Pregnant women with diabetes

Previously, pregnant women with diabetes, which was poorly controlled in the early weeks of pregnancy, were three to four times more likely than non-diabetic women to have a baby that developed problems, such as a heart defect or neural tube defect (NTD), a birth defect of the brain or spinal cord. They also were at increased risk of miscarriage and stillbirth. The key word here is control. The vast majority of pregnant women with diabetes can look forward to having a healthy baby. While diabetes poses some risks in pregnancy, advances in care has greatly improved the outlook for pregnant women with diabetes. Studies show that excellent blood sugar control in pregnant women with diabetes, both before and during pregnancy, significantly reduces the risks and complications.

It is estimated that there is somewhere in the region of 1 in 200 women of childbearing age, who have diabetes - known as pre-existing diabetes. Another 2 to 5% develop diabetes during pregnancy - known as gestational diabetes. Pregnant women with diabetes of the pre-existing form should consult their doctors before pregnancy to ensure that their blood sugar levels are well controlled. This is important because the most serious birth defects associated with pregnant women with diabetes originate in the early weeks of pregnancy, before a woman may realise she is even pregnant.

Women with pre-existing diabetes are at increased risk of having a baby with an NTD, so taking folic acid may be especially crucial for them. A recent review found that pregnant women with diabetes taking a daily multivitamin supplement before and during early pregnancy, appeared to reduce the risk of birth defects in babies of women with pre-existing diabetes. Also, pregnant women with diabetes of the pre-existing type, who take oral medications to control their blood sugar levels, would probably need to switch to insulin before conceiving and during pregnancy because of uncertainty over their safety, especially in the early weeks. Gestational diabetes in pregnant women with diabetes, is one of the most common pregnancy complications. It usually develops during the second half of pregnancy, when hormones or other factors interfere with the body’s ability to use its insulin. Once gestational diabetes is diagnosed, most women can control their blood sugar levels with diet and exercise.

A pregnant woman with diabetes of either form, ie, pre-existing or gestational, should follow a diet designed especially for her. The number of calories a pregnant woman with diabetes should eat and the proportion of foods from the various food groups (i.e., fat, carbohydrates, proteins, dairy, fruits and vegetables) depends upon many factors, including weight during pregnancy, stage of pregnancy and baby’s rate of growth. Whilst exercise may be beneficial for the vast majority, pregnant women with diabetes which is poorly controlled or have certain other complications, such as high blood pressure or blood vessel damage (caused by pre-existing diabetes), should exercise only upon the advice of their health care provider.