Pregnancy Care for Diabetes Patients

Diabetes has become very common in its prevalence for a decade. Almost every fourth person is either diabetic or prediabetic in Pakistan, according to the second National Diabetes Survey of Pakistan (NDSP), 2016–2017. The disease does not differentiate between males or females. Any person with high-stress levels, obesity, and a sedentary lifestyle can be a victim of this disease. Other than this, diabetes may affect pregnant women. Here is an overview of diabetes during pregnancy.

Diabetes is defined as continuous high blood sugar levels in an individual. There could be three relevant states where a female can be diabetic and pregnant.

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Diabetes In Pregnancy 2x

Type 1 Diabetes:

In this, the patient acquires diabetes at a very young age. A diabetic female is already taking insulins/medications and she conceives. She is already aware of her medical conditions.

Type 2 Diabetes:

In this case, the person develops diabetes in adulthood and is using oral antihyperglycemic for controlling glucose levels. She is also already aware of her medical conditions.

Pregnancy-induced Diabetes:

In this, the abnormality in the glucose levels is noted for the first time during pregnancy. The reason during pregnancy is usually the placenta and placental. Hormones create insulin resistance and it gets in their maximum effect during the last trimester (last 3 months).

Now management and care vary for the above-mentioned scenarios.

Type 1 Diabetes and Type 2 Diabetes:

  1. Preconception Counselling:

  2. Counseling about preparing the body before conception is needed with strict glycemic control before and during pregnancy.
  3. Strict weight management should be advised.
  4. Glycemic control along with BSR/BSI and Hba1c should be explained, before conception to the patient.
  5. They should be explained about an increased risk of diabetic embryopathy. specifically, encephalopathy, microencephaly, and congenital heart diseases, which increase directly with an increase in HbA1c in the mother’s blood.
  6. Chances of spontaneous abortion also increase with uncontrolled diabetes.

 

  1. Pregnancy-induced Diabetes:

  2. As there is no prior history, the patient should be assured of keeping HbA1c in view.
  3. Diet management and weight management should be advised and continuously monitoring should be explained.
  4. They should be counseled for glucose monitoring to avoid fetal anomalies, preeclampsia, macrosomia, intrauterine fetal demise. Neonatal hypoglycemia and neonatal
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Myths/Taboos about Pregnancy and Diabetes:

Q:     Blood sugars are higher naturally in pregnancy.

Ans:  No, the blood sugars are not higher in pregnancy; it needs to be regularly monitored. In the case of family history on high-risk patients, they should be properly screened in the first trimester.

Q:     Strict glycemic control is not needed.

Ans:  It is a wrong concept, as strict glycemic controls are needed to keep the fetus safe.

Q:    Weight management is not important.

Ans:  Weight management is very important as an increase in weight can result in a deranged glycemic index. Weight plays an important role in controlling the existing diseases and helps in preventing complications.

Q:    Diet has no major effect.

Ans:  A well-balanced diet is needed to keep the weight and glycemic index in control.

Q: Diabetic females/healthy mothers will have big babies.

Ans:  It is another myth and does not affect all females.

Q: Insulins are needed in all cases.

Ans: It is again a myth that insulin is needed in all cases. No, it’s again not true, insulin is found comparatively safer but few drugs (metformin, glibenclamide) are found safe also.

Courtesy by: Dr. Sonia Bakhtiar