For women pregnant with diabetes mellitus some special challenges for mother and child. If the woman has diabetes as a recurrent disease in pregnancy, it can cause early childbirth, birth defects, and very large babies.
Previous planning is emphasized if one wishes to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics requires rigorous blood glucose control even before pregnancy.
Video Diabetes mellitus and pregnancy
Physiology
During normal pregnancy, many physiological changes occur such as increased secretion of hormones that regulate blood glucose levels, such as glucose-berain 'to the fetus, slowing gastric emptying, increasing renal excretion of glucose and insulin cell resistance.
Maps Diabetes mellitus and pregnancy
Risk for child
The risks of maternal diabetes in developing fetuses include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurologic deficits, polyhydramnios and birth defects. The hyperglycemic maternal environment has also been associated with neonates who are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome.
Mild neurologic and cognitive deficits in heredity - including increased ADHD symptoms, impaired fine and gross motor skills, and explicit memory performance disorders - have been linked to pregestational type 1 diabetes and gestational diabetes. Deficiency of pre-natal iron has been suggested as a possible mechanism for this problem.
Birth defects are currently not an identified risk for girls with gestational diabetes, as they mainly occur in the later part of pregnancy, where the vital organs have taken the most important forms.
Having type I or II diabetes before pregnancy has a 2 to 3 fold increase in the risk of birth defects. The cause is, for example, oxidative stress, by activating protein kinase C and causing multiple cell apoptosis.
The importance of blood glucose levels during pregnancy
High blood sugar levels are harmful to the mother and her fetus. Experts advise diabetics to keep blood sugar levels close to normal range for 2 to 3 months before planning a pregnancy. Managing blood sugar approaching normal before and during pregnancy helps protect the health of mother and baby.
Insulin may be necessary for people with type 2 diabetes instead of oral diabetes drugs. Extra insulin may be needed for people with type 1 diabetes during pregnancy. Your doctor may suggest to check your blood sugar more often to keep your blood sugar levels close to normal.
Diabetic pregnancy management
Diabetes mellitus can be effectively managed with proper meal planning, improved physical activity and properly administered insulin treatment. Some tips for controlling diabetes in pregnancy include:
- Food - Reduce sugary foods, eat three small portions and one to three snacks a day, keep proper meal times, and include balanced fiber intake in the form of fruits, vegetables, and whole grains.
- Increased physical activity - walking, swimming/aquaerobics, etc.
- Monitor your blood sugar levels frequently, your doctor may ask to check your blood glucose more often than usual.
- Blood sugar levels should be below 95 mg/dl (5.3 mmol/l) upon awakening, below 140 mg/dl (7.8 mmol/l) one hour after meals and below 120 mg/6.7 mmol/l) two hours after meals.
- Whenever checking for blood sugar levels, keep a proper record of the results and give to the health care team for evaluation and treatment modification. If the blood sugar level is above the target, the perinatal diabetes management team can suggest ways to achieve the target.
- Many require extra insulin during pregnancy to reach their blood sugar target. Insulin is not harmful to the baby.
Breastfeeding
Breastfeeding is good for children even with mothers with diabetes mellitus. Some women wonder if breastfeeding is recommended after they are diagnosed with diabetes mellitus. Breastfeeding is recommended for most infants, including when the mother may have diabetes. In fact, a child's risk of developing type 2 diabetes mellitus later may be lower if the baby is breast-fed. It also helps the child to maintain a healthy weight during infancy. However, breastfed mothers with diabetes have been shown to have a different composition than non-diabetic mothers, containing high glucose and insulin levels and decreased polyunsaturated fatty acids. Although the benefits of breastfeeding for children of diabetic mothers have been documented, the consumption of diabetic breast milk is also associated with late dose-dependent language development.
Classification
The White Classification, named after Priscilla White who pioneered research on the effect of type of diabetes on perinatal outcomes, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes before pregnancy (diabetes pregestational). Both groups are subdivided on the basis of risk and related management.
There are 2 classes of gestational diabetes (diabetes that begins during pregnancy):
- Class A 1 : gestational diabetes; controlled diet
- Class A 2 : gestational diabetes; drug controlled
The second group of diabetes present before pregnancy can be divided into these classes:
- Class B: onset at the age of 20 years or older or with a duration of less than 10 years
- Class C: ons on age 10-19 or duration 10-19 years
- Class D: ons before age 10 or duration more than 20 years
- Class E: Clear diabetes mellitus with calcified pelvic vessels
- Class F: diabetic nephropathy
- Class R: proliferative retinopathy
- Class RF: retinopathy and nephropathy
- Class H: ischemic heart disease
- Class Q: previous kidney transplant
The initial age of onset or illness comes with a greater risk, the first three subtypes.
Treatment of pregnant women with diabetes
Blood glucose levels in pregnant women should be arranged as tightly as possible. Higher glucose levels in early pregnancy are associated with teratogenic effects on developing fetuses. A Cochrane review published in 2016 is designed to determine the most effective range of blood sugar to guide treatment for women who develop gestational diabetes mellitus in their pregnancies. The study concludes that quality scientific evidence is not yet available to determine the best blood sugar range to improve health for pregnant women with diabetes and their babies.
See also
- Diabetes mellitus
- Gestational diabetes
- Pregnancy
Footnote
External links
- The CDC National Center on Birth Defects and Developmental Disabilities
Source of the article : Wikipedia
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