Diabetes - How To Control It In Pregnancy?

Pregnancy brings with it a set of challenges, and for a diabetic woman, andand these only increase further as the pregnancy advances. Earlier, A few decades ago, the risks of dealing with pregnancy and diabetes as a combination were too high. However, over the last few decades, things have changed over time. There have been several advances in clincial management. However, the age at which women are choosing to have a baby has gone up. On the other hand,to compound it, the age of onset of diabetes has come down drastically.

Management of diabetes in pregnancy has improved significantly and many diabetic women are able to have a smooth journey through their pregnancy with good outcomes for the mother and baby. However, the pregnancies are considered high-risk and require extra care and precautions. Frequent visits and strict monitoring of sugars and increased requirement of surveillance with ultrasound scans need to be explained to the future parents. These days, there are many diabetic women who go through pregnancy smoothly without major complications. Of course, there is extra care and precaution required, but it is not something that cannot be planned and managed well between the doctor and the mother-to-be.

The potential risks in diabetic patients for conception and pregnancy include the possibility of difficulty in conceiving, increased risk of miscarriage and higher chances of birth defects in the developing baby compared to the general population. Also, poor control in pregnancy may lead to large babies, preterm labour, higher risk of high blood pressure and risk of problems for the baby after birth such as difficulty in breathing etc. However, prompt and continuous control of sugar levels reduces these risks substantially.

The following are some rough guidelines for a pregnant diabetic woman.
Potential complications-

• Fluctuating sugar levels can be a reason for not being able to conceive, as the body does not see itself as healthy.
• It increased the chances of miscarriage.
• There are higher chances of birth defects in the developing baby due to very high sugar levels in the first trimester.

Preparation-

Pre-pregnancy care If you are planning for a pregnancy, meet with your doctor to review your sugar levels. Chalk out a plan with your doctor, taking into account your diet and nutrition, exercise, lifestyle, and medications.

• Diet: Ensure you cautiously decide what and how to eat ahead of your pregnancy. Moving away from refined carbohydrates and processed foods towards wholesome food items like whole grains, fresh fruits and vegetables will make a difference.
• Exercise: Build an exercise routine to suit your body and keep yourself active. It is very important to stay active so that diabetes is under control.
• Lifestyle: Quit smoking and reduce alcohol use. This helps in managing stress also, which can help keep diabetes under check.
• Medications: Folic acid is a very important prenatal vitamin that must be started prior to pregnancy. Check with your doctor on the medicines you are taking and if dose adjustments are required to get sugar levels under control, plan them out.

During pregnancy, constant monitoring and vigilance is required to ensure diabetes is under control.

• Let your diabetologist/ endocrinologist/ obstetrician or general practitioner know about your condition (stable/fluctuating) and your desire to fall pregnant prior to pregnancy.
• During pregnancy, constant monitoring and vigilance is required to ensure diabetes is under control.
• Let your gynecologist know about your condition (stable/fluctuating), and if you are doubtful about them being able to handle your condition, do not hesitate to change.
• Report to your diabetologist and obstetrician early in pregnancy so that the necessary modifications can be made.
• Regular self-monitoring of sugar has to be done and reported at regular intervals. Many consider switching to starting oral medications as the risk of transmission to the baby is less and the control over sugar levels is better. However, if the sugars are not under control, insulin may be started to improve the outcomes.
• Constant monitoring for daily blood sugars is essential.
• A regular, healthy lifestyle in terms of eating and sleeping should help keep the sugars under check.
• Constant monitoring of the baby is essential to ensure its normal growth with no developmental defects.
• To sum up, diabetic pregancies are on the rise and need appropriate pre-pregnancy and pregnancy care to ensure a healthy mother and baby.