Pregnancy and Diabetes
Pregnancy and diabetes along with starting values of the mother's blood glucose will take center stage in this discussion. This is based on the report published in 2005 authored by Wender-Ozegowska, et al of the Department of Obstetrics and Women's Diseases, K.M. University School of Medical Sciences in Poznan, Poland.
Let's dig into the background of this report. Pregnancy and diabetes still pose a problem regarding the prevention of congenital malformations in the newborn of mothers who are diabetic. It does not pose a major threat as it once did before, thanks to studies and findings on what to do.
The aim therefore of this study was to analyze the occurrence of fetal deformity in cases involving pregnancy and diabetes. The researchers also tried to spot the termination points for the first trimester glycemia levels involving fetal malformation brought about by the disease.
What methods did they use? They collected the data from the case histories involving pregnancy and diabetes and the newborns in their department. They evaluated the mother's diabetes control record along with their A1c levels. They set the glucose cut-off values by using the statistics on the fasting, 1 hour and 2 hours after eating levels.
To find out how the control levels affect the chance of giving birth to a deformed baby, they studied 198 newborns relating to pregnancy and diabetes. They also followed 4700 babies born of healthy mothers and called this the control group. What are the results of this study? I bet you can't wait.
They identified fetal malformation of 8.6% involving pregnancy and diabetes and 3.8% of the control group. They went further than this for they also evaluated the 8.6% result with another diabetic group for fifteen years from 1988 to 1993 where they discovered that 6.2% showed malformation. This result is not significant.
However, although the A1c levels during the development of the baby's organs were not significantly higher, they proved that the risk for malformation was higher when the A1c level was over 9.3%. So even though a wide range of abnormalities were observed, it is good to know that with glucose control, the risk is lower.
Now let's go to their conclusions. They confirmed that pregnancy and diabetes still pose a risk for change in the fetal development despite better glucose control but more especially in mothers with a tendency to brittle glycemia during the first three months.
It looks like that keeping the fasting glucose levels below 5.8 mmol/l and the after eating levels below 9.1 mmol/l can be a factor in decreasing the fetal malformation. It is also useful to establish the cut-off values for fasting, 1 hour and 2 hour after eating levels.
As you can see, the prognosis from a major threat has changed. Tight control and meticulous management throughout pregnancy reduce complications to about the same rate as the rest of the population. The first trimester or the first three months are particularly important as this is the period of organ development.
Mind you, many of those who have gestational diabetes and the mild Type 2 may not need as tight a control as the cases involving Type 1 pregnancy and diabetes unless the status of the former gets worse. That is why it is important to monitor the glucose levels throughout.
GDM (gestational diabetes mellitus) happens to about 2 to 3% of pregnancies. This is why it is now routine to check this condition as soon as the pregnancy is diagnosed. The only way to do this is through a blood test. This test will also be repeated between the 24rth and 28th weeks.
The constant transfer of glucose to the mother as she nourishes the fetus through the placenta results in lower fasting glucose level. In addition, there are metabolic and hormonal changes that affect the action of the insulin. This raises the blood sugar level making it difficult to control the disease.
There is also the possibility of ketoacidosis with poorly controlled blood sugar. Ketones are bad for the fetus so it is good idea to check the mother's urine for ketones. Ketones may be due to missing a meal or snack so the body relies on the breakdown of fat for nutrition. How do we combat this?
Well, taking snacks more often and increasing the calorie intake will correct the situation. Make sure you eat a snack before bedtime so that the ketone will not sneak up on you at night. Most obstetricians recommend this. Also glucose monitoring is essential so follow the regimen as advised by the doctor.
The blood glucose when it rises, passes through the placenta into the baby. Now the trouble with this is that the insulin cannot go through the placenta so the baby's blood sugar level is unusually high when the mother's diabetes is not under control.
Then due to the rise of the blood sugar, the baby gains weight from the extra calories. The baby's pancreas become so used to making insulin to cope with the extra sugar that this is continued after birth when it is no longer needed. This will lead to low blood sugar or hypoglycemia.
Another study finds diabetes and obesity in pregnancy increases risks
Remember not to take oral hypoglycemic drugs because this may have an unfavorable effect on the fetus. Now thank heavens that the majority of pregnancy and diabetes cases end happily with normal healthy babies. Just keep working on the dietary control, glucose monitoring and exercise that's all recommended by your doctor and everything will be fine.
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