“Diabetes mellitus refers to a group of metabolic diseases characterized by high blood sugar levels. It is a result of defects in insulin secretion, action, or both.” (Diabetes Mellitus, para. 11). Before insulin started to be used as a medicine, childbirth among women with diabetes was uncommon. Pregnancy occurred only in 5% of the women and it threatened their lives; fetal death rate was 60%. Treatment with insulin has allowed the vast majority of women with diabetes to have children.
High blood sugar level in the organism of a mother, which characterizes diabetes, leads to high blood sugar in the developing fetus too. There are several risks for the pregnant women diagnosed with diabetes. First of all, there is a miscarriage risk or birth defects in the future baby. Secondly, the newborn baby can be of a bigger size than the average infant, which complicates the birth process – both for the mother and for the baby. Despite of a bigger size the baby can be underdeveloped.
There is a risk that a child can have diabetes too, though it might develop later in life. It greatly depends on the father of the child – if the father is diagnosed with diabetes the risk increases.
Nevertheless, it is possible to decrease the risk of problematic pregnancy and delivery, if the blood sugar level in the mother is carefully controlled. The basic principle of treatment of diabetes during pregnancy is aspiring for full compensation of the disease by appropriate insulin therapy in combination with a balanced diet. “Women diagnosed with diabetes have a need for more insulin when pregnant, specifically during the last one-third of pregnancy. When the pregnancy progresses, the mother’s organism becomes resistant to insulin.” (Barss, Repke, para.8)
A balanced diet should be planned with the help of the nutritionist. The diet should contain a reduced amount of carbohydrate, fat and normal or increased amounts of protein (1-2 g per 1 kg body weight), energy value – 2000-2200 kcal. In cases of obesity sub-calorie diet is required, containing 1600-1900 calories. It is important to consume the same amount of carbohydrates daily. Food intake should coincide with the beginning and the maximum effect of insulin.
Exercise is highly recommended for controlling the blood sugar level and weight. If the woman has been exercising before pregnancy, she should continue doing so. The women who have not been exercising should consult the physician first. Sharp walking is the excellent type of exercise during pregnancy.
It should also be mentioned that pre-conception care and glucose control can reduce the risks which characterize the pregnancy of the women with diabetes. Women with diabetes should plan the pregnancy at a young age when the risk of complications is the lowest. When planning the pregnancy, it is recommended to use contraceptives 3-4 months before the planned conception. As Barss and Repke (Patient information, para.20) state, planning the pregnancy gives the possibility:
- to ascertain that blood sugar level is in optimal control,
- to regulate medications if necessary,
- to treat and estimate any medical complications connected with diabetes,
- to begin supplementation of folic acid (at least 400 mcg per day is recommended, starting at least one month before conception).
It is also a possibility to have a discussion how pregnancy results on diabetes and how diabetes results on pregnancy.
In conclusion it should be mentioned that the pregnancy should be planned few months in advance. The woman and her family should be aware of all the possible complications and work on reducing the risk. During the pregnancy the woman requires special care as well. Thanks to new technological development and the progress of medical researches., nowadays pregnancy of women with diabetes is possible.