Diabetes and pregnancy – Gestational diabetes trimester wise

Before 5 decades, Women with Type 1 diabetes are advised not to have baby. But these days diabetes treatment are evolved so much that women can have baby without complications if they plan well in advance and take proper care.

Though various major improvements are made in treatments, womb development doesn’t change.

As per gynecologists the major organs such as spinal cord, brain and heart are developed at early stage during pregnancy that’s around 5 to 8 weeks after your last menstrual period. During this time most women are unware about fact that they are pregnant.

Symptoms

Women with gestational diabetes usually don’t develop any symptoms or they are mild. Symptoms usually include abnormal blood glucose level include fatigue, feeling of thirsty and increase frequency to urinate.

Risk factors

The risk factors for gestational diabetes include:

  • Overweight
  • Being prediabetic
  • Have previously given birth to a baby that has weight more than 9 pounds
  • Family member having type 2 diabetes
  • Having gestational diabetes in previous pregnancies

Complications

There are several complications. When blood glucose level increase up in mother then more glucose gets delivered in foetus which results in large size of baby and normal thing as it can lead to birth trauma for mother She might go for a caesarean delivery in case.

After birth of the baby as its risk of having low blood glucose, respiratory distress and jaundice. There are chances of obesity, diabetes and many other conditions are developed in the baby. If gestational diabetes is gone after birth of baby, there are chances of type 2 diabetes which can occur later in life. So regular check ups are to be done.

Treatment:

Changes in your body in first trimester

The foremost step are to be taken is to consult your dietician to see if there are any change made in diet to control the risk of obesity by decreasing down blood glucose levels in the body and find out which exercise routine must be followed.

If this doesnt help in controlling blood sugar levels as they will need to take medications to control it. At some cases as there is daily requirement of insulin to get good glucose under control. So one has to consult a doctor for proper dosage and proper medication routine.

Preconception

At the early development, women consult their doctors often as if A1C test number is 10% or higher there is a 1 in 5 chance of having malformed baby.

Its important to get blood glucose in target range before conceiving. But if you’re A1C is 6.5% or lower that there are chances of having baby with birth defects compared to woman without diabetes.

No matter what your A1C is, it is advisable to take prenatal vitamins with folic acid to lower the risk of child’s birth defects.

During prepregnancy you must ensure your weight is within a healthy range as obesity which can cause complications. You must get a thyroid test done because diabetic women have a higher risk of thyroid disorders.

If you have retinopathy then its important to get your eyes rechecked every trimester as there are chances for retinopathy to worsen.  Nephropathy is diabetic kidney disease which has chances to worsen so its advisable to get screened before pregnancy.

You must make sure that your doctor has a lot of experience treating Type 1 diabetic pregnant women.

First trimester

Even if you are pregnant then you should not stop your diabetes medication unless its changed by the doctor. Even though they are not approved for use during pregnancy but taking them doesn’t cause any major problem. If you stop it then it gets worse as your blood sugar levels increase instantly.

According to ADA’s Standard of Medical Care, insulin is the main drug during pregnancy. It is safe as it does not cross the placenta. For Type 2 diabetes oral medications are not much useful so doctors switch to insulin even when the blood glucose levels are controlled.

You should always make changes to your insulin dosage to inorder  risk of hypoglycaemia which is harmful to the baby’s brain.

According to the ADA, your fasting glucose level must be below 95 mg/dl and one hour after eating it should be 140 mg/dl and 2 hours after eating it should be 120 mg/dl. The notion of “eating for two” is not exactly true.

At the first trimester you don’t need extra calories. As per Gynaecologists that all diabetic women have risk of preeclampsia but after 12 weeks if you take a baby aspirin daily then it reduces the risk.

Second trimester

At your second trimester,you must stop getting morning sickness and no more feel fatigue. You are able to eat little more. At second and third trimester, you need to consume 300 extra calories but not more. When you feel better then you will be able to move more so stay active which help you to control your stress. Aim for 150 minutes of moderate exercise in a week. Don’t do heavy lifting or exercises so that they have risk of falling and increasing your temperature.

Its obvious to gain more weight, but try not to gain more than 25-30 pounds to avoid obesity. As baby growns insulin requirement which will also increase due to hormones. Its important to get an echocardiogram at 18 weeks to ensure baby’s heart. You must get a regular ultrasound and 18-22weeks get an anatomy scan done to get detailed look at your baby parts.

Third trimester

At the beginning of 28 weeks, doctor suggest to get growth scans each and every 4 weeks. Diabetes women is said to have a risk of having babys larger than normal size so its important to check baby’s size.

Having baby larger than the normal size which can complicate the vaginal delivery as the baby’s shoulder get stuck into the pelvis which forces you for a C-section. Such babies have risk for heart diseases, stroke or Type 2 diabetes.

At 30-32 weeks, you must need to start taking non-stress tests, twice a week.

Diabetic women are induced at 37-38 weeks that reduces the risk to the mother and the baby. It is strongly recommended not to go beyond 39 weeks.

Postpartum

After giving birth, paediatrician checks the baby for low blood glucose. If it is very low sugar solution is given to fix it.

Now your insulin needs decrease as the placenta is out and puts you at risk for hypoglycemia.

If you have a type 2 then you were not using insulin, you must switch back to oral medications, though some women stay on insulin for longer time. Its recommended that to opt for breast feeding as it decreased down mother’s blood glucose and mothers gestitational diabetes which can lower risk of developing type 2 diabetes in future. To prevent lower levels then you must check for breastfeeding and eating snack it’s not high.

It is most common to get postpartum depression in diabetic women. If you have thoughts of harming your baby or constantly feel sad and have mood swings, you must tell your doctor.

For diabetic women having a baby is lots of work compared to normal women but if you work you will get a good outcome from it. Working for getting a family is never a bad idea.

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