DR.-TAIWO-OREBAMJO
During the mid-20th century, women suffering from type 1 diabetes were generally advised not to become pregnant. Fortunately, advances in assisted reproductive technologies have transformed this situation.
Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra-large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large baby can lead to problems during delivery for both the mother and the baby.
Consult your doctor if you experience signs of elevated blood sugar levels, including heightened thirst, frequent urination, and a dry mouth—do not delay until your scheduled checkup. Even when feeling fine, continue getting tested because numerous individuals with diabetes might not exhibit any noticeable symptoms.
Preconception Testing
All women of reproductive age who have diabetes must receive guidance regarding the critical importance of maintaining strict blood sugar control before becoming pregnant. Research indicates that there is a heightened risk of diabetic embryopathies—such as anencephaly, microcephaly, congenital heart defects, and caudal regression—that increases proportionally with higher A1C levels during the initial ten weeks of gestation.
Hemoglobin A1C is a blood test indicating the average blood sugar levels over the past two to three months. During pregnancy, this test might be conducted quarterly or more often based on the healthcare provider’s recommendation.
Opportunities abound to inform all women and adolescent girls of childbearing age who have diabetes about the dangers of unintended pregnancies and the potential for better maternal and fetal outcomes through planned conception. Proper preconception counseling has the capacity to prevent significant health issues and related costs in their children. Discussions around family planning must take place, along with prescribing and using effective birth control methods until a woman feels fully prepared to conceive.
To reduce the occurrence of complications, starting from the onset of puberty or upon diagnosis, all women with diabetes who have the potential for childbearing should be educated about first, the risks of birth defects linked to unplanned pregnancies and inadequate glycemic control.
Secondly, consistent use of reliable birth control methods must be maintained to avoid unintended pregnancies. Providing preconception guidance with age-appropriate educational materials empowers young women to make informed choices. Adolescents ought to have access to these preconception support resources free of charge during their prenatal appointments.
Preconception Testing
Prenatal consultation appointments ought to encompass tests for rubella, syphilis, hepatitis B virus, and HIV, along with performing a Pap test, cervical cultures, blood type determination, prescribing prenatal vitamins (containing at least 400 μg of folic acid), and offering smoking cessation advice when necessary.
Testing specific to diabetes should encompass A1C levels, thyroid-stimulating hormone, creatinine, and urinary albumin-to-creatinine ratio; an evaluation of the medication list for drugs that may be harmful during pregnancy, such as ACE inhibitors, angiotensin receptor blockers, and statins; and a recommendation for a thorough eye examination. ACE inhibitors are medicines designed to ease blood vessels and arteries, thereby reducing blood pressure. These drugs are prescribed for managing hypertension and diabetes, conditions frequently seen in individuals with obesity. Both high blood pressure and diabetes, alongside obesity, elevate a pregnant woman’s risk of experiencing a miscarriage.
Pregnant women who have diabetic retinopathy from before will require careful monitoring throughout their pregnancy to make sure that the condition does not worsen.
Glycemic Targets In Pregnancy
In pregnant women with normal glucose metabolism, fasting blood glucose levels tend to be lower compared to the non-pregnant state because both the fetus and placenta absorb glucose without relying on insulin. However, after meals, these individuals often experience higher blood sugar levels and reduced tolerance to carbohydrates, which can be attributed to hormones produced by the placenta that have diabetic-like effects.
Insulin Physiology
In the initial stages of pregnancy, women with type 1 diabetes experience heightened sensitivity to insulin, reduced blood sugar levels, and decreased insulin needs. This changes quickly as insulin resistance rises sharply during the second and early part of the third trimester before stabilizing towards the end of the third trimester. Women whose pancreases work normally can produce enough insulin to cope with this natural increase in insulin resistance and keep their blood sugar within healthy ranges. However, without appropriate adjustments to their treatment regimen, those with gestational diabetes mellitus (GDM) or pre-existing diabetes may develop high blood sugar levels.
Glucose Monitoring
In line with these physiological considerations, it is advised to monitor blood glucose levels both before and after meals to attain optimal metabolic control in pregnant women who have diabetes. For those with pre-existing diabetes utilizing insulin pumps or basal-bolus regimens, pre-meal testing is suggested as well, allowing adjustments to their rapid-acting mealtime insulin dosages accordingly. Evidence indicates that postprandial monitoring correlates with improved glycemic management and reduced chances of developing preeclampsia. However, there haven’t been sufficiently large randomized studies conducted yet to definitively compare various fasting and post-prandial glycemic goals specifically within pregnancies complicated by diabetes.
Dr. Taiwo Orebamjo is a seasoned Consultant Obstetrician with expertise in medical administration, hailing from the Kingston Academy of Learning and Career College Canada. A graduate of the Royal College of Obstetricians and Gynaecologists in London, he currently serves as a Research Fellow specializing in assisted conception at St. George’s Teaching Hospital in Tooting, London. Additionally, Dr. Orebamjo holds positions as both the Consultant Obstetrician & Gynaecologist and Medical Director at Parklande Specialist Hospital and Lifeshore Fertility and IVF Clinic.
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