DIABETES AND PREGNANACY

 

If a diabetic women wishes to have a child there is no reason apart from genetic aspect why she should avoid pregnancy, provided she is not suffering from any serious complications of diabetes and she is continuously under expert medical care. But if it is not as such, she may face multiple problems during pregnancy. As in the later stages of pregnancy she may develop and excessive accumulation of amniotic fluid. Moreover, the foetus is sometimes unusually large leading to difficulty in labour. Diabetes cause risk to the life of the mother as well as the child. The chances of a diabetic mother to lose her baby, either from a stillbirth or in the early neonatal period, are greater than those of a non-diabetic mother. This mother is under most careful supervision.

Congenital (presence since birth) malformation is more common is diabetic pregnancy and is the cause for majority of the deaths. There is great difficulty during delivery and both the mother and baby suffers from trauma. But due to recent advancements, nowadays the diabetic pregnancies are much more safer than anytime before. So, if proper care is taken then they can give birth to a normal child in a normal way.

Therefore, the proper treatment of a pregnancy diabetic patient requires the close and coordinated supervision of a team consisting of physician, obstetrician, anesthetist, nurse and dietician. The sooner the pregnancy is diagnosed, the better it is. Some non-pregnant diabetic women usually miss one or more menstrual periods, particularly if their disease is poorly controlled. For this reason a laboratory test for pregnancy is of greater that oral hypoglycemic agents might be teratogenic, and any diabetic patient who is taking these drugs and wishes to become pregnant should change to a preparation of insulin. Good control of the diabetes is the key to a successful pregnancy the blood glucose level should remain normal before and at the time of conception and throughout the pregnancy. The patient must be properly educated to take care of their diet and insulin dosage while at home. Diet is normally the same as to diabetic diet but there is need for additional milk. Generally, the vomiting, which occurs in early stages of pregnancy, may create practical problems for the physician and dietitian. The administration of highly purified unmodified and depot insulin twice daily is the best treatment for pregnant diabetic patients. After the diagnosis of pregnancy has been made the patient should be seen at first at fortnightly and later at weekly intervals. Continued control of the diabetes may be complicated by other factors: -

Such as smoking, increases the blood cholesterol and triglyceride levels. If the patient smokes, then there is need of taking more amount of beta-carbonate found generally in carrot, spinach, etc. Smoking, increase the changes of kidney disease. Patient who smoke 10 cigarettes a day, have 13% chances of developing kidney disease while who smoke 30 cigarettes a day, have 25% chances of developing kidney disease. Smoking also increases the chances of developing oral cancer. Diabetic patients may develop diseases of gum and supporting periodontal structures. Periodontitis and Gingitivis are very common in pregnant diabetic individuals. They suffer from bleeding gums and painful ulceration. Nerve damage may occur in diabetic patients leading to Neuropathy. They may experience limited joint mobility and joint aches. Due to nicotine present in cigarette, the blood pressure and pulse rate may show sudden rise. It is more complicated in hypertensive patients. In case of smokes, vascular disease of the extremities like leg and foot infections may occur which requires amputation.

It is said that good diabetic control is necessary. Because if excessive amounts of glucose are last in the urine because of the lowered renal threshold, it may be needed to give extra carbohydrate feeds between meals and sometimes at night, along with suitable amounts of unmodified insulin to avoid ketosis. But then also, the requirements for insulin usually increase as pregnancy advances. Blood glucose level is tested at short intervals to ensure that an increase in insulin dosage, based on misleading urine test, is not producing any sort of hypoglycaemia.

There is a risk of sudden intrauterine death in late pregnancy, therefore the diabetic women are rarely allowed to proceed to term and most are delivered between 37 th and 38 th week by induction of labour or if necessary by Caesarean section. Date of delivery is chosen by estimating the sphingomyelin/lecithin ratio in the amniotic fluid. It the ratio is above 2.0 the risk of respiratory distress in the infant is low. On the morning of delivery the usual breakfast and insulin in replaced by an intravenous infusion of 10% dextrose with 10 units of unmodified insulin added to each 500 ml. This should be given at a rate of 100 mg hourly. Whatever method, used administration of insulin should be stopped immediately on delivery and subcutaneous insulin resumed according to need as determined by urine and blood tests. Little no insulin may be required for 12 hours after delivery.

Tests for safe pregnancy are Glycated haemoglobin test once a month, Alpha-fetoprotein test once every three months, Periodic sonography and Non-stress test in the last two weeks of gestation.