long-term Health Considerations

Women who have had gestational diabetes should adopt a healthy lifestyle to reduce their risk of developing type 2 diabetes in the future. This includes maintaining a balanced diet, engaging in regular physical activity, and keeping a healthy weight. Regular screening for type 2 diabetes is also important, as early detection can lead to better outcomes.

 

Conclusion

Pregnancy with diabetes presents unique challenges, but with proper management, most women can achieve healthy outcomes for themselves and their babies. By working closely with healthcare providers, pregnant women with diabetes can minimize the risks associated with the condition and enjoy a healthy pregnancy. The key to having a good outcome for mother and baby is to optimize blood sugar levels through good diet, plenty of exercise and regular monitoring of blood glucose levels to maintain them within optimal range. 

Here, at Tulsi Clinic, Dr Asavari Karani works with a team of dietician and pregnancy Lamaze specialists along with a pediatrician to ensure that your baby and you get the best possible result while requiring the least possible medical dosages of drugs to achieve physiologically controlled diabetes in pregnancy.