Let’s be informed about the diabetic risks during pregnancy and things to consider

By: - 14th November 2018

Diabetes is the most common medical complication of pregnancy. This can be detected by the fasting blood sugar (FBS) done at the first visit with your doctor or midwife usually around 6 weeks of gestation

Diabetes can be categorized in 2 ways during pregnancy.

  1. Pregestational or overt diabetes.
  2. Those who were known to have diabetes before pregnancy. Usually, in this category, the embryo, fetus, and mother frequently experience serious complications directly attributable to diabetes. The likelihood of successful outcomes is related to the degree of blood sugar control. Therefore, it is very important for a woman to wait to conceive until the condition is controlled and suitable for pregnancy, with the medical advice provided at pre-natal clinics. In pre-natal clinics, you will also be informed of appropriate birth control methods to delay conception. If you are afflicted by such a condition, delaying conception according to doctor’s advice will help you avoid many complications.

  3. Gestational diabetes.
  4. Those diagnosed during pregnancy. Mothers who develop diabetes after getting pregnant and mothers who did not know that they had diabetes from before pregnancy fall under this category. Therefore, every pregnant mother is tested for diabetes between week 24 and 28 using oral glucose tolerance test (OGTT). Obese mothers, mothers with a family history of diabetes, mothers who are 35 years old or over, mothers who have a history of giving birth to babies who weigh over 4kg/congenital abnormalities/unexplained still birth and being south Asian we all are at risk of developing this condition.

However, in both categories, expectant mother’s diabetic condition is controlled using same methods. That is either with diet control or hypoglycaemic medications. Diabetic mothers are asked to do daily blood glucose self-monitoring if possible. Otherwise routine blood sugar tests should be done until the delivery. Regular antenatal clinic visits and ultrasound scans specially the anomaly scan, are important in identifying the associated complications early. Then the obstetrician can arrange the management protocol depending on the condition of the mother and baby.

How to control blood sugar during your pregnancy:

When you are diagnosed with having a high blood sugar level your obstetrician will direct you to an appropriate management plan depending on the test results. If the blood sugar can be controlled through diet control, then a qualified dietician would help you to prepare a proper diet chart to ensure that you will get adequate nutrition as well as the blood sugar control. If the diet control is not sufficient then you will have to start oral hypoglycaemic drugs or insulin depending on your blood sugar levels and other health conditions. You should follow the advice given by your obstetrician and check the blood sugar levels regularly in order to obtain a better outcome.

If you have completed week 20 check your blood pressure at least once a week.Do the necessary scan tests at the right time periods according to the doctor’s recommendation in order to check the growth of the baby.

Problems that can be seen in diabetic mothers and babies.

Mother with diabetes
  • Increased risk of miscarriages.
  • Death due to diabetic ketoacidosis or hypoglycaemia.
  • Preeclampsia.
  • Cardiac problems.
  • Diabetic nephropathy.
  • Diabetic retinopathy.
  • Infections
  • Macrosomia (Large babies).
  • Congenital malformations like heart and spinal anomalies.
  • Sudden unexplained still births.
  • Neonatal hypoglycaemia.
  • Traumatic birth injury (Shoulder dystocia).
  • Neurological defects.
  • Hyperbilirubinaemia (Jaundice).

In principle, provided the pregnancy has gone well, management attempts to achieve a vaginal delivery after 38 weeks of gestation. If there are any risk factors, then can go for a caesarean section. However, the ultimate decision will be determined depending on the status of the mother and the baby.

An article prepared in consultation with Professor of University of Kelaniya, Dr. Tiran Dias, Gynecologist of Colombo North Teaching Hospital

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