Healthy Pregnancy and Beyond

Here's what to do to keep your baby safe-and protect your own health, too

Diabetes Focus: Is there anything that makes it particularly difficult for a woman with diabetes to become pregnant?

Dr. Jovanovic: Surprisingly not, and sometimes we wonder why.

Occasionally, women with diabetes will develop polycystic ovarian disease, but the answer to your question is, no, women with diabetes can become pregnant as frequently as anyone else.

DF: Once a woman with type 1 or type 2 becomes pregnant, what are the risks to the mother and the fetus?

DR. J: A11 the risks are directly related to glucose control. Women can minimize the risks to themselves and to their fetus by eating and exercising correctly and by keeping a close eye on their blood sugar.

The risks to the fetus are serious. For women who are in poor control of their diabetes during pregnancy, there is an increased risk of spontaneous abortion. In addition, they have a 25 percent risk of giving birth to a malformed child and a 20 percent risk of having a stillbirth.

As far as the mother's health is concerned, those who are not in control of their diabetes are at risk of infection, hypertension and even retinopathy. The mother's body is working harder to support a fetus, and this puts a lot more stress on all of her organs including the parrcreas.

DF: What causes gestational diabetes?

DR. J: Gestational diabetes (GD) happens because of the stress of carrying a baby.

During pregnancy, the pancreas has to produce more insulin than normal. If it is already producing as much as it can, or if something else keeps it from upping production, then the body will not have enough insulin to maintain healthy glucose levels. When this inability to produce more insulin is added to the overall stress of pregnancy, gestational diabetes may result.

After the baby is born and the added stress of carrying a baby is removed, a woman's blood sugar may return to normal.

DF: Is there any way to know who's most likely to develop gestational diabetes?

DR. J: Every woman is at some risk of developing gestational diabetes. There isn't a group of women who are at no risk. The degree of risk comes from a combination of factors. Obesity is probably the number one risk factor, followed by having a history of diabetes in the family and becoming pregnant over the age of 30.

Other high-risk groups are Latinos, African Americans and Native Americans. Asian-Americans are at an ever-increasing risk as they adopt the American lifestyle and become overweight. So, if you are an African-American, Latino or Native American woman who has a parent with diabetes, are 30 or older and overweight, your risk of developing diabetes is high and your risk of developing gestational diabetes is even higher. Nonetheless, every woman should have a blood glucose test during pregnancy to make sure GD is not developing. If your doctor doesn't suggest it, insist on it.

DF: What are the health risks to a child who was born to a mother with uncontrolled diabetes?

DR. J: If children are horn big, say 9 pounds or more, and have a high level of fat tissue, several health problems may confront them throughout life. First, they are at high risk for developing diabetes. Second, they are starting off life overweight. Obesity may follow them around for the rest of their lives, making them susceptible to cardiovascular disease and other health problems.

DF: What are the health risks, post-pregnancy, for a mom who's had gestational diabetes?

DR. J: Although you do not necessarily develop diabetes after having gestational diabetes, there are some risks. Once a woman gives birth, and has returned to her pre-pregnancy weight, she may still have elevated glucose levels. In such a case, she is said to be prediahetic. And 10 percent of these women v-i11 develop type 2 diabetes. If, after three years, glucose levels still are not normal, thirty percent of these women will develop diabetes. After five years, the number jumps to 50 percent.

This is one reason why it is so vital to keep glucose levels in check during the months and years after you experience gestational diabetes.

DF: Should all women be, tested for diabetes when they are pregnant, or only those at high risk?

DR. J: Every pregnant woman needs and deserves a blood sugar test. It's not expensive, especially when considering the high cost of not detecting the diabetes.

So, if you or someone you love is pregnant, have them ask for a 10ucose challenge test (GC'T). It's very simple. A woman's blood is tested before and after taking a sugar drink. Unfortunately, today many physicians only test women identified as high-risk. This should not be the case. Diabetes can take anyone by surprise.

DF: What should a person do if a wife, sister or daughter has had gestational diabetes and has given birth to an overweight child?

DR. J: Nag them and make sure they take proper care of themselves. The mother at high risk of developing type 2 diabetes-and the child-needs help to insure proper development. Keep on them.

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