MADISON – Diabetic women who want to become mothers face special risks: more than 20 percent of them are likely to have a child with birth defects if they begin a pregnancy while their blood sugar is poorly controlled.
Uncontrolled Blood Sugar Can Lead to Birth Defects
But that percentage can drop dramatically if women with diabetes take certain steps before conceiving a baby.
"The likelihood of birth defects could be reduced up to 90 percent if all diabetic women worked with a physician or nurse practitioner to manage risks before pregnancy," says Dinesh Shah, MD, professor of obstetrics and gynecology at the University of Wisconsin School of Medicine and Public Health.
Not so long ago, women with diabetes were discouraged from getting pregnant, because doctors feared bearing a child could lead to serious complications for both infant and mother. Shah says it's vital to determine first if women's blood sugar levels are in a safe range.
"If the mother has an unplanned pregnancy and she has diabetes that's not under control, there could be serious risk to the baby," he says.
Typically, a diabetic woman whose blood sugar is out of whack may have to wait up to six months to improve her chances for a safe pregnancy. Shah says thanks to advances in medical technology and greater education, there are fewer instances where he has to tell women with diabetes not to have children.
"We don't see as much of what we used to see 20 to 30 years ago where the diabetes had already damaged the kidneys, eyes and heart because it was not under control," he says. "We may delay conception and help them get to a better place, but it's very rare for us to tell someone they shouldn't get pregnant."
Diabetics hoping to have a child will usually be referred to an assortment of health care professionals, including a maternal-fetal medicine specialist, dietician, and a perinatal diabetes educator to advise them on how to go through their pregnancy with minimal complications.
After pregnancy is confirmed, diabetic mothers-to-be should also remember the following:
- Food intake need not be increased substantially to nourish the fetus. The appropriate increase in calories is equivalent to about a half-peanut butter and jelly sandwich and a glass of milk.
- Pregnant diabetics should take folic acid to minimize chances for birth defects. Folic acid occurs naturally in spinach and oranges, is added to some processed foods and is available over the counter as a supplement.
- Expectant mothers with diabetes should check blood sugar levels four to six times a day, especially if they have Type 1 diabetes, which requires constant insulin treatment. Type 2 diabetics (even those who may not need insulin therapy when not pregnant) will probably need to take more to keep blood sugar in check during pregnancy.
Dawn Davis, diabetes researcher at the University of School Medicine and Public Health, says all pregnant women should also continue with their normal exercise routine to help diminish excessive weight gain.
"If the woman was a couch potato, she shouldn't go out and run a marathon when she's pregnant," she says. "She should start with a low level of exercise and increase it over a period of time."
Davis adds that it's vital for pregnant diabetics to give birth in a medical facility that has the right resources on hand in case of emergencies.
"She should have the child in a hospital with a neo-natal intensive care unit, because it is not unusual for the baby to have low blood sugar or respiratory problems when born," says Davis. "You wouldn't want to have the baby at home or another location without a proper support system."
Overall, Shah believes that diabetic women who deliver healthy babies through healthy lifestyle practices can use that experience to stay motivated to manage their diabetes long-term.
"Pregnancy and children are powerful motivators, where the mother is willing to put in the extra effort, and we want to make sure they don't slide down to another level once their child is born," he says. "Since the baby is no longer the motivator after the pregnancy, we still want them motivated to live better lives and do what's necessary to keep their diabetes under control."