Diabetes and Pregnancy

Gestational diabetes is a type of diabetes that is first discovered during your pregnancy, usually in the second or third trimester. The exact cause for gestational diabetes is not known, but there are hints that we can use to figure out the main cause. As the baby grows, the placenta will grow and secrete hormones to help in the baby’s development. These hormones interfere with the action of the mother’s insulin and cause insulin resistance, making it harder for the mother to use insulin and therefore needing it in larger quantities to become effective.

Women with gestational diabetes are unable to make and use all the insulin required during the pregnancy, so the glucose stays unused, unchanged, and builds up in the blood, causing elevated blood sugar levels, known as hyperglycemia.

  1. Being over 25 years of age.
  2. History of gestational diabetes.
  3. Previously given birth to large baby (more than 4 -4.5 Kg)
  4. Family history of diabetes.
  5. History of polycystic ovary syndrome.
  6. Being overweight or obese
  7. Excess weight gain during pregnancy (more than 14 Kg)
  8. Corticosteroid use during pregnancy.
  9. Twin or triplet pregnancy.
  10. Being a certain race (Middle Eastern or South Asian)

Now-a-days women that develop GM give birth to healthy babies, however lack of attention, monitoring, and care can lead to other outcomes. Untreated or poorly controlled gestational diabetes can negatively affect your baby. The high levels of blood glucose from the mother’s body can cross the placenta and end up in the baby’s blood, causing hyperglycemia in the baby. In this case the baby’s pancreas will need to produce more insulin to clear the excess glucose. The excess glucose and insulin the baby is getting will be stored as fat in their bodies. Putting on that extra weight can cause Macrosomia (a large baby). Macrosomic babies face difficulties during deliveries, such as shoulder or nerve damages. Also, the fact that their pancreas was making a lot of insulin during the pregnancy will cause them to make excess insulin at birth resulting to low blood sugar, known as hypoglycemia. This is why the babies’ blood sugar levels need to be monitored and controlled as soon as they’re delivered.

Other problems that may affect the baby after birth, if blood glucose levels are not controlled, include; low calcium levels, baby jaundice, and respiratory problems. Those babies are at high risk for childhood obesity and type 2 diabetes during adulthood.

After pregnancy, gestational diabetes usually goes away and you can go back to having normal blood sugar levels, but it will put you at a higher risk for having GDM in future pregnancies. Also, you will be at an increased risk to developing type 2 diabetes, especially if you are overweight, have a family history of type 2 diabetes, required insulin during your pregnancy, and your gestational diabetes was discovered early in your pregnancy.

Your blood glucose will be checked before discharge. It is essential to repeat your oral glucose tolerance test at 6 weeks after your baby is born (we know you will be so busy with your new life but please make sure to visit your doctor)

  1. Weight Loss: Lose 5-7% of your body weight.
  2. Physical activity: Minimal physical activity helps, even if it’s just a 2 hour weekly workout divided over four days.
  3. Diet: Eating a well-balanced healthy diet.

It is also very important to check you blood sugar levels yearly and before pregnancies to make sure you’re in the healthy range.

(See the pre-diabetes section)

Pre-pregnancy diabetes

This is either type 1 or type 2 diabetes that’s diagnosed before pregnancy. For women with this type of diabetes, they should be evaluated, and monitored by their doctors before they get pregnant.

Plan your Pregnancy

The first six weeks of pregnancy are very important since that is when the baby’s organs will start to form. If the blood sugar is not well controlled during this period, birth defects could happen as a result.

Ask your doctor about your Hemoglobin A1c level (a blood test that will show your average blood glucose level in the past 2-3 months). A result of less than 7% is a safe level for you to become pregnant. If you’re above 7%, you should use a contraceptive method or postpone your pregnancy until you improve your average blood sugar level (Hemoglobin A1c).

Also, women with diabetes who are planning to get pregnant should stop or change any medications that might affect the baby such as (cholesterol-lowering pills, or some high blood pressure pills). This should be done after you have discussed with your doctor of course.

Women taking diabetes medications might need to switch to insulin before getting pregnant.

An eye check, urine analysis (to check for proteins), and kidney function blood test should be done before planning a pregnancy with diabetics.

Finally, women with diabetes are recommended to take folic acid supplements 3 months prior to and during the first 3 months of their pregnancies. This will help prevent or reduce congenital defects that might affect the baby.

  1. EYE: Pregnancy might worsen the retinal changes if it was happen before pregnancy.So for that reason, the retina should be checked before pregnancy, during the first, second & third trimesters of the pregnancy.
  2. KIDNEY: Pregnancy might affect the amount of protein excreted in the urine by the kidneys, so checking the protein in the urine before and during the pregnancy is very important. Monitor blood pressure and if it needs treating or intervening, do this closely with your doctor to avoid any possible problems with the mother or baby.
  3. THYROID: Run a thyroid function blood test before, during, and after pregnancies, since women with diabetes (especially type 1 diabetes) are prone to thyroid abnormality.
Other problems that could happen to the mother if blood sugar was not well controlled before & during pregnancy.
  • Cesarean section delivery.
  • Spontaneous Abortion.
  • High blood pressure & Preeclampsia.
  • Recurrent infections.

Problems that could happen with the baby if blood sugar was not well controlled before & during pregnancy
  • Unexplained fetal death.
  • Preterm Delivery.
  • Macrosomia - large baby (weighs more than 4 Kilograms)
  • Birth trauma.
  • Respiratory problems after delivery.
  • Congenital malformations.
  • Neonatal low blood sugar.
  • Neonatal jaundice.
  • Neonatal low calcium levels.

  • Type 1 Diabetes 

    It is recommended for all women with type 1 diabetes to continue taking insulin injections four times a day. However, your doctor should evaluate you after delivery because you might only require half of your pregnancy doses or even less.

    Checking the retina after delivery is very important giving that pregnancy can have an affect on the retina a whole year after delivery.

    A thyroid function test should be done because up to 25 % of women with type 1 diabetes develop thyroid abnormality after delivery.

  • Type 2 Diabetes 

    If you are planning to breast-feed and were taking diabetes pills before pregnancy, you should continue with insulin therapy till you stop breast-feeding. Insulin doses are usually required to be cut in half compared to the insulin doses during pregnancy. If you were already taking insulin before pregnancy, then you should go back to your pre-pregnancy doses. This should be discussed in more detail with your diabetes specialist or doctor.

Dr Abdulmohsen a member of the Kuwait Diabetes Team is more than happy to receive your questions regarding pregnancy and diabetes. Hurry and book your consultation appointment to avoid future disappointment!

Remember if you have developed GDM, arrange to have a repeat of your oral glucose tolerance test in 6 weeks once your baby is born and a fasting blood test with every birthday of your child. (Mark your calendar) . Happy deliveries.

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