Diabetes is a condition that causes high levels of glucose in the
blood. Glucose is a sugar that is the body's main source of energy.
Health problems can arise when the glucose levels are too high.
Diabetes is of special concern during pregnancy.
Causes
Diabetes occurs when there is a problem with the way the body makes or
uses insulin. Insulin is a hormone that converts glucose in food into
energy. When the body does not make enough insulin, or when the body is
not using insulin properly, the level of glucose in the blood becomes
too high. This is called hyperglycemia (high sugar levels in the
blood).
During
pregnancy, the hormones produced by the placenta can limit the actions
of insulin. As a result, gestational diabetes may occur.
Effects During Pregnancy
The risk of problems during pregnancy is greatest when blood sugar
levels are high. Some of these problems may increase the chance of a
cesarean birth. This is why you need good blood sugar control during
pregnancy. Good control of glucose levels, before and during pregnancy,
can lower the risks.
If
you have diabetes or if you are at risk of developing gestational
diabetes, you should be aware of the problems that may arise:
- Macrosomia (very large baby) occurs when the mother's blood sugar level is high throughout pregnancy.
- Preeclampsia is high blood pressure and protein in the
urine during pregnancy. This can pose problems for the mother and the
baby.
- Hydramnios occurs when there is too much amniotic fluid in the sac that surrounds the baby.
- Urinary tract infections can occur without symptoms.
- Respiratory distress syndrome can make it harder for the baby to breathe after birth.
- Stillbirth — delivery of a baby that has died before birth
— occurs more often in babies of women whose diabetes was not well
controlled before and during pregnancy.
Diabetes Control
There are a number of ways that you can measure your glucose level. You
may have to go to a lab to have your blood tested, or you may be able
to check your blood sugar level yourself using a glucose meter.
Glucose
can be controlled with diet and exercise and, in some cases, by taking
pills or insulin. You and your doctor will decide together on the best
method or mixture of methods for you.
Diet
A
balanced diet is key in pregnancy. Your baby depends on the food you
eat for its growth and nourishment. This is even more important if you
have diabetes. Not eating properly can cause glucose levels to go too
high or too low.
Exercise
Moderate
exercise is always good. For women with diabetes it is even more
important. Regular exercise helps keep blood glucose levels low.
Medications
Some women with diabetes need to use insulin shots to keep their
glucose at normal levels. Insulin shots can be safely used during
pregnancy to control diabetes.
Some
women take diabetes pills instead of insulin shots. In some cases,
pills alone will not control the diabetes and you may be switched to
insulin shots.
Prenatal Care
You play a key role in controlling your diabetes. Prenatal care helps monitor your condition as well as that of the baby.
A woman with diabetes often needs to be monitored closely during pregnancy.
Delivery
In most cases, women with diabetes go into labor normally when the time
comes and have a normal vaginal delivery. They may require special
monitoring of their glucose levels and the baby during labor.
Postpartum Care
Problems in the Newborn
After birth, most babies do well. Some babies may need to spend time in a special care nursery.
Problems that may occur include:
- Low glucose levels
- Low blood calcium and magnesium levels
- An excess of red blood cells
- Neonatal jaundice (yellow discoloration of the skin)
- Breathing problems
These problems are not serious in most cases.
Contraception
Women with diabetes or those who develop gestational diabetes need to plan future pregnancies with care.
Glucose Control
Your blood sugar levels may be monitored after you give birth. If they
remain high, you may need to take medication to control your blood
sugar.
Weight Control
Weight
loss during pregnancy is not a good idea-even if you are overweight.
You and your doctor should set up a program of diet and exercise for
you to follow after delivery.
Finally...
Most women with diabetes can have healthy babies. You and your doctor
can work together to plan your pregnancy and control your glucose
level.
This
excerpt from ACOG's Patient Education Pamphlet is provided for your
information. It is not medical advice and should not be relied upon as
a substitute for visiting your doctor. If you need medical care, have
any questions, or wish to receive the full text of this Patient
Education Pamphlet, please contact your obstetrician-gynecologist.
To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.
Copyright © August 2005 The American College of Obstetricians and Gynecologists
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