Dear Readers,

Lisa K. is a 33-year-old woman who writes Lifeline from a Manchester address. She finds herself in the 'odd' situation of feeling both happy and concerned (scared) at the same time. She was diagnosed with diabetes only a year ago and is now pregnant for the first time.

She is happy with the pregnancy but is worried about how the diabetes will affect her health and that of the baby's.

She has heard a lot of 'horror' stories about very large babies with breathing problems at birth, difficult deliveries, even increased possibility of death. She has been reading about the subject but has also been reading Lifeline for years and would like to hear what Lifeline has to say about diabetes in pregnancy.

Congratulations to Lisa! She should not worry unduly as our local obstetricians are very skilled with the management of pregnant Diabetic women. A diabetic pregnancy is, however, still classified as a high-risk pregnancy and she should, under these circumstances, be best cared for by a specialist obstetrician or at a hospital's antenatal clinic.

Diabetes in pregnancy encompasses both diabetes which was diagnosed before the pregnancy as well as what may be more temporary diabetes which is induced by the pregnancy and tends to resolve after delivery of the infant. Diabetes significantly influences the course of a pregnancy for both mother and foetus (infant in the womb). However, in this day and age, any pregnant female diabetic who has uncomplicated diabetes and good control of her blood sugar levels can expect a good outcome for herself and her baby.

The maternal mortality rate for women with diabetes is less than 0.1 to 0.5 per cent in the developed world. In some places this figure is as low as 0.01 per cent.

blood-sugar control

Modern management of a diabetic pregnancy involves a medical team of professionals including the obstetrician, family physician, midwife and dietician. Maternal complications in a diabetic pregnancy are fully preventable with good medical care and patient compliance with the health-management plan.

Diabetic women should visit the doctor as early as possible, after knowledge of the pregnancy, in order to have the very best control of the sugar. Oral medication is not safe for the foetus and Insulin is necessary for optimum blood-sugar control, as well as for foetal health.

If the mother-to-be is already consuming a 'diabetic' diet, then no major dietary changes will be necessary.

However, if some vomiting is occurring in early pregnancy, as often is the case in any normal pregnancy, then tight monitoring of the blood sugar will be necessary. Insulin requirements will change as the pregnancy matures and this will need to be closely monitored by the woman and her doctor.

Insulin requirements increase significantly during the course of a pregnancy and can almost double when pregnancy is at 'term' (baby's birth imminent).

Blood sugar should be maintained at between 5.5 and 6.5 mmol/l to minimise complications such as pre-eclampsia, Caesarean section, high foetal weight and respiratory-distress syndrome.

Deliveries are usually normal unless a high-birthweight baby is expected, then caesarean section is advised. After delivery, insulin requirements will rapidly return to pre-pregnancy levels. Insulin should be continued until the cessation of breastfeeding, which is encouraged. Keeping the foetal birth weight normal is important and is achieved by optimising the blood-sugar control.

POSSIBLE COMPLICATIONS

The delivery of a large baby at birth can cause some incidence of haemorrhage after delivery. Today obstetricians know to prepare for this possibility.

Stillbirth, is still occasionally documented and is associated with poor diabetic control during the pregnancy and a largebirth will weight baby. To prevent this occurring, the diabetic pregnant woman might be delivered a bit early (at 38 to 39 weeks gestation, instead of 40).

There is some evidence that the risk of respiratory complications at birth is greater in babies of diabetic mothers.

Poorly controlled diabetes, at the time of conception, is associated with a greater occurrence of congenital abnormalities. This is avoided with proper sugar control.

In poorly controlled diabetic women there is a higher incidence of miscarriage. When diabetes is well controlled this discrepancy does not exist.

It is clear that an otherwise healthy diabetic pregnant woman has only to obtain good obstetric care, and keep well in hand her blood-sugar control, to ensure a healthy pregnancy and a safe delivery.

Write to:

Lifeline

PO Box 1731 KGN 8