Diabetes in Pregnancy

In the spirit of studying for the exams, i'm going to write about the effect of pre-existing and gestational diabetes on the mother, the fetus (alright, i know it's American spelling although i've been adhering to the British system but "foetus" just looks weird...) and the neonate.


Why does pregnancy increase blood sugar levels?

Because the hormone progesterone and human placental lactogen is an antagonist of insulin (the hormone needed for glucose uptake into cells). Therefore, pregnancy causes a relative state of insulin resistance.


What does high blood sugar levels do to the mother?

Increased risk of...
1. infection - chorioamnionitis, candida, urinary tract infections

2. miscarriage

3. pre-eclampsia (high blood pressure > 140/90mmHg, proteinuria [protein in urine] and generalised oedema [swelling])

4. polyhydramnios (excessive fluid around the baby in the uterus. In diabetes, caused by excessive peeing by the fetus because glucose crosses the placenta by diffusion and hence baby has high blood sugar levels too and get the same symptoms as adults with diabetes.)

5. operative delivery - rates of caesareans at 50% in pre-pregnancy diabetes

6. postpartum haemorrhage (bleeding of more than 500ml by vaginal delivery or 1L by caesarean)


What does high blood sugar levels do to the fetus?

Increased risk of...
1. congenital malformations - 2-3 times that of normal population. The most common malformations are neural tube defects like spina bifida, anencephaly (no brain. I mean like literally, not because they are stupid) and cardiac defects.

2. perinatal death - perinatal mortality rate is doubled compared to normal population. Also increased risk of late and unexpected fetal death in utero (fetus dies in the womb).


What does high blood sugar levels do to the neonate?

Increased risk of...
1. macrosomia (big baby) - they have a smaller head to body ratio. Big babies aren't always a good thing because they are harder to deliver which brings me to the next point...

2. birth trauma - especially shoulder dystocia (baby's shoulder gets impacted on the mum's pelvic bone and gets stuck) which can then lead to fracture of the clavicles.

3. hypertrophic obstructive cardiomyopathy - too difficult for me to explain so i shall not attempt it...

4. respiratory distress syndrome - baby has trouble breathing

5. hypoglycaemia (low blood sugar levels) - because it's used to high levels of glucose from mum, therefore fetus produces lots of insulin. But after it's born there is no more glucose from mum but still alot of circulating insulin, hence baby's sugar levels drop.

6. low calcium and low magnesium levels - can lead to apnoea (cessation of breathing > 10 seconds) and seizures.

7. polycythaemia (increased amount of red blood cells) which can then lead to...

8. hyperbilirubinaemia (increased amount of bilirubin in the blood) from the break down of red blood cells

9. type 1 diabetes mellitus later in life


Now that you've seen the list of problems that high blood sugar levels can cause, the good news is, the risk of having these problems can be minimised/ameliorated by good (almost anal) control of the blood sugar levels.

All you've got to do is...

1. See a Dr regularly for check up and management of glucose levels and possible complications
2. See a dietitian who will teach you how to eat healthy
3. See a diabetes educator who will teach you what, when and how to use insulin and how to recognise hypoglycaemic episodes and manage it.
4. Exercise regularly
5. Monitor blood sugar levels 4 times a day aiming for a fasting level of <5.5 or <6.7 2 hrs after food
6. Jab yourself 4 times a day with insulin - unless your Dr says you don't have to


Easy as right?! NOT. Frankly speaking, it's a lot of effort and i have doubts about whether i could pull it off were i in this position. So kudos to those of you out there who are doing an excellent job. To the rest of us mortals, just think of the health of your baby and do it for him/her.

*Disclaimer* This post is in no way a substitute for proper tailored medical advice. Please seek advice from your doctor regarding the specifics. Please don't sue me if i gave some wrong information.