CHENNAI: In 2015, there were an estimated 199.5 million women living with diabetes. Two out of every five women with diabetes are of reproductive age, accounting for over 60 million women worldwide. These women are facing an unprecedented challenge, as diabetes not only affects them but also their progeny.
With advancements in medical science, it is becoming increasingly possible for women (with medical complications) to become mothers and women with diabetes is no exception.
However uncontrolled diabetes during pregnancy increases the risk of fetal and maternal complications such as early labor, birth defects and very large babies. The risk of these complications is directly proportional to the high blood sugar levels in the mother.
In developing countries including India, the risks are compounded by the to lack of awareness, resources and proper action. By doing pre-conception counseling and with optimal control of diabetes before, during, and after pregnancy, we can minimise maternal and fetal risks including birth defects.
Most experts recommend that all pregnant women be screened for gestational diabetes between the 24 and 28 weeks. Especially women at risk (who are overweight, over 35 years, have a family history of diabetes, had a previous diagnosis of gestational diabetes or had given birth to large baby) must undergo a full checkup for diabetes in every trimester, and an oral glucose tolerance test (GTT) is usually recommended.
If you already have diabetes and are planning to have a baby, it is desirable to achieve and maintain blood sugar levels for at least three months before conceiving. This is essential as the baby’s organs start developing in the first six to 10 weeks of the pregnancy.
The four fundamentals to manage diabetes during pregnancy are diet, physical activity, insulin and monitoring. A nutritionist can help plan a diet that can fulfill all requirements in the pregnancy without leading to excessive weight gain based on the body weight and other details. The key objective of dietary modifications is to avoid peaks in blood sugar levels and provide proper nutrition.
Physical activity is beneficial. If you aren’t exercising regularly, now is a good time to start, but check with your doctor about your planned activity and start slowly. You’ll need to plan your periods of activity along with your food intake and insulin injections.
Your insulin dose need to be adjusted periodically; as the hormones that accompany pregnancy interfere with the action of insulin, but in consultation with your treating physician only.
After delivery, if you had gestational diabetes, you should test for diabetes 6-12 weeks after you give birth and yearly after that. If you had diabetes before pregnancy, you will be able to go back to your pre-pregnancy insulin dosage very soon after delivery. Breastfeeding is good for the babies, as well as the women with diabetes.
Breastfeeding can also lower the amount of insulin you need. Oral anti diabetic drugs are not recommended during breastfeeding. The normal advice for pregnancy also applies to women with diabetes- eat a healthy, balanced diet, avoid smoking, and alcohol.
Women with diabetes who have good control can carry their baby to full term without any challenges. So, stay calm and be positive!
(The writer is a diabetologist from Chennai)