All-round care for the pregnant woman and an appropriate treatment plan before, during and after pregnancy can help women with type 1 or type 2 diabetes to live their pregnancy consciously and in peace.
Pregnancy and diabetes: the importance of going to specialized centers
Women with type 1 or type 2 diabetes may fear the idea of becoming pregnant, because of potential complications associated with diabetes, or, on the contrary, may have little awareness of the risks associated with limited or no pregnancy preparation and inadequate care for their underlying condition during pregnancy.
It is important to emphasize that, with the support of a specialized center and adequate preparation, women with diabetes can start a pregnancy in peace.
In Italy there are ‘diabetes and maternity centres’ in almost all major hospitals in major urban areas.
Access to one of these centers is essential:
- before pregnancy to prepare as best as possible
- during pregnancy and near delivery in case hospitalization becomes necessary.
What Are the Risks of Diabetes During Pregnancy?
The recommendations of the specialists should be followed with the realization that the woman with diabetes can do much to reduce the risks that diabetes, if not controlled, can pose during pregnancy.
Diabetes in fact
- increases the frequency of miscarriages and birth defects if glycemic control is not optimal during the conception period;
- increases the risk of hypertension and preeclampsia, a condition that can cause serious organ damage in the second part of pregnancy and may be associated with a placental defect;
- it increases the risk of preterm birth and cesarean deliveries if blood glucose is not well controlled during pregnancy;
- it increases the risk of hypoglycaemia in the newborn if blood glucose control is not optimal in the last weeks of pregnancy.
What is involved in the pregnancy course for women with diabetes
The course of pregnancy in women with diabetes is challenging and includes:
- continuous blood glucose monitoring optionally using continuous blood glucose sensors and hypoglycemia alarms;
- insulin therapy with a pump or multiple injections that are continuously adjusted for changes in insulin resistance at different stages of pregnancy to keep blood glucose levels as close to the normal range as possible;
- frequent obstetric outpatient checks in specialized centers.
The preconception trajectory for women with type 1 or type 2 diabetes
The preconception trajectory for a woman with type 1 or type 2 diabetes, elaborated and closely monitored by a special multidisciplinary team, is the starting point and aims to optimize blood sugar levels, which are as close as possible to normal hypoglycaemic episodes before conception. possibly limit.
For this it is also checked whether patients have all those tools available and know how to use them correctly that help to manage extreme glycemic events, such as for example
- the strips;
- the ketonemia measuring device.
If the woman is not already using a sensor, consideration should be given to prescribing one by educating her on its use.
Re-evaluating eating habits and the ability to adjust insulin therapy during meals is also important.
Specialists are also at this stage assessing possible pre-existing complications of diabetes (hypertension, retinopathy or nephropathy) and the drugs taken alongside insulin (e.g. antihypertensives, statins, etc.), to verify that they are also indicated during pregnancy.
The majority of women with type 2 diabetes take oral antidiabetic drugs: in view of pregnancy, they must necessarily be replaced with insulin therapy before the onset of pregnancy, in order to avoid exposing the embryo to drugs whose effects during pregnancy are unknown.
These women must therefore learn to carry out daily blood glucose checks and insulin injections independently.
Expectant mothers with type 2 diabetes often arrive unprepared for conception: this makes their care in a specialized center and the development of a preconception trajectory even more important.
Before conception: folic acid supplementation
Folic acid supplementation, in the diet of women of childbearing age, through food and/or through supplementation, ie supplementing the diet with supplements, on the advice of the gynaecologist, is of great importance for the prevention of spina bifida and heart defects in the fetus.
It is important to remember that the risk of developing heart defects or spina bifida is three times higher for babies born to mothers with pre-gestational diabetes: 6-9% compared to 2-3% in physiological pregnancies.
It is therefore very important to take a daily preventive intake of at least 4-5 mg folic acid in the 2 months before conception and in any case during the first trimester of pregnancy, a higher dose than is normally found in pregnancy supplements.
Regular checkups during pregnancy
During pregnancy, the women in specialized centers are visited every 15 days by a team of specialists, including the diabetologist and gynaecologist.
Routine examinations and periodic checkups are varied:
- blood and urine tests
- weight and blood pressure checks;
- glycosylated hemoglobin controls: glycemic control index for the last 2 months;
- thyroid function;
- presence of protein in the urine to detect the onset of possible preeclampsia at an early stage;
- ultrasound scans to assess the possible presence of deformities and the progressive growth of the baby;
- fetal cardiac monitoring, ie cardiotocographic monitoring, during the last 2 months, from which the well-being of the fetus can be inferred.
The woman must make an effort every day to
- perform regular blood glucose checks yourself, at least 6-8 times a day;
- use a sensor for continuous interstitial blood glucose monitoring and download the data to specific platforms for remote evaluation if needed.
Insulin therapy is calibrated, adjusted and monitored over 9 months with the support of the diabetologist who assesses measured blood glucose levels, changes in insulin therapy and frequency of hypoglycemia at each visit.
Childbirth: before and after
Delivery is generally planned with induction of labor at 38/39 weeks: in women with diabetes, the caesarean section rate is 65-75%.
The newborn, especially if he is heavy, may develop hypoglycemia, which often resolves with early breastfeeding, but sometimes requires an intravenous glucose infusion.
After the birth of the baby, it is necessary for the mother to regain a good glycemic balance and to lose the excess weight acquired during pregnancy.
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