There are two different considerations regarding diabetes and pregnancy.
The first concerns the diabetic who wants to conceive and carry a healthy baby
to full term and delivery (pre-existing diabetes). The second involves the
development of gestational diabetes in a mum to be who showed no sign of the
disease prior to her pregnancy.

It is important that any woman with diabetes, who either wants to conceive
or finds herself to be pregnant, should control her glucose levels strictly – particularly
in the early months of pregnancy. The risk of serious birth defects is thought
to be increased by poor control of pre-existing diabetes and it is also thought
to be the cause of an increased risk of miscarriage.

For those women who develop gestational diabetes there is no increased risk
of birth defects although it is important that glucose levels are strictly
monitored and controlled to reduce the risk of stillbirth.

Diabetics – be the conditional gestational or pre-existing – tend
to deliver much larger babies than the average. The babies grow larger because
some of the additional sugar from the mother passes through the umbilical cord
into the blood stream of the baby where insulin then converts it into fat stores.
These large babies very often have to be delivered by caesarian section as
they are too large for a vaginal delivery.

Provided diabetes is properly controlled there is no reason why diabetic
women should not enjoy uncomplicated pregnancies and deliver healthy babies.
It is when the diabetes is not controlled that problems occur and complications
arise. These complications can lead to miscarriage, high blood pressure, premature
delivery and stillbirth.

Women with pre-existing diabetes may be offered a blood test to measure the
level of glycosylated haemoglobin before conception. This test provides an
accurate measure of how well glucose levels have been controlled in the preceding
months and can indicate the safest time to conceive. This test can also be
used throughout the pregnancy to measure how well the diabetes is being controlled.

The current recommendation is for all women to take folic acid before conceiving
to avoid the baby developing with neural tube defects. This advice is particularly
important for diabetic women as diabetes can increase the risk of this type
of birth defect.

Currently, oral medications used to control type 2 diabetes are not approved
for use during pregnancy so any woman who is using these drugs will need to
switch to insulin before conceiving and during her pregnancy.

Most pregnant women are tested for gestational diabetes at some stage between
the 24 th and 28 th week of pregnancy and those who develop this condition
usually find that blood glucose levels return to normal after the birth of
the baby.

Moderate exercise, with the approval of the obstetrician, is thought to assist
cells make good use of available insulin and so is recommended during pregnancy.

It is important that blood glucose levels are monitored closely during pregnancy
as insulin requirements can vary significantly from those required before conception.
Urine can also be checked for ketones as the presence of these can be an indication
that the diabetes is not being adequately controlled. If ignored a condition
called ketoacidosis can develop and this can jeopardise the life of the baby.

For the sake of the mum-to-be and the baby it is important that diabetes
be controlled during pregnancy to ensure the health of both.