Diabetes and Pregnancy

Diabetes is the most common complication in pregnancy, in fact some studies show one in 5 women is at risk for diabetes in her pregnancy. In my gyno practice we urge women to be tested prior to getting pregnant because it is so important to stabilize their blood sugar to minimize the effects of diabetes on both mom and baby. We think there are far reaching health effects of being diabetic in pregnancy. In women with Type I Diabetes prior to pregnancy, the ones who are the most ill with kidney or vascular problems are the ones with the worst outcomes. But Type 2 Diabetes is a risk factor for problem pregnancies as well.

We even think that in childhood there is likelihood that pre-diabetes (insulin resistance) may be caused by fetal life exposure to blood sugar levels that are too high. AS we get older we are more likely to lose cells from our pancreas and thus we become diabetic. Why this may preferentially happen in pregnancy we don't really understand. When you are being checked in each day at your prenatal appointment, do not be alarmed if you have sugar in your urine. Women have high blood volume, and they process more substances into their urine and so it is more likely that even a healthy women might spill some sugar in their urine. it takes more sophisticated tests than that to detect diabetes in pregnancy.

High blood sugar can affect your developing fetus in many ways, the heart, the kidney and the liver of the baby are all affected. Actually the brain is not, although we used to worry that high levels of ketones, the result of metabolism complicated by high blood sugar used to be thought of as a problem for the developing fetus. The blood stream of the developing baby in a diabetic pregnancy will begin to have more insulin and insulin-like growth factors and more of the hormone leptin which controls obesity. After birth the baby can then have problems with the baby's blood sugar going too low (hypoglycemia). The better mom's blood sugar is the less likely the baby will be diabetic or obese at birth.

If you struggled with diabetes in pregnancy you have over a 70% chance of being diabetic in the next pregnancy. If you are diabetic entering a pregnancy the worse off your sugar control is the more likely you will even miscarry to begin with. Sadly in the miscarriages studied the babies are more likely to be abnormal from diabetic pregnancies and there are specific birth defects that the babies are likely to have.

So if you are thinking of becoming pregnant and you want to have the healthiest outcome possible, talk to your gyno! If you have a story to share about how you successfully conjured diabetes pre-pregnancy let us know!


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