Managing diabetes in pregnancy

Diabetes in pregnancy can be detrimental not only to the mother, but also to the unborn child, writes ALLAN OLINGO

Diabetes is a disease that develops when the body is unable to produce or respond to insulin hormone in the normal way.

If not detected early and controlled, diabetes can lead to serious complications including blindness, kidney failure, heart disease and strokes. In pregnant women, diabetes increases the chances for birth defects and other problems for the baby, as well as difficulties and complications for the mother.

According to Eva Muchemi of the Diabetes Management and Information Centre, diabetes occurs due to the lack of insulin, alcohol consumption, which damages the pancreas and obesity or increase in weight and less exercise, which lead to accumulation of blood sugars.

“These trends make the body insensitive to insulin reception and result in blood sugar levels going up, making diabetes a reality,” says Muchemi.

During pregnancy, it is important for a woman to constantly check her blood sugar level because the chances of congenital malfunctions is higher as when the blood sugar is imbalanced. The pregnant woman should undergo hypertension, kidneys, liver and endocrine diseases tests as early as possible.

There has been a debate whether it is automatic for diabetic mothers to go through caesarean section to ensure the safe delivery of the baby and the mother’s safety.

Dr Alfred Murage, a gynaecologist says that should not always be the case because if the diabetes is properly managed, normal delivery is the option of choice.

Says Dr Murage: “Poor blood sugar control leads to large babies (referred to as ‘macrosomic’) and this can cause problems with delivery. If macrosmia is diagnosed, caesarean section may be the better option, but delivery must be discussed with the supervising obstetrician.”

Mothers also ought to know that low blood sugar is bad for the baby and babies born of diabetic mothers must immediately be fed.

Still birth

“Some may need blood glucose monitoring to avoid low blood sugar (called hypoglycemia). Hypoglycemia can cause many problems including convulsions,” advises Dr Murage.

Diabetes that is out of control could lead to miscarriage or still birth. High blood pressure during pregnancy could also cause an early birth, seizures or a stroke in the mother during labour and delivery. Other complications could include too much production of amniotic fluid, which may also lead to a premature birth.

Some patients are pre-disposed to diabetes during pregnancy. This happens when the blood sugar is not regularly checked or monitored during pregnancy, yet in the second trimester, the sugar levels always go up.

“As a result, the baby grows too big and the birth becomes complicated. This leaves caesarean section, which comes with increased risks and complications, as the only alternative,” says Dr Nancy Ngugi, a physician at Kenyatta National Hospital.

Says Dr Ngugi: “We encourage periodical testing of blood sugars for pregnant women so that we do not lose mothers or even the babies through sugar-related complications. The testing should be normal routine checks.”

Apart from being a lifestyle disease, diabetes is also genetic. Children born to women who develop gestational diabetes are likely to have diabetes within the first two years their life. The good news is that it is preventable and can be managed.

There are two types of diabetes: Type one and type two diabetes. Type one diabetes is less common than type two and occurs when the body fails to produce insulin. It usually results from the destruction of the insulin-producing cells of the pancreas by the immune system.

Type two diabetes occurs when the body fails to respond to insulin in a normal way. This leads to the overproduction of insulin, which may result in a partial failure of the insulin-producing cells of the pancreas and consequently insufficient insulin production.

Dr Murage points out that pregnant women on insulin need strict blood sugar monitoring during pregnancy and that insulin requirements must be adjusted according to blood sugar levels.

“The better the blood sugar control, the better the pregnancy outcomes,” he says.

It is also important to note that doctors prefer insulin to oral medications during pregnancy.

“Oral medications can be used, but usually in women who have developed gestational diabetes (pregnancy-induced diabetes). Women already on insulin should continue on the same. A proportion of women on oral medications will not achieve good blood sugar control and will eventually need to commence insulin injection,” says Dr Murage.

It is also important for women who are already diabetics to discuss the most appropriate contraception with their family planning providers, as some birth control pills can affect glucose levels.

According to Dr Ngugi, there has been an increase in the number of children getting type two diabetes because of their lifestyle.

“In recent days, most children are getting type two diabetes because of lifestyle issues — little or no exercise and the kind of foods they take,” she says.

She advises parents to feed their children with unrefined healthy foods.

“Even though the natural foods have become expensive, the treatment of diabetes and its complications is more expensive, so the cost benefit analysis is in favour of healthy foods. We need to teach the children about healthy lifestyles to protect them from heart, kidney and sugar related diseases at an early age,” she says.

Although many people do not consider the possibility, diabetes has also been associated with infertility.