Pre-existing Diabetes and Pregnancy
Diabetes is associated with greater risks during pregnancy, particularly for the developing foetus but also for the mother. The good news is that with careful preparation, which should begin before conception, and modern high standards of care, over 90 per cent of diabetic pregnancies result in the birth of a healthy child. Similarly, the great majority of diabetic mothers sustain no harm as a result of pregnancy and childbirth. There are foetal and maternal risks (listed below), but they should not be a cause of alarm but rather regarded as the reasons why extra care is needed and worthwhile.
Risks to Baby
- Incidence of congenital abnormalities increased by a factor of 3 to 4. Good glycaemic control lessens the risk; poor glycaemic control increases the risk tenfold or higher.
- Greater incidence of foetal death, some of which may be connected with congenital abnormalities and poor glycaemic control.
- Greater incidence of complications immediately after birth, especially macrosomia, hypoglycaemia, respiratory distress syndrome, jaundice, birth trauma.
- Increased risk of diabetes developing in child.
Risks to Mother
- Greater risk of infection of the urinary tract.
- Greater risk of pre-eclampsia (the development of high blood pressure and fluid retention which requires monitoring and treatment). The risk is 10 per cent in diabetic mothers compared to 4 per cent in those who do not have the condition.
- Deterioration in glycaemic control, especially during the last six months of pregnancy, requiring higher insulin doses (Type 1 diabetes). Type 2 diabetes, previously managed by diet and/or tablets, usually requires insulin therapy.
- Greater rate of lipolysis increases the risk of ketosis and diabetic ketoacidosis in women with Type 1 diabetes. However, this is still uncommon.
- Severe morning sickness is a particular problem, especially for women with Type 1 syndrome. Repeated vomiting and inability to eat may lead to ketosis. Ketones must be monitored and anti-sickness drugs may be needed. Severe morning sickness may require hospital treatment so that fluids etc. can be delivered by an intravenous drip.
- Diabetic complications, especially retinopathy and nephropathy, can deteriorate during pregnancy, especially if advanced. Women with these conditions require particular care.
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