World Diabetes Day, which falls on November 14, is the primary global awareness campaign focusing on diabetes mellitus.
A woman with diabetes mellitus, either type one or type two, may become pregnant.
When the same disease occurs during mid-pregnancy, it is called gestational diabetes and it can develop in overweight, hyperinsulinemic, insulin-resistant women.
Gestational diabetes occurs in at least three to 10 per cent of all pregnancies, but the rate may be much higher in certain ethnic groups.
Risk factors include obesity, family history, ethnicity, polycystic ovarian syndrome and history of gestational diabetes in previous pregnancy.
Diabetes during pregnancy increases fetal and maternal morbidity and mortality and women who experience gestational diabetes are at a greater risk of developing type two diabetes in the future.
Neonates are at increased risk of respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia and polycythemia.
Poor control of pre-existing diabetes during pregnancy increases the risk of major fetal congenital malformations, miscarriages, big baby, hypertension, shoulder dystocia, operative delivery, pre-term birth and stillbirth.
Screening pregnant women for diabetes is usually recommended at 24 weeks of pregnancy with an oral glucose tolerance test, but earlier if there is personal or a family history of diabetes.
Preconception counselling and optimal control of diabetes before, during, and after pregnancy minimise maternal and fetal risks, including congenital malformations.
It is advised that diabetic women should begin taking folic acid and vitamin D supplements prior to pregnancy.
Although diabetic retinopathy, nephropathy, and mild neuropathy are not absolute contraindications to pregnancy, they require preconception counselling and close management by doctors of respective specialties before and during pregnancy.
To minimise risks, obstetricians should involve a diabetes team to take care of the patient.
During pregnancy, the mother should aim to keep fasting blood glucose levels at < 95 mg/dL and two-hour postprandial levels at ≤ 120 mg/, while glycosylated Hb (HbA1c) levels should be maintained at <6.5 per="" cent="" p="">
Insulin is used to control blood glucose during pregnancy but in some cases, too much insulin can trigger hypoglycemic coma, in which case the pregnant woman and her family members should be instructed in giving glucagon if severe hypoglycemia occurs (blood glucose levels < 40 mg/dL).
Oral hypoglycemic drugs, such as Glucophage, are being increasingly used to manage diabetes in pregnant women because of the ease of administration and the low cost.
Delivery is usually spontaneous at term although when there is a risk of stillbirth and shoulder dystocia which increases near term, delivery may be induced between 37 to 39 weeks of pregnancy to avoid stillbirth.
Dysfunctional labour, fetopelvic disproportion and shoulder dystocia may need Cesarean delivery.
After delivery, insulin requirement is decreased immediately.
Women who have had gestational diabetes should have a two-hour oral glucose tolerance test at six to 12 weeks postpartum to determine whether diabetes has resolved.
Women should continue to maintain a healthy lifestyle even if blood sugar returns to normal levels.
For more information, please contact consultant obstetrician and gynaecologist Dr Asra Qaseem Ali Khan at 17240444, visit www.alkindihospital.com or email info@alkindihospital.com.
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