Women with diabetes can and do have healthy babies all the time. It doesn't cost them their lives or health, either. The survival rate for pregnancy is no different between women with and without diabetes, as long as the woman with diabetes takes care to practice tight blood glucose management and treats any diabetes complications before becoming pregnant. And chances are excellent that her baby will be just as healthy as a baby born to a mother without diabetes.
But there are risks. High glucose levels early in pregnancy may cause miscarriage or improperly formed organs in the baby. High glucose levels later in the pregnancy put the mother at risk for hypertension and preterm labor as well as possible worsening of any diabetes complications. High blood glucose levels later in pregnancy can cause the baby to grow too large and cause problems with delivery.
Pregnancy puts stress on any woman's body. This is why it is so important that you and your health care team keep a close watch on your health before and throughout your pregnancy. But here's the good news: When women with type 1 diabetes who have been pregnant are compared to women with type 1 diabetes who have never been pregnant, about the same number of women in each group show signs of diabetes complications. Being pregnant doesn't seem to raise your risk for complications over your lifetime.
364 ADA COMPLETE GUIDE TO DIABETES FACT OR MYTH? (Continued)
With newer insulins, self-monitoring of blood glucose levels, and improved techniques for early detection and treatment of complications, women with diabetes have entered an era of expanded possibilities. Don't let old-fashioned thinking stop you from working toward having a healthy baby.
may also be an issue: The mother's blood glucose is directly related to the risks to the growing baby. You also need a complete evaluation of your overall health and to check for any complications from diabetes. Because your diabetes management may change, meeting with a dietitian or diabetes educator will help.
Genetics. Whether you are a potential mother or father with diabetes, you may have concerns about your child someday developing diabetes. The best time to assess the genetic risk of your child developing diabetes is before pregnancy.
Type 1 diabetes is caused by an autoimmune attack on the pancreas that destroys the insulin-producing cells. A child born to a parent who has type 1 diabetes is at slightly greater risk of developing type 1 diabetes than children of parents without diabetes. The risk is slightly higher when the father has type 1 diabetes. Researchers have identified genes that could play a role in type 1 diabetes. But it is not yet clear what percentage of children who inherit a "diabetes" gene go on to develop diabetes or what environmental factors are also involved.
If a baby is born to a mother who is age 25 or older and has type 1 diabetes, that baby has a 1 percent risk of developing diabetes. If the mother is younger than age 25 at the time the child is born, the risk increases to about 4 percent. If the father has type 1 diabetes, the risk for the child of developing diabetes is about 6 percent. Each of these risks is doubled if the parent with type 1 diabetes developed it before the age of 11. If both parents have type 1 diabetes, the risk is not known but is probably somewhat higher. A child born to parents who do not have diabetes has a 0.3 percent risk of developing the disease.
Development of type 2 diabetes seems to depend on both genetic and lifestyle factors. Type 2 diabetes tends to run in families. Research on families with type 2 diabetes shows that you can inherit genes that increase your tendency to develop type 2 diabetes. Studies of twins have shown that genetics play a very strong role in whether a person develops diabetes, especially type 2 diabetes. Obesity also tends to run in families, and families tend to have similar eating and exercise habits.
If you have a family history of type 2 diabetes, it may be difficult to figure out whether your diabetes is due to lifestyle factors or genetic susceptibility. Most likely it is due to both. But just because you may have a tendency toward developing type 2 diabetes does not mean that insulin resistance cannot be prevented or reversed. In a large national study called the Diabetes Prevention Program (DPP), participants who lost a modest amount of weight (5-10% of total weight) and participated in a moderate amount of exercise (150 minutes of walking per week) were able to delay or prevent type 2 diabetes even in the face of genetic susceptibility.
If you are concerned or have questions about the likelihood of having a child with either type 1 or type 2 diabetes, ask your provider to refer you to a medical geneticist or genetic counselor. They are trained to assess the contributions of genetic and environmental factors in causing many diseases, including diabetes. They will know the results of the latest diabetes and genetics studies and studies to prevent diabetes in high-risk individuals.
Mother's Health. Before becoming pregnant, you need a thorough physical exam. Any problems that could jeopardize your health or that of your baby will be assessed. These problems include high blood pressure, heart disease, and kidney, nerve, and eye damage. If you have any of these complications, they need to be treated before you try to conceive. Even kidney transplant recipients who are otherwise healthy have had babies. Your A1C level will be measured, as well as your thyroid function, if you have type 1 diabetes. In addition, your exam will include a review of all the medications, herbs, and supplements you are taking to make sure they are compatible with a safe pregnancy.
In rare cases, diabetes-related problems may be so serious that it's safer to avoid pregnancy. If you have untreated high blood pressure, cardiovascular disease, kidney failure, or crippling gastrointestinal neuropathy, think carefully about this decision. Pregnancy can make these conditions worse, or they can lead to related problems, such as stroke or heart attack.
If you have any signs of heart disease, such as chest pain on exertion, an electrocardiogram may be done. Signs of nerve damage will also be checked. If the nerves that control heart rate or blood pressure have been damaged, this can affect how you will respond to the physical stress of pregnancy. Neuropathy can also affect how well your body nourishes you and your growing baby, so tell your provider if you have had persistent problems with nausea, vomiting, or diarrhea.
Your prepregnancy exam will also include an evaluation of your kidneys. In women with high blood glucose levels and untreated kidney disease, kidney function can worsen during pregnancy. Fortunately, pregnancy does not appear to have long-lasting effects on kidney function. If you have kidney problems, you need to be prepared for a potentially more difficult pregnancy. This can include problems with edema
(swelling) and high blood pressure. If you have been treated with ACE inhibitors or ARBs for kidney disease or high blood pressure, your medication will probably be changed. Taking these drugs during pregnancy can cause kidney problems for the baby.
You will also be referred to an ophthalmologist who will examine your eyes, especially the retina—the part of your eye that senses visual images. Your pupils will be dilated so that the back of the retina can be checked for damage caused by diabetes. Untreated diabetic retinopathy may get worse during pregnancy and should be treated and stable before you become pregnant. You will continue to get your eyes examined throughout the pregnancy.
Glucose Management. Although birth defects occur in 1 to 2 percent of all babies born to women without diabetes, they occur more often among babies born to women with diabetes. These problems include abnormalities of the central nervous system, heart, and kidneys. The risks cannot be completely eliminated for anyone. But you can lower your risk to the same level as mothers without diabetes by keeping your blood glucose levels as close to normal as possible before and during the first trimester of your pregnancy.
Why is well-controlled blood glucose important before conception? You want your blood glucose levels to be as favorable to your developing baby as possible. All the baby's major organs are formed during the first 6 to 8 weeks of pregnancy,
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