The women's zone
Pregnancy needs tight control
Parents please note, this article addresses adult matters and may not be suitable for younger readers.
Here's good news for women with diabetes who want to have a baby. Just because you have diabetes, it doesn't mean you can't have a healthy and successful pregnancy and deliver a healthy baby. But you do need to plan ahead and work with your diabetes healthcare team. So don't throw away your contraceptives too soon, read this first…
Before you start
If you're thinking about having a baby, you really do need to talk to your diabetes healthcare team well before you become pregnant. It's important to talk to the team early so you can be in the best possible health before you become pregnant.
The pre-pregnancy environment is important to the fetus. It is best if good blood glucose control is achieved for at least three months prior to pregnancy and kept under control.
"High blood glucose levels make it harder to get pregnant and make a woman more prone to having a miscarriage, so that's the first reason for getting blood glucose levels in the normal range before becoming pregnant," says Jo Morgan of the Diabetes Clinic at National Women's Health, Auckland Hospital.
A review with a diabetes physician to ensure the medication you are taking is safe for your pregnancy is recommended. It is also important that your general health is good - healthy eating, regular exercise, being smoke free and not drinking alcohol. Ensure you are up to date with your eye checks and cervical smears. It is recommended that women considering pregnancy take folic acid for at least four weeks prior to conception until the twelfth week of pregnancy to help with the normal development of the baby.
For some women, it can take a while to achieve satisfactory blood glucose levels and to achieve a successful pregnancy. So don't despair if things are not happening quickly, you are not alone with the problem.
Keeping it low
Typically women with diabetes will be advised to keep their blood glucose levels lower during pregnancy than at other times. Where it might be OK to be 8 after a meal for anyone else, during pregnancy it is better to be 6.5 or lower. Of course, you don't want to achieve this at the expense of hypoglycaemia. It can be particularly difficult if you have Type 1 diabetes to achieve normal blood glucose levels, and the diabetes team is aware of this. So don't be afraid to ask for help.
For many women, the need to keep blood glucose levels low is quite a challenge and, to some, it may seem an unduly severe goal. But it matters, and here's why:
- High blood glucose increases the risk of miscarriage.
- Very high blood glucose puts the baby at risk of abnormalities, especially heart and spine defects.
- High blood glucose crosses the placenta to your baby and may contribute to bigger babies seen in babies born to mothers who have diabetes.
- It is often more difficult to control your blood glucose during pregnancy due to the effect of placental hormones on your body.
- After birth your baby is at risk of low blood sugars - they will have regular checks during the first 12 hours. Other complications that can sometimes happen include jaundice, breathing or feeding difficulties. If there are any concerns about your baby he or she will be cared for in the Neonatal Unit.
Taking care of baby
Along with taking care of mum's health, there is also another vitally other important person to protect. Baby. That's true for all pregnant women, but more so for those with diabetes. As mentioned earlier, your baby can be affected by your high blood glucose which can cause abnormalities such as heart or spine defects. The risk is especially high early in pregnancy when baby's organs are first developing.
The other big factor for women with diabetes is having a big baby. The higher your blood glucose, the higher the level of glucose crossing the placenta to your baby. This is stored as fat. The more glucose your baby receives, the more insulin your baby produces. Insulin is a growth promoting hormone, making the baby even bigger. Having a big baby can lead to a difficult delivery and an increased risk of Caesarean Section delivery.
Without making too much doom and gloom we also need to mention that there are increased risk of miscarriage or stillbirth as a result of poorly controlled diabetes. But - and you know the story by now - do your best to keep your blood glucose under control and you'll reduce the risk of having a big baby and increase the likelihood of a healthy pregnancy and baby.
Hello baby
Finally the day comes when all this hard work has been worth it. Despite the risks and challenges of pregnancy for women with diabetes, a healthy, successful birth happens more often than not. A healthy new baby is born. Women with diabetes are encouraged to breastfeed their baby because of the benefits to both mother and baby.
In fact, at National Women's Health Diabetes Clinic the major outcomes for women with diabetes are the same as for mothers who attend National Women's general clinics. In other words, the good control and attention to the health of mother and baby is well worth the effort.
So, if you're thinking about having a baby, or know anyone who is, give yourself the best chance of a healthy pregnancy and birth. Talk to your healthcare team and get some advice about your current health well before you start anything else. Your baby will thank you for it.