Diabetes And Pregnancy

     Deciding to have a child is one of the most important decisions of
peopleís lives. Diabetes is a very serious disease. It attacks million people
around the world many of them women. These women one day may be thinking about
having a baby. Numerous precautions must be taken by women during pregnancy.

Special safeguard must be taken by women with diabetes. These precautions need
to be taken due to birth defects. "An estimated 1.5 million women of
child-bearing age in the United States have diabetes. A diabetic pregnancy is
one of the leading causes of birth defects." (Henderson pNA) Diabetes can
strike at any age and can occur in anyone. Although it is not exactly known for
sure about the what causes it. Diabetes is believed to do with the bodyís own
immune system attacking and destroying insulin producing cells in the pancreas.

There are two forms of Diabetes, Type I diabetes, also called insulin dependent
diabetes. The second form, Type II diabetes, or non insulin dependent diabetes.

Before insulin was introduced women with diabetes were told that pregnancy was
not for them. It is true that in the past, pregnancy did present major problems
for women with diabetes. In the pre-insulin era, "Many diabetic women died
before the child bearing age and those that survived were often infertile." (Ellenberg

696) Their babies did not often survive. When insulin became available in the

1920ís, pregnancies became more common with diabetic women. Yet, the number of
successful pregnancies remained far below that of women who did not have
diabetes. Today Tabarez 2 the news is good, It is now known that the key to a
healthy pregnancy for women with diabetes is tight blood glucose control. The
goal of tight control is to keep blood glucose levels as close to non-diabeteic
or normal as possible. Although the rate of successful pregnancies among women
with diabetes has improved, there are still some problems with to be concerned
about. "Pregnant women are who are insulin dependent Diabetic are more likely
to deliver children with birth defects and more likely to deliver stillborn then
the general population. They also have a much higher rate of miscarriages." (Casson

I.F. 275) We now know that many birth defects are related to the motherís
blood glucose control during the first eight weeks of pregnancy. What is
important to note is that many women may not even know they are pregnant at this
time. For women who have diabetes or with any pregnancy, the solution to this
problem is obvious. You must plan ahead for your pregnancy. If you are a
diabetic and donít already practice good diabetes control regularly, your
priority should change. "Patients with pre existing diabetes require intensive
insulin therapy before conception and during pregnancy. Glucose self monitoring
assists in achieving near normal glucose levels during pregnancy." (Pasui, K.

273) Women should maintain good blood glucose control three to six months before
she plans to become pregnant. Another problem that rarely occurs is stillbirth.

The baby dies before birth, still births used to occur more frequently among
women with diabetes. But now, with care and good diabetes control the chances
for still births are low. One more problem , called jaundice, is common among
all babies. But increase more so among those born to women who have diabetes.

Jaundice is a yellowing of the skin caused from a waste Tabarez 3 product.

Before birth the baby needs a large supply of red blood cells. However, at birth
the baby no longer needs this supply. The babyís body will work through the
liver to break down and excrete the old red blood cells. If the babyís liver
is not mature enough, it may have trouble handling this work load. The broken
down red blood cells are called bilirubin. Instead of being excreted, bilirubin
is deposited in the babyís tissues. Bilirubin is what colors the skin yellow.

Babies with jaundice are sometimes treated by being exposed to special lights.

The lights help break down and get rid of bilirubin. "Treatment of the problem
is usually by photo therapy but exchange transfusions may be necessary." (Hollinssworth,

D.R. 266) But high levels of bilirubin becomes toxic. A baby might need a blood
transfusion, but the chance of this happening is rare. Finally, as women
consider pregnancy, they must realize that managing diabetes during pregnancy is
time-consuming and expensive. There will be more doctor visits, special tests,
more frequent blood glucose testing, and more insulin injections each day. There
will also be more time away from work. Depending on your condition, your OB may
ask you to reduce your hours or stop work by the late weeks of pregnancy. You
and your partner need to be aware of these factors and discuss their impact on
your finances and lifestyle.


Books: Ellenberg, Max M. D., et al., eds. Diabetes Mellitus: Theory and

Practice. 3rd Ed., New York:Medical Examination Publishing Co., Inc. 1983

Hollingsworth, Dorothy Reycroft. Pregnancy, Diabetes, and Birth:A Management

Guide. 2nd Ed., Baltimore: Williams & Wilkins.,1992 Periodical: Casson, I.F.

"Outcome of pregnancy in insulin dependent diabetic women:results of a five
year population cohort study." British Medical Journal 2 Aug. 1997: p275 Pasui,

Kristine "Management of diabetes in pregnancy." American Family Physician

June 1997: p273 Henderson, Charles W. "Study Suggests Promising Treatment for

Diabetic Pregnancies." Transplant Weekly 17 May 1999