There is no reason for diabetic women to dread pregnancy and avoid it. She, however, needs meticulous attention and care by the physicians, specialists and dietitians. Patients’ cooperation in following regulations and restrictions go a long way in making pregnancy absolutely normal.
Pregnancy, in diabetic women, carries slightly greater risk than in normal women. During the later stages of pregnancy, problems like high blood pressure, oedema, excessive accumulation of amniotic fluid may further complicate the diabetic condition. Moreover, chances of miscarriage and still-birth are greater for the diabetic mother than the normal one. It is always advisable to control diabetes before pregnancy to minimise the severity of complications.
Pregnant diabetics can be grouped into two classes:
(a) Gestational diabetics
(b) Known or identified diabetics
Gestational Diabetics
At times, diabetes develops during pregnancy. This is commonly prevalent among women having a family history of diabetes. It may occur temporarily and cease to exist after confinement. Such patients are always susceptible to develop the disease during stressful conditions later in life. Mild or borderline cases of diabetes during pregnancy needs to be controlled. Any abnormality of blood sugar level affects the foetus and increases the chances of congenital malformations.
Known or Identified Diabetics
A diabetic woman who wishes to have a child should prepare herself for pregnancy in advance. She should get herself thoroughly examined and should control the blood sugar level, within the accepted limits.
Problems of Pregnant Diabetics
Once pregnancy is diagnosed, the patient should be constantly under the supervision of a team of specialists comprising the gynaecologist, diabetologist, dietitian and others. Control of blood sugar level during pregnancy is of utmost importance. It reduces the risk and ensures prospects of normal delivery and a healthy baby.
Morning Sickness
In the early weeks of pregnancy, most women suffer from nausea and vomiting, especially in the morning. Excessive vomiting, giddiness, dislike for food may result in the fall in blood sugar during early hours which may usually be overcome by the use of high carbohydrate foods, such as sugar, toffee, jelly and glucose syrup. An insulin dose should be adjusted according to the blood sugar level. Frequent measurement of blood sugar is required to stabilise the insulin dose and adjustments should be made as per daily requirements.
Decrease in Kidney Threshold
If the blood sugar exceeds 180 mg per 100 ml of blood, sugar tends to appear in the urine. This level (180 mg / TOO ml) is considered the normal kidney threshold for sugar.
As pregnancy advances, at times the kidney threshold level for sugar decreases. Due to the decreased level, sugar may appear in the urine, even though the blood sugar level is within the normal limits. Excessive excretion of sugar may result in hypoglycemia. It is, therefore, recommended to maintain blood sugar at a slightly lower level than normal. Blood sugar test, in this case would be more reliable than urine sugar test.
High Blood Pressure
Maintenance of normal blood pressure during pregnancy is necessary for normal growth of the foetus. High blood pressure is common during the last few months of pregnancy but a diabetic mother is always at a greater risk. Swelling of legs, hands, fingers and at times the entire body, passing of albumin in urine, are the common symptoms accompanied with hypertension. An expectant mother should always avoid taking medicine indiscriminately. It is better to consult the doctor who knows the complete history of the patient. Generally the patient is advised complete bed-rest. Anti-hypertensive drugs should be avoided.
Overweight
It is normal for women to gain about 9-12 kgs of weight during pregnancy. Weight gain should be gradual during the course of the pregnancy. Overweight may cause high blood pressure and oedema which tend to cause difficulty in labour.
Treatment
During pregnancy, sugar level is controlled by modifying the diet alone and / or by insulin. Hypoglycemic drugs are not recommended as they may result in congenital malformation. In insulin-dependent diabetics, the requirement of insulin dosage increases as the pregnancy progresses.
Treatment by Diet
An expectant mother needs a nutritious, balanced diet which provides adequate nutrition for increased body requirements and maintenance of blood sugar level within the normal acceptable limits. Diet for the pregnant diabetic depends on her body weight, insulin treatment and severity of blood sugar level.
In general, the patient should take a diet high in protein, iron, calcium and vitamins. Calorie and carbohydrate intake should be adjusted to avoid abrupt fluctuation of blood sugar level. Proper instructions regarding diet, insulin dose, timing and its modification during the course of pregnancy is very important. Urine and blood examinations are the most important on which rests the treatment of the mother.
Diet during Pregnancy and Lactation
For pregnant and nursing mothers, diet is of utmost importance because the mother is nourishing the child through her own body either in the uterus before birth or through her milk after birth. The nutrients needed, for the child, should be furnished in the mother’s diet.
The nutritive needs, during pregnancy, are best met by simple wholesome diet, rich in proteins, vitamins, minerals, iron and folate. The basis of such a diet is in milk, milk products, meat, legumes, nuts, whole grains, lentils, soyabean products, leafy vegetables and fruit. If the diet consumed before pregnancy was adequate, then, only a simple modification is required to meet all additional nutrient allowances. An addition of 2 glasses of milk or cheese, or one egg or a large amount of fish, poultry or legumes or one serving of green vegetables with frequent substitution of fruit is enough. Of these, fruits and leafy vegetables are of great nutritive value.
During lactation there is increased need for energy, protein, minerals and vitamins, to cover the amount secreted in the milk for nourishment of the infant. Energy requirement varies with the amount of milk produced.
A Pregnant Diabetic Needs to Know
I. Introduction
• What is gestational diabetes and what causes it?
• Who is at risk for developing gestational diabetes and how is it detected?
• What can be done to reduce problems associated with gestational diabetes?
• How does gestational diabetes differ from other types of diabetes?
• How does gestational diabetes affect pregnancy and the baby?
II. Glucose Monitoring
• What is self blood glucose monitoring?
• How often and when should the tests be done?
• Are there any other tests one should know about?
• When does one test for ketones?
• Will the baby be healthy?
• Should one expect the baby to have any problems?
• How should one record his/her test results?
• How does one test for ketones?
• Is it necessary to take insulin?
• Does gestational diabetes affect labour and delivery?
• Will diabetes affect labour and delivery?
• Will one develop diabetes in the future?
III. Diet and Weight Gain
• Why is a special diet recommended?
• How should one eat during pregnancy?
• How does one plan meals?
• Is breast-feeding recommended?
• How much weight should one gain?
• What food patterns help keep blood sugar levels normal?
• What can be done to slow weight gain during pregnancy?
IV. Exercise
• Should one exercise?
• What happens if diet and exercise fail to control the increase in blood sugar level?
• Can blood sugar level go too low, and if so, what can one do?