Diabetes and Pregnancy

Diabetes During Pregnancy

During pregnancy, some women develop a problem controlling their blood sugar. It doesn't have anything to do with eating too much pickles and ice cream. It's a medical condition in which the body becomes less able to absorb glucose, a type of sugar, from the blood. Glucose is essential to normal muscle function and to many processes in the body. It's also extremely important for the brain.

Normally, the pancreas makes insulin, and the insulin signals the muscles to absorb glucose. But, certain hormones and other processes in pregnancy raise the body's insulin requirements. Sometimes, the pancreas isn't able to keep up and glucose builds up in the blood. The resulting condition is called gestational diabetes.

Testing for Diabetes

Around the 24th week of pregnancy, your obstetrician should test you for diabetes. You'll be asked to drink a sweet liquid that tastes a little like Kool-Aid. After an hour, you'll have a blood test to check your glucose level. If the glucose level is high, you'll need a second test to find out for sure if you have gestational diabetes.

The second test requires fasting overnight. In the morning, you'll drink another dose of the sweet liquid. You'll then need several blood tests, over a period of hours. Your doctor will look at how your body reacts to the sugar.

Complications of Diabetes and Pregnancy

In most cases, diabetes and pregnancy are not a terrible combination. With proper care, both mother and baby will usually do fine. However, there are some risks, especially if the diabetes is not treated.

Risks to Baby

• Macrosomia. Babies of mothers with uncontrolled diabetes are at risk of growing too large while still in the uterus. This is called macrosomia. Although it might seem like a large baby would be a healthy one, oversize babies can have trouble during the birth process. A baby that's too large can actually get stuck, so that a C-section is essential. Even if the baby is able to be born vaginally, dislocated shoulders and broken collarbones are possible complications of a too-large baby passing though the birth canal.
• Low blood sugar. When the mother's blood sugar is high, the baby's pancreas makes lots of insulin to help absorb the sugar. After the baby is born, it no longer has access to the sugar in the mother's blood. All that excess insulin can lead to a sudden, severely low level of blood glucose, which is dangerous for the baby's brain.

Risks to Mom

• High blood pressure and seizures. Preeclampsia is a condition consisting of high blood pressure and problems with kidney function. It can proceed to eclampsia, which involves of life-threatening seizures. It can also lead to HELLP syndrome, with hemolysis (destruction) of red blood cells, elevated liver enzymes signaling liver damage, and low platelet count (leading to bleeding problems). Preeclampsia usually requires prompt delivery of the baby.
• Diabetes after the pregnancy is over. Although most cases of gestational diabetes go away after the baby is born, gestational diabetes does create a risk of developing diabetes later on. It also raises the risk of developing diabetes in a future pregnancy.

Treatment for Diabetes and Pregnancy

If you have gestational diabetes, you'll need to keep your blood sugar under control. That means watching your diet, making sure to exercise, and monitoring your blood glucose. Exercise helps your muscles absorb glucose. Your doctor will probably recommend you follow a healthy diet, with a balance of proteins and carbohydrates. Most women will still be able to enjoy occasional sweets.

Monitoring your blood glucose requires pricking your finger one or more times each day and testing the tiny drop of blood using a special machine. Your doctor will tell you how to interpret the results.

If diet and exercise aren't working, your doctor may prescribe insulin shots. The extra insulin helps meet your body's higher requirements. Other medicines for insulin-resistant diabetes are available in pill form, but they aren't safe in pregnancy.