Pregnancy needs a little bit of planning and if you are a diabetic, this could mean meticulous planning. High sugar levels in the blood can come in the way of conception and make it difficult for you to get pregnant. But if your sugar levels are in control conceiving should not be a problem. ‘If one is diabetic, it is essential to consult your doctor before conception to take control of the situation. If you can get the sugar levels under control, then conception and pregnancy can get easier,’ says Dr Meghana Sarvaiya, Consultant Gynaecologist and obstetrician, Cloudnine Hospital, Mumbai.
Here she explains how one should plan pregnancy with diabetes:
First, it is necessary for the woman and her partner to be on the same page when it comes to planning a pregnancy. If both of you agree to have a baby talk to your doctor about how to get your blood sugar levels in check. If you are on oral medications to control sugar levels or any other hypoglycaemic agent, ask your doctor if it is safe to have them while trying to conceive. ‘The widely used oral medication Metformin is considered safe during pregnancy. Depending on your condition your endocrinologist might put you on a combination of Metformin and insulin or just insulin. Any other form of medication during conception is not advisable,’ says Dr Sarvaiya. Apart from this, simple measures like losing a few kilos, cutting down on sugar, diet management and giving up vices like smoking and alcohol are also advised.
If there are any other conditions like a heart, kidney or liver problem due to diabetes that too needs treatment before one opts to become a mother. As pregnancy can aggravate these problems and they can, in turn, be fatal for the fetus.
Once the sugar levels are close to normal which means between 70 mg/dL to 120 mg/dL fasting and 140 mg/dL postprandial, your doctor might encourage you to try for conception. Having sex during the most fertile period can help you achieve results faster. ‘Once your sugar levels are in control, it is possible to conceive within two to three months of trying to have a baby, provided the sugar levels are not high again. It is essential to take your diabetes medication as advised by your diabetologist or endocrinologist during your pregnancy to keep your sugar levels in check,’ says Dr Sarvaiya.
Once you are pregnant, it is important that you stay vigilant as an increase in your sugar levels can be detrimental to both you and the baby. Here are few things that you need to be doing:
Manage your diet
Don’t fall for the ‘eat for two during pregnancy’ myth, especially if you are diabetic. Excess calorie intake during this time can increase your sugar levels which can harm the baby and increase chances of miscarriage too. It is essential that you maintain a balanced diet and take help of a nutritionist to be on the right track with your food intake. Ideally, include foods from all food groups to ensure that your baby gets the right nutrition to grow and thrive in the womb.
Take your medications on time
Be very regular with your prenatal vitamins and folic acid intake. Lack of adequate folic acid can lead to neural tube defects in the baby. It is recommended that a pregnant woman have 400 mg of folic acid to prevent birth defects in the baby.
Take your tests seriously
Go for your routine blood tests to be sure that your blood sugar levels are under control, uncontrolled sugar levels can impact the baby and make it overweight or bigger. Since the vital organs of the baby develop during the first 13 weeks of pregnancy, high sugar levels can cause birth defects. ‘During the second trimester, a glucose challenge test is done to check for the blood glucose levels of the mother where the mother is given 50 or 75 mg of glucose to consume and the readings are taken two hours post consumption. If the mother is unable to control her sugar levels, the same would be true for the baby. This can have implications on the fetus,’ says Dr Sarvaiya.
Regular exercise like a 15 or 30 minutes walk can help to keep the sugar levels in check.
Cut down on vices
Smoking and drinking can lead to a toxic build-up in the body which can cross over the placenta and reach the baby. It can lead to organ damage, abrupt heart rate, deprivation of oxygen, mental retardation and much more. Instead, having a healthy lifestyle can save your baby from such risks.
During labour and delivery
If everything seems under control, a vaginal delivery can be planned for the mother. However, if there are signs of fetal distress or any other emergency a mother might have to go for a c-section. ‘If the sugar levels go high close to labour a c-section might be considered. In any case, we avoid inducing labour for a diabetic mother anytime before 39 weeks. In a normal scenario we might induce labour after 37 weeks, but in the case of the diabetic mother, her fetus might not reach complete maturity before 39 weeks. In case we induce labour before 39 weeks, steroid injections might be given to the baby to achieve lung maturity,’ says Dr Sarvaiya.
In some cases, a mother suffering from diabetes can have big or macroscopic baby with a large head. If this happens, a vaginal birth becomes challenging, especially if the mother has a narrow pelvis. ‘The baby’s head can get stuck in the birth canal or it can lead to shoulder dystocia during birth. To avoid such complications the doctor might advise a c-section,’ says Sarvaiya. But if the sugar levels are under control and the baby weighs less than 4 kilos a vaginal birth is also possible.
How diabetes affects the mother and baby during pregnancy
Uncontrolled, high sugar levels is harmful to both mother and the baby, here is how:
For the baby: In the early months of pregnancy high sugar levels can lead to major organ damage – damage to heart, kidney, lungs, brain and lead to birth defects. It also increases chances of miscarriage, premature delivery, weight gain, underdeveloped organs or stillbirth.
For the mother: Uncontrolled sugar can also lead to preeclampsia in the mother which can be life-threatening for both. One way to save the baby from the effects of preeclampsia is to deliver the baby soon. However, you need to wait till at least 37 weeks to deliver your baby.