Diabetes mellitus and pregnancy
Encyclopedia
For women with diabetes mellitus
, pregnancy
can present some particular challenges for both mother and child. If the woman who is pregnant has diabetes, it can cause early labor
, birth defects, and very large babies.
Planning in advance is emphasized if one wants to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics needs stringent blood glucose control even in advance of having pregnancy
.
glucose
levels, such as a glucose-'drain' to the fetus
, slowed emptying of the stomach
, increased excretion of glucose by the kidney
s and resistance of cell
s to insulin
.
, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios
and birth defects.
Birth defects are not currently an identified risk for the child of women with gestational diabetes
, since those primarily occur in the latter part of pregnancy, where vital organs already have taken their most essential shape.
Still, having diabetes type I or II has a 2-3 fold increase in risk of birth defects. The cause is e.g. oxidative stress
, by activating protein kinase C
and lead to apoptosis
of some cells.
Insulin
may be needed for type 2 diabetics instead of diabetes medication (oral) or extra insulin may be needed for type 1 diabetics during pregnancy. Doctors' may advise to check blood sugar more often to maintain near normal blood sugar level.
If already pregnant, then consult the doctor right away. It’s not too late to bring the blood sugar close to normal so that the mother and the baby stay healthy during the rest of the pregnancy.
who pioneered research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed before pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.
There are 2 classes of gestational diabetes (diabetes which began during pregnancy):
The second group of diabetes which existed before pregnancy can be split up into these classes:
An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.
, oral antidiabetic drugs should be replaced with insulin
.
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
can present some particular challenges for both mother and child. If the woman who is pregnant has diabetes, it can cause early labor
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
, birth defects, and very large babies.
Planning in advance is emphasized if one wants to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics needs stringent blood glucose control even in advance of having pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
.
Physiology
During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that influence bloodBlood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
levels, such as a glucose-'drain' to the fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
, slowed emptying of the stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
, increased excretion of glucose by the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s and resistance of cell
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
s to insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
.
Risks for the child
MiscarriageMiscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios
Polyhydramnios
Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in 0.2 to 1.6% of pregnancies,,...
and birth defects.
Birth defects are not currently an identified risk for the child of women with gestational diabetes
Gestational diabetes
Gestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy . It is widely accepted as a disease only in the United States, there is some question whether the condition is natural during pregnancy...
, since those primarily occur in the latter part of pregnancy, where vital organs already have taken their most essential shape.
Still, having diabetes type I or II has a 2-3 fold increase in risk of birth defects. The cause is e.g. oxidative stress
Oxidative stress
Oxidative stress represents an imbalance between the production and manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage...
, by activating protein kinase C
Protein kinase C
Protein kinase C also known as PKC is a family of enzymes that are involved in controlling the function of other proteins through the phosphorylation of hydroxyl groups of serine and threonine amino acid residues on these proteins. PKC enzymes in turn are activated by signals such as increases in...
and lead to apoptosis
Apoptosis
Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation...
of some cells.
Importance of blood glucose level during pregnancy
High blood sugar is harmful to both the mother and her fetus. Experts advise diabetics to maintain the blood sugar level close to normal range for 2 to 3 months in advance, before planning for pregnancy. Managing blood sugar close to normal before and during pregnancy helps to protect the health of both mother and the baby.Insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
may be needed for type 2 diabetics instead of diabetes medication (oral) or extra insulin may be needed for type 1 diabetics during pregnancy. Doctors' may advise to check blood sugar more often to maintain near normal blood sugar level.
Tips for diabetics before and during pregnancy
- Coordinate with the health care team to achieve blood sugar level close to the normal range.
- Consult with a doctor, who has experience in handling diabetes mellitus during pregnancy.
- Put some extra care to the eyes and kidneys and check it frequently, because pregnancy may make it worst.
- Stop smoking, drinking alcohol, or use of harmful drugs.
- Consult and coordinate with an experienced dietician and plan your meal and follow it strictly and make sure the mother and the unborn baby have a healthy diet.
If already pregnant, then consult the doctor right away. It’s not too late to bring the blood sugar close to normal so that the mother and the baby stay healthy during the rest of the pregnancy.
Diabetes pregnancy management
Diabetes mellitus may be effectively managed by appropriate meal planning, increased physical activity and properly-instituted insulin treatment. Some tips for controlling diabetes in pregnancy include:- Meals – cut down sweets, eats three small meals and one to three snacks a day, maintain proper mealtimes, and include balanced fiber intake in the form of fruits, vegetables and whole-grains.
- Increased physical activity - walking, swimming/aquaerobics, etc.
- Monitor blood sugar level frequently, doctors may ask to check the blood glucose more often than usual.
- The blood sugar level should be below 95 mg/dl (5.3 mmol/l) on awakening, below 140 mg/dl (7.8 mmol/l) one hour after a meal and below 120 mg/dl (6.7 mmol/l) two hours after a meal.
- Each time when checking the blood sugar level, keep a proper record of the results and present to the health care team for evaluation and modification of the treatment. If blood sugar levels are above targets, a perinatal diabetes management team may suggest ways to achieve targets.
- Many may need extra insulin during pregnancy to reach their blood sugar target. Insulin is not harmful for the baby.
Breast feeding
Breast feeding is good for the child even with a mother with diabetes mellitus. Some women wonder whether breast feeding is recommended after they have been diagnosed with diabetes mellitus. Breast feeding is recommended for most babies, including when mothers may be diabetic. In fact, the child’s risk for developing type 2 diabetes mellitus later in life may be lower if the baby was breast-fed. It also helps the child to maintain a healthy body weight in infancy.Classification
The White classification, named after Priscilla WhitePriscilla White (physician)
Priscilla White, M.D. was a pioneer in the treatment of diabetes during pregnancy and type 1 diabetes, and was also a founding member of the Joslin Diabetes Center....
who pioneered research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed before pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.
There are 2 classes of gestational diabetes (diabetes which began during pregnancy):
- Class A1: gestational diabetes; diet controlled
- Class A2: gestational diabetes; insulin controlled
The second group of diabetes which existed before pregnancy can be split up into these classes:
- Class B: onset at age 20 or older or with duration of less than 10 years
- Class C: onset at age 10-19 or duration of 10–19 years
- Class D: onset before age 10 or duration greater than 20 years
- Class E: overt diabetes mellitus with calcified pelvic vessels
- Class F: diabetic nephropathyDiabetic nephropathyDiabetic nephropathy , also known as Kimmelstiel-Wilson syndrome, or nodular diabetic glomerulosclerosis and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse...
- Class R: proliferative retinopathyRetinopathyRetinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease.-Pathophysiology:Causes of retinopathy are varied:...
- Class RF: retinopathyRetinopathyRetinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease.-Pathophysiology:Causes of retinopathy are varied:...
and nephropathyNephropathyNephropathy refers to damage to or disease of the kidney. An older term for this is nephrosis.-Causes:Causes of nephropathy include administration of analgesics, xanthine oxidase deficiency, and long-term exposure to lead or its salts... - Class H: ischemic heart disease
- Class T: prior kidney transplant
An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.
Treatment of pregnant women with diabetes
Blood glucose levels in the pregnant woman should be regulated as strictly as possible. In diabetes mellitus type 2Diabetes mellitus type 2
Diabetes mellitus type 2formerly non-insulin-dependent diabetes mellitus or adult-onset diabetesis a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and...
, oral antidiabetic drugs should be replaced with insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
.