Can we have a normal Baby when I have Diabetes?

Pregnancy Diabetes is a very important area and needs special attention, close supervision both by Obstetrician and Diabetes physician. Diabetic pregnancies are mainly of two types.

First one is women with known diabetes either type 1 or 2 becoming pregnant. The other is diabetes for the first time detected in the current pregnancy what is called Gestational Diabetes.

What are the types of Diabetes in Pregnancy?

Diabetic pregnancies are mainly of two types. First one is women with known diabetes either type 1 or 2 becoming pregnant called pre-gestational Diabetes. The other is diabetes for the first time detected in the current pregnancy what is called Gestational Diabetes Mellitus (GDM).

Who are at risk of developing Diabetes in Pregnancy?

Any of the following conditions can be a risk for developing diabetes in pregnancy:

• Obesity
• Family history of diabetes
• High blood pressure
• Birth of a big baby in the last pregnancy
• Pregnancy after 35 years of age
• History of unexplained loss of baby in uterus before

These high risk women should be carefully looked for diabetes by frequent monitoring rather than waiting for symptoms of diabetes to appear.

Why is it important to treat Diabetes in Pregnancy?

It is important to treat Diabetes in pregnancy for a safe confinement. Some potential risks to the foetus if sugars are uncontrolled include:

• The baby’s body is larger than normal – called macrosomia.  A large baby may need to be delivered by caesarean section, instead of normal delivery.
• Small baby, low forage can happen in uncontrolled Diabetes pregnancy.
• The baby’s blood sugar is too low – called hypoglycaemia.  Starting to breastfeed right away can help get more glucose to the baby.  The baby may also need to get glucose through a tube into his or her blood.
• The baby’s skin turns yellowish and the whites of the eyes may change colour – called jaundice.
• The baby may have trouble breathing and need oxygen or other help- called Respiratory Distress Syndrome.
• The baby may have low calcium levels in the blood.  This problem can cause muscle twitching or cramping but can be treated by giving the baby extra calcium.

Why pregnancy Diabetes is different from Diabetes in other time?

The dose requirement of Insulin in pregnancy always increases as the baby grows bigger. This is because placenta increases in size throughout the pregnancy to keep the baby well.

The placenta secretes some hormones which work against Insulin. If the dose of Insulin does not increase we feel worried about the function of the placenta and safety of the baby.

Is the diet different in Pregnancy?

As the demand is more the calorie intake should be more in pregnancy. In average an increase of 500 calorie is advised. If you are overweight then there is no need to increase this, also you should not try to diet strictly or lose weight.

It is better to see a professional dietician at the time of diagnosis. Three meal and three snack regimen are very much indicated in pregnancy.

Why cannot I use tablet for Diabetes in pregnancy?

Safety of the available tablet for diabetes treatment in pregnancy not clear, some of them cross placenta. We do not give tablet in pregnancy with the fear that baby’s blood sugar may drop. Also tablets take long time to work and we need to change the treatment in pregnancy very frequently.

What is the best way of monitoring Diabetes in Pregnancy?

In pregnancy we strongly recommend using glucometer, so that control will be there in your hand. It is important to remember that we check all postprandial sugar, rather than checking only after breakfast, as is the common practice. HbA₁C checking is usually not helpful in pregnancy.

How often to monitor sugar in pregnancy?

It is important that we keep a close eye on the sugar in pregnancy. Normally in pregnancy, we prefer monitoring fasting and 2-hr after meal sugars i.e., fasting, 2 hrs after breakfast, 2 hrs after lunch and 2 hrs after dinner. This set we would prefer should be done twice a week 2-3 days apart.

Remember time starts when you start eating, not when you finish.

Fasting	2-hr after breakfast	2-hr after lunch	2-hr after dinner

What is the Target sugar control to be achieved in pregnancy?

In pregnancy the targets are much stricter. We want fasting sugar <90mg/dl, but surely <95 mg/dl and 2 hr value <125mg/dl, but surely <130mg/dl.

Why my Insulin dose is changing every time?

This is very important to understand. As pregnancy advances, particularly from after 26 to 28 weeks, placental activity increases to keep the baby in good health. To do this placenta produces some hormones which act against Insulin and your dose of Insulin goes up and up.

What exercise is good in Pregnancy?

Standard antenatal exercise should be fine from sugar point as well. Walking would be the best and weight lifting or strenuous exercise should be avoided. Walking for 10mins half an hour after each meal is a good antenatal exercise. Swimming is also a very good exercise. This helps in glucose control, improves quality of life and also helpful for labour.

What extra care needed during delivery?

At the time of delivery, a normal or near normal sugar is very important. Most of the time during delivery you will not be eating, particularly if the delivery is by section. So we commonly connect you to a glucose drip (to give you nutrition) with Insulin.

At this time for a strict control we check blood sugar by pricking finger frequently, sometimes once in every hour.

In the case of gestational diabetes, we disconnect Insulin soon after delivery of the placenta. If you had diabetes from before your dose of Insulin reduced to that before pregnancy. If you were on a tablet before, you should continue Insulin till the time you are breastfeeding.

What happens to the sugar of my baby?

The baby’s sugar is usually normal. If at the time of delivery, the mother’s sugars are not under control, then there is a chance that the baby’s sugar can be on the lower side. Early initiation of breast feeding after delivery is advised.

What follow-up is required?

People with gestational diabetes should get glucose tolerance test 6 weeks after delivery to make sure that diabetes is disappeared. You must remember that you will have a high risk of diabetes in future, so take precaution. Eat healthy food, take some form of regular exercise and do not become fat.

Follow up for people with type 1 or 2 diabetes would be the same as in non-pregnant time. If you are planning to conceive again, make sure your control at the time of conception is very good and you take Folic acid vitamin 5 mg every day.