Challenging Nine Months: Fighting Risks of Pregnancy and Diabetes

By Owen C. Franklin

Today, there are so many unplanned pregnancies ?but people with diabetes have to plan.

When Patty Carlson decided to get pregnant, she knew she faced more than swelled ankles and morning sickness. As a woman with diabetes, Carlson was up against an even longer list of complications that, for some, seem too risky.

"There are people that don’t know anything about diabetes that would say we shouldn’t get pregnant," said Carlson. "But I had wonderful pregnancies. My two boys are perfect."

Carlson reflects a new hope. Today, if women with diabetes recognize risks and manage them with proper care, they can enjoy a successful and healthy pregnancy.

For many years, women with diabetes endured high rates of trauma during pregnancy. Kidney failure, miscarriage and birth defects were all too common. The effects of these tragedies are still felt today.

"I’ve known girls that are too scared and think they shouldn’t get pregnant," said Carlson.

But breakthrough research has made big strides in recent years. Now, doctors say they’ve identified the most critical factor in managing diabetes and pregnancy.

"The single most important factor is good glucose control prior to pregnancy," said Dr. Kimberlee Sorem, a maternal and fetal medicine specialist at Stanford University Medical School.

This marks an important shift in how doctors approach these pregnancies. In the past, doctors focused on glucose levels during pregnancy. While this practice is still important, it can be "too little too late."

A crucial reason for this strict preparation is that many problems can occur before a woman with diabetes even realizes she is pregnant.

Problems for the mother can arise if she is highly susceptible to certain complications such as kidney failure and high blood pressure. Some people with diabetes are more prone to these problems than others, and a pregnancy can exacerbate the risks.

A fetus’s organs develop in the first few weeks of pregnancy. If a woman’s glucose levels peak and drop during this delicate time, it could lead to birth defects — especially in the central nervous system.

"Today, there are so many unplanned pregnancies," said Dr. Sorem. "But people with diabetes have to plan."

The risks, however, don’t disappear once this precarious time is over.

High glucose levels are toxic to a growing fetus. If woman with diabetes does not keep tight glucose levels, she could increase the chances of miscarriage and stillbirth.

The growth of the fetus is another concern. Fetuses of women with diabetes may be supplied with high amounts of glucose. This glucose is often stored as fat. Poorly maintained glucose levels can lead to macrosomia, or overgrowth. Some babies of diabetic women weigh over ten pounds at birth.

"It sounds like a good thing, it sounds like a big healthy baby," said Dr. Sorem. "But it can pose complications for the baby and the mother."

If a woman with diabetes has high levels of glucose in her blood, her fetus will become accustomed to these levels. Once the child is born and the umbilical cord severed, s/he may have a strong reaction to the sudden drop of glucose. Some children born to women with diabetes experience seizures soon after birth.

Here, professional monitoring is key.

"The real danger is if [a drop in glucose] isn’t recognized," said Dr. Sorem. "If a team is checking the baby, they can make sure those levels don’t drop too quickly."

Women with juvenile onset diabetes must also take care when breastfeeding. These women can experience a quick drop in blood sugar levels when they nurse.

While these risks are serious, each can be overcome. Some people, however, aren’t prepared for this uphill battle.

"The problem is, not everybody who gets pregnant is responsible," said Paula Yutzy, a diabetes educator at the Diabetes Center at Mercy Medical Center in Baltimore, Maryland. "Some people have poor diabetes control and then they get pregnant without realizing it and have to put a whole bunch of things in order."

Yutzy says a first step is contacting diabetes specialists. Endocrinologists, maternal and fetal specialists and diabetes educators all offer different expertise.

"They can help you approach [pregnancy] in an organized manner," said Yutzy. "Not only do you have a good support system, you have a good team."

Equally important, says Yutzy, is controlling glucose levels. Yutzy says women should begin this process well before they even try to conceive — three to six months is a good time frame.

Well-controlled glucose levels require more daily glucose checks. While most people with diabetes are told to monitor their glucose levels at least four times a day — women with diabetes should make up to eight daily checks before, during and after pregnancy.

These daily checks indicate the first sign of a problem. An early alert can be a life saving tool. By seeking the right medical information and advice, women with diabetes have the tools they need to conquer the risks.

"Everything is negotiable," said Paula Yutzy, a diabetes educator at the Diabetes Center at Mercy Medical Center in Baltimore, Maryland. "Diabetes is a disease of choices. Today we have more choices. We have more tools, and a better understanding."

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