Pregnancy and Diabetes

Although the expectant mother with pre-existing diabetes is often worried that she will transmit her diabetes to her baby, most babies born to women with diabetes do not contract the condition.

• The babies of women with type 1 diabetes have a 1-3% chance of having diabetes.

• The babies of fathers with type 1 diabetes have a 3-6% chance of having diabetes.

• The babies of a parent who gets type 2 diabetes after age 50 have a 7% chance of having diabetes.

• The babies of a parent who gets type 2 diabetes before age 50 have a 14% chance of having diabetes.

However, the risk of congenital abnormalities in the babies of women with diabetes is three times higher than in the nondiabetic population. Careful control of blood glucose levels immediately before and during pregnancy can reduce this risk significantly.

High glucose levels during pregnancy can cause birth defects, macrosomia (abnormally large body size), and low blood glucose in the baby, as well as urinary tract infections in the mother.

Special measures ensuring the health of the pregnant diabetic and her baby include avoidance of oral hypoglycemic agents. Instead, your obstetrician will usually switch you to management with insulin therapy with frequent self-monitoring of your blood glucose. To ensure adequate fetal nutrition, weight reduction is not recommended during pregnancy.

Though approximately 50% of pregnant women with diabetes undergo cesarean birth due to problems including pre-eclampsia, abnormally large babies and abnormal fetal heart rate, vaginal delivery can be a viable option to many.

In the past, since many diabetic pregnancies persist beyond fullterm, producing large babies, it has been suggested that delivery should be induced early, at 37 to 38 weeks, especially if glycemic control during pregnancy has been inadequate. Currently, the treatment of choice has moved away from elective cesarean section and toward labor induction.

During the birth itself, there is an increased risk of failure to progress and injury to the mother, so labor and delivery must be carefully monitored. Insulin dosage will need to be adjusted in the postpartum period.

Pregnant mothers with diabetes should seek the care of a maternal-fetal medicine specialist or endocrinologist for guidance either in the pre-pregnancy period, or early in the course of pregnancy. Regular monitoring should continue throughout the pregnancy and postpartum period.

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