Diabetes is a medical condition occurring due to inadequacy or deficiency of certain hormones required to properly use glucose. This condition causes the blood sugar to be very high and denies the body opportunity of using the glucose. Diabetes mellitus is the commonest type encountered in pregnancy, however diabetic insipidus also occurs, but it is very rare.
Diabetes, though a cause of high risk pregnancy and adverse pregnancy outcomes, favorable outcomes can be achieved with cooperation between the physicians and mother to be.
A Diabetic woman, who is planning to get pregnant or already pregnant, requires specialist care from Endocrinologist, Nutritionist as well as obstetricians.
Diabetes in pregnancy can be broadly categorized into two:
CATEGORY A : This refers to diabetes occurring in a woman before pregnancy and continuing throughout the pregnancy.
For a woman in category A; i.e has been diagnosed to be diabetic before achieving conception would require adequate medical assessment and screening during pre-conception care. The goal of the preconception care includes
- Achieving normal weight with dietary modification and moderate physical exercises.
Healthy dietary choices
Modeerate physical exercises.
- Achieving normal glucose level through self-monitoring of blood glucose, intake of balanced diet with lots of fresh fruits and vegetables and being compliant on medications she had been on.
Self-monitoring and recording of blood glucose.
A high maternal blood glucose level is associated with miscarriages, malformations in the unborn child, prematurity and difficult labour due to a large baby. The expectant mother with poorly controlled blood sugar level is also prone to infections, complications in the eyes, kidneys and blood vessels, all of which contribute to maternal mortality.
CATEGORY B: This refers to diabetes occurring in a woman only in pregnancy and symptoms usually disappear after pregnancy. (Gestational diabetes)
The following are pointers to risk of having diabetes in pregnancy. A woman with any of the following risks would require appropriate medical evaluation during antenatal care.
- Obese expectant mothers, i.e women weighing more than 90kg
- Women who have had a previous still birth whose cause of death is unknown.
- Women with a family history of diabetes.
- Women who have had babies weighing 4kg or more.
- Women who have had diabetes in previous pregnancies.
- Women who are 35 years and above.
- Women with a history of polycystic ovarian syndrome (PCOS)
These women have their blood sugar return to normal after pregnancy; however they stand the risk of having Diabetes mellitus in 10-20 years’ time.
Diabetes in pregnancy is not a death sentence. If properly managed, complications to the mother and child can be prevented thereby reducing maternal and infant morbidity and mortality.
By Sydney Roseline
College of Medicine, University of Ibadan