Relatively recently, doctors were categorically against the combination of diabetes and pregnancy. It was believed that, in this case, the likelihood of giving birth to a healthy baby is too small.
Today the situation has changed. At any pharmacy one can buy a pocket glucometer that will allow you to monitor the blood sugar level daily and, if necessary, several times a day. In most maternity welfare centers and maternity homes, there is all the necessary equipment to lead the pregnancy and birth of diabetics, as well as to nurse children born in such conditions.
Due to this, it became obvious that diabetes and pregnancy are quite compatible things. A woman with diabetes can give birth to a completely healthy child with the same success as a healthy woman. However, in the course of pregnancy, the risks of complications in diabetic patients are extremely high. The main condition for such pregnancy is the constant supervision of a specialist.
Types of Diabetes Mellitus
Medicine distinguishes three types of diabetes:
- Insulin-dependent diabetes, it is also called diabetes mellitus type 1. It develops, as a rule, in adolescence;
- Non-insulin-dependent diabetes, respectively, diabetes type 2. It occurs in people after 40 with excess weight;
- Gestational diabetes during pregnancy.
The most common among pregnant women is diabetes type 1. The reason is simple: it affects women of childbearing age. Diabetes type 2, although it is more widespread, is much less common in pregnant women. The fact is that women face this type of diabetes much later, already before the menopause, and even after its onset. Gestational diabetes is extremely rare and causes much fewer problems than any other type of the disease.
Gestational Diabetes Mellitus
This type of diabetes develops only during pregnancy and completely disappears after childbirth. Its cause is the increasing burden on the pancreas due to the release of hormones into the blood, the action of which is opposite to that of insulin. Usually, the pancreas copes with this situation but, in some cases, the blood sugar level changes noticeably.
Despite the fact that gestational diabetes is extremely rare, it is desirable to know the risk factors and symptoms in order to exclude this diagnosis in yourself.
Risk Factors Are the Following:
- polycystic ovarian syndrome;
- sugar in the urine before or at the beginning of pregnancy;
- presence of diabetes mellitus in one or more relatives;
- diabetes in previous pregnancies.
The more factors there are in a particular case, the greater is the risk of the disease.
The symptoms of diabetes mellitus during pregnancy, as a rule, are not manifested clearly. What’s more, in some cases diabetes is completely asymptomatic. However, even if the symptoms manifest themselves well enough, it can be difficult to understand that it is about diabetes.
- strong thirst;
- frequent urination;
- blurred vision.
As you can see, almost all these symptoms are common during normal pregnancy. That’s why it is so important to regularly and timely take a blood glucose testing. When the sugar level is raised, doctors prescribe additional studies.
Diabetes and Pregnancy Planning
Keep in mind that, with any form of diabetes, only a planned pregnancy is possible. Everything is pretty obvious. If the pregnancy is accidental, a woman will find out about it only a few weeks after the day of conception. During these several weeks, all the basic systems and organs of the future person are already being formed.
And if during this period the level of sugar in the blood drops at least once, developmental pathologies cannot be avoided. In addition, sharp jumps in the level of sugar should not happen in the last few months before pregnancy. This may affect the development of the fetus.
Many patients with diabetes mellitus in mild form do not regularly measure blood sugar, and therefore do not remember the exact figures that are usually considered the norm. They simply do not need this. It is enough just to take a blood test and listen to the doctor’s verdict. However, what concerns diabetes and pregnancy, during the planning and management of pregnancy, a woman will have to independently monitor these indicators very often.
A normal level is 3.3-5.5 mmol/L. The amount of sugar from 5.5 to 7.1 mmol/L is called the pre-diabetes state. If the sugar level exceeds the figure of 7.1 mmol/L, then doctors are already talking about this or that stage of diabetes.
It turns out, that the preparation for pregnancy must begin 3-4 months in advance. Get a pocket blood glucose meter so that you can check the sugar level at any time. Then visit your gynecologist and endocrinologist and inform them that you are planning a pregnancy.
The gynecologist examines the woman for the presence of concomitant infections of genitourinary infections and helps to treat them if necessary. The endocrinologist will help to choose a dose of insulin for compensation. Communication with the endocrinologist is mandatory throughout the entire pregnancy.
No less obligatory is the consultation of an ophthalmologist. The doctor’s task is to examine the vessels of the fundus and assess their condition. If some of them look unreliable, they are cauterized to avoid ruptures. Repeated consultation with an ophthalmologist is necessary before delivery. Problems with the vessels of the fundus may become indications for Cesarean section.
Perhaps you will be advised to visit other specialists to assess the risk levels during pregnancy and prepare for possible consequences. Only if all the experts give a go-ahead for pregnancy, it will be possible to cancel contraception.
From this point on, one should monitor the amount of sugar in the blood very carefully. Very much depends on how successfully this will be done, including the health of the child, his/her life, as well as the health of the mother.
Contraindications to Combination of Diabetes and Pregnancy
Unfortunately, in some cases, a woman with diabetes mellitus is still contraindicated to give birth. In particular, the combination of diabetes with the following diseases and pathologies is absolutely incompatible with pregnancy:
- kidney failure;
- negative Rh factor of the mother.
Features of the Course of Pregnancy
At the beginning of pregnancy under the influence of the hormone estrogen in pregnant women with diabetes mellitus, there is an improvement of carbohydrates tolerance. As a result, the synthesis of insulin increases. During this period, the daily dose of insulin, naturally, should be reduced.
From the 4th month, when the placenta is finally forming, it begins to produce counter-insulin hormones, such as prolactin and glycogen. Their action differs from that of insulin. As a result, the volume of injections will have to be increased again.
In addition, starting from the 13th week, it is necessary to strengthen the control over the blood sugar level. At this period the pancreas of the baby starts its work. It begins to react to mother’s blood, and if there is too much sugar in her blood, the pancreas responds by injecting insulin. As a result, glucose breaks down and turns into fat. That means that the fetus actively gains fat mass.
In addition, if during the entire pregnancy a child often faces “sweetened” maternal blood, there is a high probability that in the future they will also face diabetes. Of course, during this period, compensation for diabetes is a must.
Pay attention that at any trimester the dose of insulin should be appointed by an endocrinologist. Only an experienced specialist can do it quickly and accurately. While independent experiments can lead to disastrous results.
Toward the end of pregnancy, the intensity of production of counter-insulin hormones decreases again, which forces to lower the dosage of insulin. With regard to childbirth, it is almost impossible to predict the level of glucose in the blood. Therefore, blood control should be performed every few hours.
Principles of Pregnancy and Diabetes Mellitus
It is quite natural that the management of pregnancy of women sick with diabetes will be fundamentally different from the management of pregnancy in any other situation. The combination of diabetes and pregnancy quite predictably creates additional problems for women. As can be seen at the beginning of the article, the problems associated with the disease will begin even at the planning stage.
At first, you’ll have to visit a gynecologist every week. In the case of any complications, visits will be daily, or the woman will be hospitalized. However, even if everything goes well, you’ll still have to stay in the hospital at least several times throughout pregnancy.
The first hospitalization is usually appointed at an early date, before the 12th week. During this period, a full examination of the woman is carried out. Identification of risk factors and contraindications to pregnancy takes place. Based on the results of the examination, the decision is made whether to keep the pregnancy or terminate it.
The second time a woman needs to go to the hospital is at 21-25th week. At this time, a re-examination is necessary, during which doctors identify possible complications and pathologies. Treatment is also prescribed. In the same period, a woman needs to make an ultrasound. After that, this examination should be done weekly. This is necessary to monitor the condition of the fetus.
The third hospitalization is for a period of 34-35 weeks. Usually, the woman stays in the hospital already up to the birth. Again, the doctors will examine the woman’s state of health. Its purpose is to assess the state of the child and decide when and how the delivery will take place.
Natural Childbirth or Cesarean Section?
Since diabetes itself does not prevent natural childbirth, this option is always the most desirable. However, sometimes diabetes leads to complications because of which it is impossible to wait for a full-term pregnancy. In this case, the onset of labor is stimulated.
There are also a number of situations that force physicians to initially decide on Cesarean section, such situations include:
- a large fetus;
- breech presentation;
- pronounced diabetic complications in the mother or the fetus, including ophthalmological.
Childbirth and Diabetes
Childbirth, in this case, also has its own characteristics. First of all, you need to prepare the birth canal in advance. In addition, to enhance labor activity, doctors can inject the necessary hormones. Anesthesia is an obligatory component as well.
The level of sugar in the blood and the heartbeat of the fetus are monitored with the help of CTG. When the birth activity of the pregnant woman is attenuated, oxytocin is injected intravenously. If the problem is with the level of the sugar in the blood, then insulin is injected.
By the way, in some cases, glucose can be injected simultaneously with insulin. There is nothing dangerous in this. So, there is no need to resist it.
If, after the administration of oxytocin and the opening of the cervix, the birth activity begins to fade again or acute fetal hypoxia occurs, obstetricians may resort to the use of forceps. If the hypoxia begins before the cervix opens, then, most likely, the delivery will take place by Cesarean section.
However, regardless of whether the birth takes place naturally, or by Cesarean section, the chance of a healthy baby is high enough. The main thing is to carefully treat your body, and respond in time to all negative changes, as well as strictly follow all of the doctor’s prescriptions.