Pregnant women are always worried about the risk the thought of diabetes could have on their foetus and it is imperative for mothers to take proper steps to ensure the safety and health of their unborn child.
Nellie is 23 years old. She was diagnosed with type 1 diabetes when she was 16, and has been on insulin injections since then.
She has been married for two years, but is hesitant to have a baby as she is worried about potential complications. Her friends told her that having diabetes, especially when on injections, will put her and her unborn baby at serious risk.
Zabedah also has diabetes, and she is on tablets for treatment. She was diagnosed at age 24 when she went for a routine blood check before starting work.
Now 26 and married, she is keen to have children, but is not sure if it is safe.
The two situations above illustrate the dilemma a married couple may face when deciding to (or not to) raise a family when the wife has diabetes.
It is true that with diabetes, there are additional challenges that a couple has to overcome beyond the usual stress and strains of having a baby. But, these are not insurmountable – with full commitment and proper guidance, it is not impossible for a woman with diabetes to have a safe pregnancy and deliver a healthy baby.
Diabetes is a life-long condition characterised by persistently raised blood glucose (sugar) levels.
There are three major types.
Type 1 diabetes mellitus (T1DM) typically occurs at an early age and is caused by autoimmune destruction of insulin-producing cells in the pancreas.
A person with T1DM (as in the case with Nellie) produces little or no insulin at all, and has to take insulin injections for life.
Zabedah has type 2 diabetes mellitus (T2DM), which usually occurs in an older age group (but is increasingly more common in the young due to poor diet, overweight and obesity, and lack of physical activity).
T2DM is due to impaired insulin secretion and the inability of insulin to work properly to usher glucose into body cells, a condition referred to as “insulin resistance”.
A third type, called gestational diabetes mellitus (GDM), refers to diabetes that first develops during pregnancy.
Due to the hormonal changes occurring during pregnancy, blood glucose levels of pregnant women with diabetes are likely to rise and may be difficult to control.
The high and uncontrolled blood glucose levels cause increased risk of complications for both mother and baby.
Women with diabetes may have difficulty conceiving, or once pregnant, may be more prone to miscarriage (spontaneous abortion) and premature delivery.
They may also suffer from high blood pressure, or too little or too much water in the womb.
These women are more likely to develop fits (seizures) related to a condition known as eclampsia (toxaemia of pregnancy), which may be life-threatening.
And because the baby may be larger than normal, a woman with poorly-controlled diabetes would have difficulty during delivery and is more likely to end up with a Caesar-ean section.
Babies of mothers with (uncontrolled) diabetes before or in early pregnancy, are at higher risk of suffering congenital abnormalities such as heart defects, cleft palate, or more seriously, neural tube defects.
High blood glucose levels in the mother may alternatively lead to excessive weight increase in the baby (macrosomia), which can lead to injuries during delivery.
Babies of mothers with diabetes require close observation during the post-delivery period as they are more prone to developing complications such as low blood glucose levels (hypoglycaemia), breathing difficulties or severe jaundice.
Researchers have also established that babies of mothers who had diabetes during pregnancy are more likely to develop diabetes (as well as obesity and heart disease) as adults, compared to children of non-diabetic mothers.
The good news
Studies have shown that with proper care during (and just as importantly, before) pregnancy, a woman with diabetes is able to reduce the risks and have a safe pregnancy.
For women with diabetes (and those with prediabetes), careful planning is crucial in making sure that both mother and baby are healthy during the pregnancy.
This preparation must start at least six to nine months before attempting to conceive (but for many, unfortunately, there is no planning and pregnancy is deemed an “accident”).
In established centres, these individuals will be directed to attend dedicated “pre- pregnancy counselling clinics” provided by a team comprising of a physician specialising in diabetes (diabetologist), obstetrician, dietitian, diabetes educator, physical therapist and others.
If this facility is not available in your area, you could request your doctor to refer you to appropriate healthcare professionals to help you prepare for your pregnancy.
Complications of diabetes such as those affecting the nerves, eyes, kidneys and heart, tend to occur in those with long-standing diabetes, especially when the disease is not properly managed.
A person with diabetes must make sure that she does not have complication(s) that would compromise her pregnancy.
As a rule, those with serious complications, such as advanced diabetic retinopathy (eye disease), kidney or heart disease, are not recommended to get pregnant.
Your doctor will check for these and will advise you if it is safe for you to conceive.
Once you are cleared for pregnancy, you will need to take positive steps to ensure a safe pregnancy, free of complications, so that you will have a healthy baby.
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