Diabetes During Pregnancy

What is diabetes?
Diabetes is a condition in which the body can't make enough
insulin, or can't use insulin normally. Insulin is a hormone. It
helps sugar (glucose) in the blood get into cells of the body to
be used as fuel. When glucose can’t enter the cells, it builds up
in the blood. This is called high blood sugar (hyperglycemia).

High blood sugar can cause problems all over the body. It can
damage blood vessels and nerves. It can harm the eyes,
kidneys, and heart. In early pregnancy, high blood sugar can
lead to birth defects in a growing baby.

There are 3 types of diabetes:

• Type 1 diabetes. Type 1 diabetes is an autoimmune disorder.

The body's immune system damages the cells in the pancreas
that make insulin.
• Type 2 diabetes. This is when the body can’t make enough
insulin or use it normally. It’s not an autoimmune disease.
• Gestational diabetes. This is a condition in which the blood
glucose level goes up and other diabetic symptoms appear
during pregnancy in a woman who has not been diagnosed with
diabetes before. It happens in about 3 in 100 to 9 in 100
pregnant women.

What causes diabetes during pregnancy?

Some women have diabetes before they get pregnant. This is
called pregestational diabetes. Other women may get a type of
diabetes that only happens in pregnancy. This is called
gestational diabetes. Pregnancy can change how a woman's
 body uses glucose. This can make diabetes worse, or lead to
gestational diabetes.

During pregnancy, an organ called the placenta gives a growing

baby with nutrients and oxygen. The placenta also makes
hormones. In late pregnancy, the hormones estrogen, cortisol,
and human placental lactogen can block insulin. When insulin is
blocked, it’s called insulin resistance. Glucose can't go into the
body’s cells. The glucose stays in the blood and makes the
blood sugar levels go up.

Who is at risk for diabetes during pregnancy?

• You are more likely to get gestational diabetes if:
•
• You were overweight before you got pregnant.
• You are African-American, Asian, Hispanic, or Native American.
• Your blood sugar levels are high, but not high enough to be
diabetes.
• Diabetes runs in your family.
• You’ve had gestational diabetes before.

What are the symptoms of diabetes during pregnancy?

Common symptoms of diabetes

The most common signs and symptoms of diabetes are:

1- Frequent urination

Excessive thirst and frequent urination are classic symptoms of

diabetes.
Have you been going to the bathroom to urinate more often
recently? Do you notice that you spend most of the day going to
the toilet? When there is too much glucose (sugar) in your blood
you will urinate more often.

If your insulin is ineffective, or not there at all, your kidneys cannot

filter the glucose back into the blood. The kidneys will take water
from your blood in order to dilute the glucose - which in turn fills up
your bladder.

2- Disproportionate thirst

If you are urinating more than usual, you will need to replace that
lost liquid. You will be drinking more than usual. Have you been
drinking more than usual lately?

3- Intense hunger

As the insulin in your blood is not working properly, or is not there

at all, and your cells are not getting their energy, your body may
react by trying to find more energy - food. You will become hungry.

4- Weight gain

This might be the result of the above symptom (intense hunger).

5- Unusual weight loss

This is more common among people with Diabetes Type 1. As

your body is not making insulin it will seek out another energy
source (the cells aren't getting glucose). Muscle tissue and fat will
be broken down for energy. As Type 1 is of a more sudden onset
and Type 2 is much more gradual, weight loss is more noticeable
with Type 1.

6- Increased fatigue

If your insulin is not working properly, or is not there at all, glucose

will not be entering your cells and providing them with energy. This
will make you feel tired and listless.

7- Irritability

Irritability can be due to your lack of energy.

8- Blurred vision

This can be caused by tissue being pulled from your eye lenses.
This affects your eyes' ability to focus. With proper treatment this
can be treated. There are severe cases where blindness or
prolonged vision problems can occur.

9- Cuts and bruises don't heal properly or quickly

Do you find cuts and bruises take a much longer time than usual to
heal? When there is more sugar (glucose) in your body, its ability
to heal can be undermined.

10- More skin and/or yeast infections

When there is more sugar in your body, its ability to recover from
infections is affected. Women with diabetes find it especially
difficult to recover from bladder and vaginal infections.

11- Itchy skin

A feeling of itchiness on your skin is sometimes a symptom of

diabetes.

12- Gums are red and/or swollen - Gums pull away from teeth

If your gums are tender, red and/or swollen this could be a sign of
diabetes. Your teeth could become loose as the gums pull away
from them.

13- Frequent gum disease/infection

As well as the previous gum symptoms, you may experience more

frequent gum disease and/or gum infections.

14- Numbness or tingling, especially in your feet and hands

If there is too much sugar in your body your nerves could become
damaged, as could the tiny blood vessels that feed those nerves.
You may experience tingling and/or numbness in your hands and
feet.
How is diabetes during pregnancy diagnosed?

Doctors use these tests to find out if you have diabetes:

1- Fasting plasma glucose test. The doctor tests your blood sugar levels

after fasting for 8 hours and it’s higher than 126 mg/dL.

2- Oral glucose tolerance test. After fasting for 8 hours, you get a special

sugary drink. Two hours later your sugar level is higher than 200.

3- Random check. The doctor tests your blood sugar and it’s higher than

200, plus you’re peeing more, always thirsty, and you’ve gained or lost a

significant amount of weight. He’ll then do a fasting sugar level test or an

oral glucose tolerance test to confirm the diagnosis.

Any sugar levels higher than normal are unhealthy. Levels that are higher

than normal, but not reaching the point of full-blown diabetes, are called

prediabetes.

How is diabetes during pregnancy treated?

Treatment will depend on your symptoms, your age, and your
general health. It will also depend on how severe the condition
is.
 Treatment focuses on keeping blood glucose levels in the
normal range, and may include:

• A careful diet with low amounts of carbohydrate foods and

drinks
• Exercise
• Blood glucose monitoring
• Insulin injections
• Oral medicines for hypoglycemia

complications of diabetes during pregnancy

Most complications happen in women who already have
diabetes before they get pregnant. Possible complications
include:

• Need for insulin injections more often

• Very low blood glucose levels, which can be life-threatening if
untreated
• Ketoacidosis from high levels of blood glucose, which may also
be life-threatening if untreated
Women with gestational diabetes are more likely to develop
type 2 diabetes in later life. They are also more likely to have
gestational diabetes with another pregnancy. If you have
gestational diabetes you should get tested a few months after
your baby is born and every 3 years after that.

Possible complications for the baby include:

• Stillbirth (fetal death). Stillbirth is more likely in pregnant

women with diabetes. The baby may grow slowly in the uterus
due to poor circulation or other conditions, such as high blood
pressure or damaged small blood vessels. The exact reason
stillbirths happen with diabetes is not known. The risk of
stillbirth goes up in women with poor blood glucose control and
with blood vessel changes.
• Birth defects. Birth defects are more likely in babies of diabetic
mothers. Some birth defects are serious enough to
cause stillbirth. Birth defects usually occur in the first trimester
of pregnancy. Babies of diabetic mothers may have major birth
defects in the heart and blood vessels, brain and spine, urinary
system and kidneys, and digestive system.
• Macrosomia. This is the term for a baby that is much larger
than normal. All of the nutrients the baby receives come directly
from the mother's blood. If the mother's blood has too
much sugar, the pancreas of the baby makes more insulin to
use this glucose. This causes fat to form and the baby grows
very large.
• Birth injury. Birth injury may occur due to the baby's large size
and difficulty being born.
• Hypoglycemia. The baby may have low levels of blood glucose
right after delivery. This problem occurs if the mother's blood
glucose levels have been high for a long time. This leads to
a lot of insulin the baby’s blood. After delivery, the baby
continues to have a high insulin level, but no longer has
the glucose from the mother. This causes the newborn's blood
glucose level to get very low. The baby's blood glucose level is
checked after birth. If the level is too low, the baby may need
glucose in an IV.
• Trouble breathing (respiratory distress). Too much insulin or
too much glucose in a baby's system may keep the lungs from
growing fully. This can cause breathing problems in babies.
This is more likely in babies born before 37 weeks of
pregnancy.

Can diabetes during pregnancy be prevented?

Not all types of diabetes can be prevented. Type 1 diabetes
usually starts when a person is young. Type 2 diabetes may be
avoided by losing weight. Healthy food choices and exercise
can also help prevent type 2 diabetes.

How is diabetes during pregnancy managed?

Special testing and monitoring of the baby may be needed for
pregnant diabetics, especially those who are taking insulin. This
 is because of the increased risk for stillbirth. These tests may
include:

• Fetal movement counting. This means counting the number of

movements or kicks in a certain period of time, and watching for
a change in activity.
• Ultrasound. This is an imaging test that uses sound waves and
a computer to create images of blood vessels, tissues, and
organs. Ultrasounds are used to view internal organs as they
function, and to look at blood flow through blood vessels.
• Nonstress testing. This is a test that measured the baby’s heart
rate in response to movements.
• Biophysical profile. This is a measure that combines test the
nonstress test and ultrasound to check fetal movements, heart
rate, and amniotic fluid.
• Doppler flow studies. This is a type of ultrasound that uses
sound waves to measure blood flow.
A baby of a diabetic mother may be delivered vaginally or by
cesarean section. It will depend on your health, and how much
your pregnancy care provider thinks the baby weighs.
Your pregnancy care provider may advise an amniocentesis in
the last weeks of pregnancy. This test takes out some of the
fluid from the bag of waters. Testing the fluid can tell if the
baby's lungs are mature. The lungs mature more slowly in
babies whose mothers have diabetes. If the lungs are mature,
the healthcare provider may advise induced labor or a cesarean
delivery.

Key points about diabetes during pregnancy

• Diabetes is a condition in which the body can't produce enough
insulin, or it can't use it normally.
• There are 3 types of diabetes: type 1, type 2, and gestational
diabetes.
• Nearly all pregnant women without diabetes are screened for
gestational diabetes between 24 and 28 weeks of pregnancy.
• Treatment for diabetes focuses on keeping blood sugar levels
in the normal range.
• Women with gestational diabetes are more likely to develop
type 2 diabetes in later life. Follow-up testing is important.