Diabetes in pregnancy can be gestational (only during the pregnancy) or pre-gestational, where patients have diabetes outside of pregnancy. Both require patients and providers to work together to optimize blood glucose control for the best outcomes for the mom and the baby.
Over 8 million women in the United States have pre-gestational diabetes, which includes Type 1 and Type 2 diabetes mellitus. Type 1 diabetes is an autoimmune condition where the pancreas cells that produce insulin are destroyed by the body’s own immune system – leading to a need for insulin replacement.Type 2 diabetes is more common, usually occurs late in life, and is caused by insulin resistance. This means that even though the pancreas is producing insulin, the body is not able to utilize it appropriately. Some patients can control their Type 2 diabetes with diet and exercise alone, while others may require medications or even insulin.
What many patients don’t know are the risk factors associated with poorly controlled diabetes for both pregnancy and life long. Additionally, the effects of poor glucose control last for several weeks, so it’s best to have good glucose control prior to becoming pregnant. Diabetes control is usually measured with a blood test called hemoglobin A1C, which represents glucose control over the past 3 months. A normal hemoglobin A1C is less than 6%. A pre diabetic hemoglobin A1C is between 6-6.4%. Diabetes is diagnosed when the hemoglobin A1C is 6.5% or greater. An elevated hemoglobin A1C during the first trimester when the baby’s organs are developing is associated with congenital fetal abnormalities, such as heart defects, skeletal malformations, and central nervous system anomalies. The higher the hemoglobin A1C, the greater the association with a fetal anomaly. Also, hormonal changes during pregnancy alter the body’s response and glucose and insulin, frequently worsening certain long-term diabetes complications. Thus, it’s crucial to optimize blood glucose control prior to becoming pregnant.
In addition, blood glucose control should be well-managed throughout pregnancy to improve the health of mom and baby. Poor glucose control can increase risks of a large baby requiring a c-section, trauma to the mom or baby during delivery, developing a blood pressure complication necessitating early delivery or additional treatment. Some patients may feel that a bigger baby means a healthier baby, but this is not necessarily true. If a newborn is large secondary to poor diabetes control, he/she can need NICU admission, fluid supplementation, and medical treatment to correct the glucose-insulin imbalance after birth. On the other end of the spectrum, a long history of poorly controlled diabetes leads to vascular damage and increases the risk of having a small baby or even stillbirth.
The longterm medical complications for patients with diabetes are diverse and sometimes life-threatening. Diabetes impacts blood vessels and ultimately can damage eyesight leading to blindness, impair kidney function requiring dialysis, and affect blood flow to the lower extremities and lead to infection or need for amputations. Diabetes mellitus is equivalent to coronary artery disease, which means it can have the same impact on heart health as some heart conditions. It increases the risk of heart and stroke – both which can cause significant disability or death.
With the incidence of diabetes on the rise nationwide, and particularly in Texas, I urge all women to at least visit a primary care provider to be screened. The American Diabetes Association recommends all women begin screening for Type 2 diabetes mellitus annually at age 45 or sooner if you have risk factors. If you are diagnosed, realize the potential for complications and start taking ownership of your health early. It’s never too late to change your diet or start exercising – but be sure to speak with a medical provider before making major adjustments to your lifestyle.
Dr. Parin Patel is an OB/GYN Resident Physician at University of Texas Medical Branch. She is the District XI Toy Advocacy Fellow, which is a fellowship focused on Advocacy and Leadership.