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Pregnancy and Diabetes

Diabetes affects 11.5 million women in the United States. According to the American Diabetes Association, more than 10 percent of all women aged 20 or older have the condition.

If diabetes is left untreated, the consequences are blindness, kidney failure, and limb amputation are just a few of the potential health hazards. And if you're pregnant, your baby can suffer healthwise too. The good news? If you get the proper medical treatment, neither you nor your baby has to suffer from this very serious -- but very manageable -- disease.

Put simply, diabetes develops when the pancreas produces too little or no insulin, a hormone that enables sugar derived from food to enter the body's blood cells and be converted to energy. Without sufficient insulin, sugar builds up in the blood and over time can damage the eyes, kidneys, heart, and nerves. Diabetics are also at risk for hypoglycemia (low blood sugar), which can lead to a diabetic coma.

There are two main types of diabetes, type 1 and type 2. Type 1, which is less common but more severe, is an autoimmune disease that develops when the pancreas fails to produce insulin. It's usually diagnosed during childhood or early adolescence. Symptoms include frequent urination, extreme thirst, and sudden weight loss. To control their disease, type 1 diabetics need to inject themselves with insulin throughout the day.

Type 2 diabetes is a metabolic disorder resulting from the body's failure to produce enough or properly respond to insulin. The symptoms are similar to those of type 1, though they're less severe. Some type 2 diabetics can control their disease through diet and exercise only. Others use medications to keep sugar levels in check.

A third type, gestational diabetes, is pregnancy-specific, occurring in about 3 percent of all pregnancies and disappearing after delivery. It occurs when hormone levels in the placenta begin to prevent the mother's insulin from effectively transporting sugar into cells. In most cases, blood sugar can be regulated by special meal plans and exercise; however, some women will require more serious treatment with insulin injections. Gestational diabetes usually cures itself when the pregnancy ends, but just because it goes away doesn't mean you've said good-bye to diabetes; women with gestational diabetes are at greater risk for developing type 2 diabetes later in life.

While the cause of diabetes is unclear, the risk factors are well known. These include:

  • A family history of diabetes
  • Obesity or being overweight
  • A history of gestational diabetes
  • A history of having a baby who weighed more than 9.5 pounds at birth
  • A sedentary lifestyle
  • Being of Native American, African-American, Hispanic, or Pacific Island descent

If someone is diagnosed with diabetes, regardless of type, she needs to carefully balance the amount of carbohydrates (fruits, vegetables, starches, and sweets) and protein (meat, fish, eggs, beans, and dairy) in her diet, monitor her blood sugar levels, and exercise regularly. The reason? Some foods contain more sugar and break down into sugar more quickly than others. By carefully monitoring how much sugar goes into the blood through food, diabetics can more easily keep their sugar in balance. A woman with diabetes will know if she needs to change her habits -- or see her doctor -- by pricking herself to draw blood and feeding the sample into the glucose monitor, which measures blood sugar. Exercise helps by getting rid of glucose in the blood, making it easier to keep blood sugar in balance.

Unfortunately, growing numbers of women are diabetic or become diabetic during pregnancy, due in part to the rapidly expanding American waistline. Obesity is a major factor for type 2 diabetes: According to the Centers for Disease Control and Prevention, 64 percent of American adults are overweight or obese. Furthermore, the incidence of type 2 diabetes is growing among younger adults. More and more women are overweight and are delaying having children, so there's an increase in the number of pregnancies complicated by diabetes, says James Bernasko, MD, director of the Diabetes in Pregnancy Education Program at North Shore University Hospital in Manhasset, New York.

When women with type 1 or type 2 diabetes become pregnant, the primary concern is that the extra sugar in the mother's blood will be delivered to the baby during the first six weeks of pregnancy, increasing the risk of heart and neural tube defects. (Birth defects are not a concern with gestational diabetes because it occurs later in pregnancy, usually between 24 and 28 weeks, after major organs have formed.)

Beyond birth defects, other risks to the baby are the same for type 1, type 2, or gestational diabetes. If the mother's blood sugar levels are high, the baby is "fed" excess sugar and grows too large, and a large baby can result in premature birth, birth trauma, or cesarean delivery. Additionally, when the baby gets excess sugar, his pancreas produces extra insulin, which may continue after birth and result in dips in the newborn's blood sugar levels.

One in three Americans with type 2 diabetes doesn't even know it -- symptoms can develop so gradually that they go unrecognized. Any woman planning to get pregnant should talk to her primary care physician about being tested.

Good prenatal care is important for all pregnant women, but for women with diabetes, preconception care is also crucial. Excellent blood sugar control, before and during pregnancy, is the key to a healthy pregnancy, says Dr. Bernasko. Because the greatest risk to the baby can occur before a woman even knows she is pregnant, women should have their diabetes in control at least three months before they conceive.

When you're a type 1 diabetic, a healthy pregnancy requires a team approach. According to the American Diabetes Association, it's a good idea to go to a high-risk obstetrician who has handled pregnant diabetics, a registered dietician, and a diabetes educator, who will work with you to create a life plan to help you manage your disease.

Because a diabetic's blood sugar issues change as the pregnancy evolves, she must keep records of her diet, exercise, and insulin regimen, as well as maintain a schedule of medical appointments. Blood sugar must also be monitored.

Women with type 2 diabetes will also need extra care, particularly if they're controlling their blood sugar with medication. The safety of such medicines during pregnancy has not been established, so insulin injections are sometimes a must. Needless to say, going from taking a pill to giving yourself injections is an adjustment that requires a doctor's supervision.

Most women with gestational diabetes, and some with type 2, can keep their blood sugar levels in check through diet and exercise alone. For many, the diet is the toughest part. It can be very challenging for someone to stay on a low-carb diet. But it's critical to do so when another life is at stake. The beautiful, healthy baby that you will have is totally worth it.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Updated 2010