Frequent symptoms of either hypo or hyperglycemia may occur, but if symptoms are unknown to the woman may be associated with normal pregnancy announces and not followed up on. "The severity of the symptoms and the rate at which they develop may differ, depending on the type of diabetes." (Clark, 2004, p. 3) Increased urine production, glucose in the blood and urine, ketones (undigested protein) in the blood or urine, increased number of infections and decreased or limited healing of such infections, weight loss, or weight gain and occasionally (in extreme cases) numbness and/or tingling in extremities and vision disturbances are all symptoms of diabetes but as one can see from the list if such changes occur during pregnancy they could be attributed to normal pregnancy related changes, unless they become severe.
Particular attention should be paid to hypoglycemia and ketosis. Blood sugar control is essential, even in the first weeks after conception. Indeed, careful monitoring should begin as soon as pregnancy is planned, even before pregnancy is confirmed. (Edelwich & Brodsky, 1998, p. 198)
The value of early treatment is of course recognized but without clear teaching and observations the pregnant women is at increased risk for many symptoms as well as long-term complications of the disease.
Increased glucose in the blood and/or urine as well as the presence of ketones, or unprocessed protein can be the early sign of the disease's development during pregnancy and if these findings are persistent a fasting blood glucose test should be taken. If such a test shows increased blood glucose upon fasting diabetes should be assumed and treated. (Feinbloom, 2000, p. 15)
Implications for pregnancy:
If the complications created by hyperglycemia are significant and persistent during pregnancy the individual woman is at risk for accelerated progression of the secondary complications of diabetes, including high blood pressure, heart disease, vision decrease or blindness and increased weight gain. Preeclampsia, and severely increased level of blood pressure during pregnancy is also much more likely in women with diabetes during pregnancy, and this in and of itself creates extreme duress on the mother and possibly the infant and complications that must be treated, often with bed rest and pharmacological treatment, specific to pregnancy.
Diabetic mothers are more prone to toxemia and infection during pregnancy (Hotchner, 1979); one-fourth to one-half of all diabetic mothers can expect to experience preeclampsia, eclampsia, or hypertensive disease during pregnancy (Moore, 1983; Ziegel & Cranley, 1984). Eclampsia is a leading cause of maternal death. In the early decades of this century in the United States, death from eclampsia accounted for one-quarter of all maternal deaths (Slemons, 1941). Thus, the diabetic mother is also at risk during pregnancy. (Mansfield, 1986, p. 95)
Water retention and excessive weight gain are also common, and if diabetes is present before or persists after pregnancy this weight gain may be very difficult to overcome after pregnancy.
Implications for the infant:
Different gestational ages of the infant are differently affected by hyperglycemia but;
Much of a baby's critical development including heart, brain, spinal column, nerves, and muscles occurs during the first six to eight weeks after conception. When diabetes is well controlled in early pregnancy, the chances of birth defects associated with diabetes drop dramatically. (Edelwich & Brodsky, 1998, p. 198)
It is therefore essential that early detection of diabetes, gestational or otherwise is essential to ensuring reduced risk of complications for the fetus, as well as the long-term complications for the mother.
An unplanned pregnancy in which blood sugar has not been well controlled will certainly raise fears of possible birth defects. (Leung, Kamla, Lee & Mak, 2007, p. 38)
Fetal mortality is a not so uncommon occurrence among unplanned pregnancies, associated with diabetes and as the age of women who are childbearing increases these possibilities as well.
Diabetes is another chronic disease that becomes more prevalent with advancing age. It has been linked to a greater likelihood, as much as eight to ten times greater, of fetal or perinatal mortality (Galabin, 1886; Moore, 1983; Naylor, 1974; Niswander & Gordon, 1972; Pedersen, Tygstrup & Pedersen, 1964). Intrauterine or perinatal death or fetal distress may be the result of ketoacidosis with the increasing likelihood of fetal malformation or intrauterine death; preeclampsia; hypertension; difficulties in labor; a major malformation; and immaturity or respiratory distress (Beischer & Mackay, 1986; Ziegel & Cranley, 1984). In addition, maternal diabetes usually promotes excessive growth of the fetus, especially toward the end of pregnancy; the high insulin levels in the fetus act as a growth factor (Ziegel & Cranley, 1984). An oversized fetus may result in prolonged or obstructed labor and an increased likelihood of an operative delivery. (Mansfield, 1986, p. 95)
The increasing incidence of diabetes, as well as the decreased average age of onset and an increased age of childbearing are all considerations that are specific to the concerns of diabetes occurring simultaneously with pregnancy. The development of gestational diabetes is also likely to increaser in occurrence with the development of earlier onset diabetes. Nurses and doctors must be vigilant in the treatment of diabetes in pregnancy, as there is considerable increased risk for mother and child with regard to this occurrence and the development of long-term complications, such as those associated with diabetes, alone are often accelerated with pregnancy as symptomology of diabetes can increase, especially if one is unaware of the condition. As the demographics of obesity, and diabetes continue to change pregnancy will continue to occur, more frequently, simultaneously with pregnancy.
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Clark, M. (2004). Understanding Diabetes. Hoboken, NJ: Wiley.
Edelwich, J., & Brodsky, a. (1998). Diabetes: Caring for Your Emotions as Well as Your Health. Reading, MA: Perseus Books.
Feinbloom, R.I. (2000). Pregnancy, Birth, and the Early Months: The Thinking Woman's Guide (3rd ed.). Cambridge, MA: Perseus Publishing.
Leung, R.W., Kamla, J., Lee, M., & Mak, J.Y. (2007). Preventing and Treating Type 2 Diabetes through a…