Planning a pregnancy with diabetes? Experts Tips

While the majority of women with diabetes have successful pregnancies. But, it's crucial to plan when you have diabetes carefully because uncontrolled diabetes can increase the risk of health complications for both you and your baby. These potential issues may cause delivering a larger baby, which can make labour more challenging, as well as increase the risks of miscarriage, congenital disabilities, and stillbirth. Furthermore, planning a pregnancy with diabetes requires a multi-dimensional approach and, support and proper guidance from healthcare professionals to plan a healthy pregnancy. A comprehensive team comprises a diabetologist, obstetrician, paediatrician and a dietician.

Diabetes as a diseasenbsp;

Diabetes is a multisystem disease that affects all the systems of your body and is a major deciding factor in deciding the outcome of pregnancy. A number of adverse events are associated with diabetes in pregnancy, including spontaneous abortion, congenital anomalies, congenital heart diseases, pre–eclampsia, foetal demise, macrosomia, neonatal RDS, neonatal hypoglycaemia and neonatal hyperbilirubinemia.

Planningnbsp; Pregnancy – Prerequisitesnbsp;

Checking blood glucose values and ketones

Planning a pregnancy requires strict control of blood sugars and avoiding sudden hyper and hypoglycemia. According to the American diabetic association, the following targets are recommended –

• Pre-prandial sugar – 60-99 mg/dl [ fasting]
• Post prandial sugar – 100-129 mg/dl [post - prandial]
• HBA1c – less than 6%
• Blood ketones - negative

Insulinnbsp; and oral medicationsnbsp;

Insulin has always been the first choice to control blood sugar during pregnancy as it does not cross the placenta; it is safe for the baby and provides stable blood sugar control.? Insulin can be delivered through a syringe, an insulin pen, or an insulin pump. All methods are safe for pregnant women and their children.

The body's need for insulin during pregnancy will increase, mainly during the last trimester. This increased need for insulin is due to pregnancy hormones primarily secreted by the placenta and the growing fetus. Also, these hormones may cause mild insulin resistance. As a result of these pregnancy hormones, the need for insulin will increase, creating an insulin-deficient state.?

If the patient takes oral hypoglycemics to control blood glucose, like metformin, it can be continued with insulin as required. The use of oral hypoglycemics is considered safe by some scientific societies, whereas others refuse it due to inadequate evidence. Also, insulin resistance during pregnancy often decreases the effectiveness of oral diabetes medication. For pregnant mothers who have gestational diabetes, meal planning and exercise often work and help in achieving an euglycemic range; however, if still uncontrolled, we put the patient on insulin therapy.??

Healthy Dietnbsp;

While planning a pregnancy, a diabetic mother should be in close association with a dietician who will devise a diet plan for the mother based on previous measurements of her blood sugar level to avoid sudden blood sugar level changes which may be detrimental to the pregnancy. However, care should be taken to meet the mother's nutrient demands. A healthy diet will comprise fresh vegetables, non-fat dairy products, fruits, Beans, lean meats, poultry and fish. The increase of 300 kcal/day is recommended during pregnancy and should be met. If the mother is obese, then during pregnancy, one should not lose weight as it may create a calorie deficit stage in the body; rather, the weight gain during pregnancy can be scientifically limited without negatively impacting pregnancy.

Weight Goals During Pregnancy By? American Diabetic Association?

Pre-pregnancy Weight????Recommended gain?

Underweight???? 28-40 pounds

Normal??????? 25-35 pounds??

Overweight?? 15 – 25 pounds?

Obese????? 11 – 20 pounds

These are just averages the ADA recommends to give an idea of adequate weight gain during pregnancy based on the pre-pregnancy BMI.

Lifestyle modifications and exercisenbsp;

A healthy lifestyle and including exercise in the daily routine is important. Many people don't consider exercising during pregnancy and think it harms pregnancy, but this is not the case. Certain forms of exercise and yoga are recommended, and the patient can get detailed information from their treating doctors. Exercising helps in decreasing insulin resistance. Exercising might be deferred in patients who have diabetic retinopathy and renal complications.?

Complication screeningnbsp;

All diabetic patients, before stopping contraception and planning for pregnancy, should undergo screening for the presence of any diabetic complications like renal dysfunction, diabetic retinopathy, neuropathy, acidosis or uncontrolled sugars. In such cases, pregnancy should be withheld till the time the crisis is controlled, and the decision for pregnancy should be based on the risk-benefit ratio to the patient.?

Good preconception care

Having good preconception care for women with diabetes, providing them with a supportive environment, giving them proper counselling on what to expect during pregnancy, and explaining the implications of diabetes on pregnancy and vice versa. Helping them make an informed decision. Also, an important part of this is to inform the patients about additional risks to the baby and additional screening [neonatal hypoglycaemia] needed for newborns of diabetic mothers.

Diabetes is a disease which needs to be put under strict control before planning conception to decrease any kind of morbidity or mortality arising as a complication of ‘ diabetes with pregnancy '.