![]()
"
Keep and Copy Series
VOLUME 8 NUMBER 2 • JUNE 2011
81
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Patient
information
leaflet
DIABETES IN PREGNANCY
INTRODUCTION
Diabetes is a disease of poor blood sugar (glucose) control, usually due
to a lack of or resistance to the hormone insulin.
The effects of diabetes mellitus are many and can affect various or-
gans of the body. In pregnancy, diabetes can pose potential risks for both
the mother and baby, such as big babies (macrosomia). Many of these
problems can be avoided or minimised by careful management of the
pregnancy – from its planning to after delivery.
Outlined below are certain important principles and facts regarding
diabetes and pregnancy. The information provided should be used in
conjunction with the care given to you by your doctor. Do not use this
information to change your treatment without consulting your doctor first.
PRE-PREGNANCY CARE
All pregnancies in patients who are known diabetics (on diet, tablets or
insulin injections) must plan their pregnancies. This must be done as a
team with your doctor and diabetes care sister.
Blood sugar control must be optimal. Your HbA
1c
level should ideally be
below 6.5%. Patients with HbA
1c
levels above 10% should not fall preg-
nant until better blood sugar control is established, as these pregnancies
are at greater risk of complications.
Dietary supplements: folic acid should be taken before and during
pregnancy to reduce the risk of abnormalities in the baby.
Weight loss: you need to exercise and have a weight-loss program if
your body mass index (BMI) is 27 kg/m
2
or above.
GESTATIONAL DIABETES (GDM)
GDM is diabetes that is diagnosed for the first time in pregnancy. It may
disappear after pregnancy. Patients who may develop pregnancy-related
diabetes are:
•
overweight (BMI
≥
27 kg/m
2
)
•
have had GDM in a previous pregnancy
Dr Randolph Green-Thompson
Department of Obstetrics and Gynaecology, Grey’s Hospital, Pietermaritzburg
e-mail: randolph.greenthompson@kznhealth.gov.za
S Afr J Diabetes Vasc Dis 2011;
8
: 81–82.
•
have had previous unexplained stillborn babies
•
have a first-degree relative (parent or sibling) with diabetes
•
have had a previous big baby (
≥
4 kg)
•
are of certain ethnic groups, e.g. South Asian (Indian).
GDM is diagnosed by doing a blood sugar test (oral glucose tolerance test
– OGTT) during which a patient is given ‘sugar water’ (water with usually
75 g of glucose added) to drink.
GDM poses risks to both mother and baby.
•
Baby: big baby (macrosomia
>
4 kg) with the risks of injury during
birth; long-term risk of obesity and diabetes in adulthood; other risks
of diabetes – outlined below.
•
Mother: increased risk of late-onset diabetes (after the age of 40
years); increased risk of heart disease.
ESTABLISHED DIABETES
Established diabetics are patients who are known to have diabetes prior
to conceiving. These patients may be on diet, tablets (oral hypoglycae-
mics) or insulin injections.
Patients with established diabetes are at risk of:
•
Caesarean section
•
induction of labour
•
abnormalities of the baby
•
sudden unexplained stillborn babies late in pregnancy
•
miscarriage
•
worsening eye problems (retinopathy).
All patients with known diabetes must have the following special care
during their pregnancy:
•
Eye care: your eye problems (retinopathy) may worsen during preg-
nancy and need to be assessed by your doctor. You may need treat-
ment (e.g. laser).
•
Kidney assessment: your kidney function needs to be assessed as
well. This should preferably be done prior to you falling pregnant.
