Pregnancy among diabetics is no longer taboo. Armed with medical advancements and a better understanding of the disease, reproductive-age women with diabetes can now beat the odds with active diabetic management before, during and after pregnancy.
Still, it is important to know the risks involved. Compared to women without the condition, those with diabetes are eight times more likely to have children with birth defects (two percent versus 15 percent), with older estimates as high as 25 percent. The health risks to both mother and baby make it imperative to employ strategies for a smooth pregnancy and uncomplicated delivery.
Diabetes before and during pregnancy
In 2008, the National Nutrition and Health Survey estimated that around 17.8 percent of Filipinos have diabetes or are pre-diabetic. What’s more, diabetes is now increasing among young people; eventually, there will be more pregnant women with diabetes.
About two to five percent of all pregnancies are complicated by diabetes. Diabetes that develops during pregnancy is called gestational diabetes mellitus (GDM), while diabetes before pregnancy is pre-gestational diabetes mellitus (PGDM). Both are associated with increased risk but it is uncontrolled PGDM that results in serious complications for both mother and child. Most women at average risk for gestational diabetes are tested between 24 to 28 weeks in their pregnancy—earlier if a health care worker suspects higher than average risk.
Hyperglycemia is the root cause of diabetic complications. Persistently high blood sugar damages the kidney, heart and nerves and can eventually lead to loss of sight, kidney failure, heart attacks, poor circulation, neuropathy and gangrene. During pregnancy, blood sugar levels may be more difficult to control and can lead to worsening of eye and kidney problems. Women with diabetes are also more susceptible to urinary tract infections, infections of vaginal area and pre-eclampsia, or high blood pressure sometimes complicated by convulsions. There is also an increased risk for miscarriage and difficult delivery.
Problems for the baby
Glucose or blood sugar passes through the placenta so if the pregnant woman has hyperglycemia, her baby will also have high blood sugar. If hyperglycemia is dangerous for the mother, it can be fatal for her baby.
Other major complications include:
• macrosomic or larger-than-usual babies who weigh up to 4.5 kilos, leading to a difficult vaginal delivery that may necessitate a cesarean section;
• birth injuries;
• premature delivery; and
• complications after birth such as respiratory distress syndrome, hypoglycemia and prolonged jaundice.