What are the risks of untreated or poorly controlled hyperglycemia in pregnancy?
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For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such as high blood pressure and kidney damage, are present. Pregnancy tends to make diabetes (types 1 and 2) worse but does not trigger or worsen the complications of diabetes (such as eye, kidney, or nerve damage). Show
(See also Diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more .) Gestational diabetesAt least 5% of pregnant women develop diabetes during pregnancy. This disorder is called gestational diabetes. Gestational diabetes is more common among the following:
Unrecognized and untreated, gestational diabetes can increase the risk of health problems for pregnant women and the fetus and the risk of death for the fetus. Most women with gestational diabetes develop it because they cannot produce enough insulin. Insulin helps control the level of sugar (glucose) in the blood. More insulin is needed during pregnancy because the placenta produces a hormone that makes the body less responsive to insulin (a condition called insulin resistance). This effect is particularly noticeable late in the pregnancy, when the placenta is enlarging. As a result, the blood sugar level tends to increase. Then, even more insulin is needed. Some women may have had diabetes before becoming pregnant, but the disease was not recognized until they became pregnant. Risks of Diabetes During PregnancyIf poorly controlled, diabetes is more likely to cause problems. Early in pregnancy, poor control of diabetes increases the risk of the following:
Late in pregnancy, poor control of diabetes increases the risk of the following:
Babies born to women with diabetes tend to be larger than those born to women without diabetes. If diabetes is poorly controlled, babies may be particularly large. A large fetus is less likely to pass easily through the vagina and is more likely to be injured during vaginal delivery. Consequently, cesarean delivery may be necessary. Also, the fetus’s lungs tend to mature slowly. Newborns of women with diabetes are at increased risk of having low sugar, low calcium, and high bilirubin levels in the blood (hyperbilirubinemia Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more Diagnosis of Diabetes During Pregnancy
Most experts now recommend that doctors routinely screen all pregnant women for gestational diabetes. To check whether women have diabetes, some doctors first take a sample of blood, usually after women have fasted overnight, and do a blood test to measure the blood sugar (glucose) level. But the best way to confirm the diagnosis of diabetes is a two-part test that begins by having the woman drink a liquid that contains glucose. One hour after the woman drinks the liquid, doctors take and test samples of blood to determine whether the blood sugar level becomes abnormally high. If it is abnormally high, doctors give her a liquid that contains larger amount of glucose. After 3 hours, her blood sugar level is measured again. If it is still abnormally high, diabetes is diagnosed. This test is called the oral glucose tolerance test. Treatment of Diabetes During Pregnancy
To reduce the risk of problems, doctors usually do the following:
Controlling blood sugar levelsThe risk of complications during pregnancy can be reduced by controlling the level of sugar in the blood. The level should be kept as near normal as possible throughout pregnancy. Doctors advise women who have diabetes and who are planning to become pregnant to immediately start taking steps to control their blood sugar level Treatment Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more if they have not already done so. These steps include following an appropriate diet, exercising, and, if needed, taking insulin. High-sugar foods are eliminated from the diet, and women should eat so that they do not gain excess weight during pregnancy. Most pregnant women with diabetes are asked to measure their blood sugar level several times a day at home using a home blood sugar monitoring device. If blood sugar levels are high, women may need to take an oral hypoglycemic drug or insulin. Treatment sometimes causes blood sugar levels to decrease too much (called hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar (glucose) in the blood. Hypoglycemia is most often caused by medications taken to control diabetes. Much less common causes of hypoglycemia include... read more ). Hypoglycemia, if severe, causes confusion and loss of consciousness and can occur without any warning. If a woman is prone to episodes of hypoglycemia (for example, if she has had type 1 diabetes for a long time), she is given a glucagon kit and taught how to use it. Glucagon, when injected, increases blood sugar levels. A family member is also taught how to use the kit. Then if symptoms of severe hypoglycemia occur, the woman or the family member can inject glucagon. Controlling diabetes is particularly important late in pregnancy because then, the blood sugar level tends to increase. A higher dose of insulin is usually needed. Monitoring the fetusWomen are often asked to count the number of times they feel the fetus move each day. If all is well, they should feel at least 10 movements (kicks, flutters, or rolls) within 2 hours. Usually, the fetus moves 10 times in less time. Women should report any sudden decreases in movement to the doctor immediately. Doctors monitor the fetus Fetal monitoring Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more by doing tests such as fetal heart rate monitoring, nonstress tests, or biophysical profiles (using ultrasonography). Monitoring often begins at 32 weeks of pregnancy or sooner if complications develop—for example, if the fetus is not growing as much as expected or if the woman develops high blood pressure. If any of the following are present, doctors may remove and analyze a sample of the fluid that surrounds the fetus (amniotic fluid):
This procedure, called amniocentesis Amniocentesis Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more , helps doctors determine whether the fetus’s lungs are mature enough to breathe air and thus determine when the baby can be delivered safely. Labor and deliveryIf labor has not started by 39 weeks, doctors may start labor using a drug (called induction of labor Induction of Labor Induction of labor is the artificial starting of labor. Usually, labor is induced by giving the woman oxytocin, a drug that makes the uterus contract more frequently and more forcefully. The... read more ). If blood sugar is not controlled well or if women are not following their treatment plan, labor may be started as early as 37 weeks. Usually, vaginal delivery is possible. During labor and delivery, many women with diabetes need to be given a continuous infusion of insulin through a catheter inserted in a vein. After deliveryIn newborns of women with diabetes, hospital staff members measure blood levels of sugar, calcium, and bilirubin because these newborns often have abnormal levels. The newborns are also observed for symptoms of these abnormalities. For women with diabetes, the requirement for insulin dramatically drops immediately after delivery. But the requirement usually returns to what it was before pregnancy within about 1 week. After delivery, gestational diabetes usually disappears. However, many women who have gestational diabetes develop type 2 diabetes as they become older. What are the risks of poorly controlled diabetes during pregnancy?Diabetes during pregnancy—including type 1, type 2, or gestational diabetes—can negatively affect the health of women and their babies. For women with type 1 or type 2 diabetes, high blood sugar around the time of conception increases babies' risk of birth defects, stillbirth, and preterm birth.
What effects does poor glucose control have on pregnancy?Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission).
What happens if hyperglycemia is left untreated?If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy.
What are the risks of poorly controlled diabetes?Complications of diabetes. Eye problems (retinopathy) ... . Diabetes foot problems are serious and can lead to amputation if untreated. ... . Heart attack and stroke. ... . Kidney problems (nephropathy) ... . Nerve damage (neuropathy) ... . Gum disease and other mouth problems. ... . Related conditions, like cancer.. |
