Pregnancy and Diabetes: Risk Factors and Avoiding Complications Birth Weight

Birth Defects

Death in-Utero and Death Following Birth

Health of the Diabetic Mother

Preventive Measures

Testing

Pre-Conception Counseling

Medical and Advisory Team

Pregnancy requires more insulin in the body than normal because of the increased production of hormones that can lead to insulin resistance.

For a woman suffering from type 1 diabetes this is especially problematic because she already has difficulty producing or responding to insulin. Not only is the mother's health at risk, but the baby's health may suffer as well. As insufficient insulin causes blood sugar to rise in the mother, the sugar travels across the placenta to the baby. When the baby's blood sugar is high, the baby makes extra insulin to keep its own blood sugar normal. Problems of the developing baby may include larger or smaller size, increased risk for malformations or birth defects, or death in-utero. Fortunately, there are several precautions that a woman can take to dramatically decrease the risk of complications.

Large and small birth-weight babies are a significant problem in the deliveries of diabetic mothers. Smaller than usual size typically occurs when the mother has had diabetes for several years and has changes in her blood vessels. On the other hand, the combination of high sugar and high insulin make cause the baby to grow larger than normal. Large birth weight, macrosomia, occurs two to three times more often in diabetic pregnancies as in the general population. Risks of fetal macrosomia include:

Injury to the nerves to the arm called brachial plexus palsy

The collar bone may break, called fractured clavicle

The baby may need more help breathing at birth because it took longer for the head and shoulders to come out.

The doctors may need to use forceps or a suction cup to help with delivery

Due to the increased risk of fetal macrosomia, women with diabetes are three to four times more likely to have a cesarean section.

If a diabetic woman does not receive preconception care to regulate blood sugar levels, the rate of major congenital malformations in women with preexisting diabetes is ten percent...

zero to five percent for women who receive preconception care. Other birth defects frequently associated with diabetes include eye defects, respiratory tract defects, cleft palate, anal atresia/stenosis, hypospadias, urinary tract defects, and positional defects of the foot. The most common birth defects include damage to the heart and central nervous system.
Babies of a diabetic mother face an uphill battle for survival. The physician must closely monitor a diabetic woman during pregnancy for death in-utero. If the child makes it through delivery, three to five percent of pregnancies among women with diabetes result in death of the infant within twenty-eight days. In contrast, one and a half percent of women who do not have diabetes lose their newborn during this same time frame.

After birth, infants of diabetic mothers commonly have low blood sugar, breathing problems such as Respiratory Distress Syndrome and Transient Tachypnea, Polycythemia, and Meconium Plug.

The health of the diabetic woman is also at risk as a result of her pregnancy. These women are up to five times as likely to develop toxemia, a disorder of unknown cause whose symptoms include hypertension, protein in the urine, edema, headache, and visual disturbance. Diabetic women are also five times as likely to develop a condition called hydramnios which involves excessive amounts of amniotic fluid as women without diabetes.

The good news is that perinatal and neonatal centers that provide preconception counseling and early prenatal care report that the risks for diabetic mothers and their newborns do not exceed those for women without diabetes. But, a diabetic woman must carefully plan her pregnancy and must take adequate birth control measures to avoid pregnancy until she is medically ready to carry a child. It is recommended that a woman obtain good blood sugar control three to six months before getting pregnant. The main problem is that many women do not know they are pregnant until the baby has been growing for two to four weeks. For the diabetic woman this in unacceptable because blood sugar levels during these early weeks affect the baby's organs and can lead to birth defects. A blood test called the glycosylated hemoglobin test (HbA1c) evaluates how well diabetes has been controlled. This test is used along with home glucose monitoring to…