Diabetes, Pregnancy, and IVF: Navigating the Challenges in English
During the mid-20th century, women suffering from type 1 diabetes were usually advised against conceiving children. Fortunately, advancements in assisted reproductive technologies have transformed this landscape.
Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra-large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large baby can lead to problems during delivery for both the mother and the baby.
Consult your doctor if you experience signs of elevated blood sugar levels, including heightened thirst, frequent urination, and a dry mouth—do not delay till your scheduled checkup. It’s important to get tested regardless of how healthy you might feel since numerous individuals with diabetes do not exhibit noticeable symptoms.
Preconception Testing
Each woman of reproductive age who has diabetes needs to receive guidance regarding strict blood sugar management before becoming pregnant. Research indicates that there is a heightened risk of diabetic embryopathies—such as anencephaly, microcephaly, congenital heart defects, and caudal regression—that correlates directly with higher A1C levels within the initial ten weeks of gestation.
Hemoglobin A1C is a blood test indicating the average blood sugar levels over the past two to three months. During pregnancy, this test might be conducted quarterly or more often based on the healthcare provider’s recommendation.
Opportunities abound to inform all women and adolescent girls of childbearing age who have diabetes about the dangers of unintended pregnancies and the potential for better maternal and fetal outcomes through careful pregnancy planning. Proper preconception counseling has the power to prevent significant health issues and related costs in their children. Discussions around family planning must take place, along with prescribing and using reliable forms of birth control until a woman feels fully prepared and ready to conceive.
To reduce the occurrence of complications, starting from the onset of puberty or upon diagnosis, all women with diabetes who have the potential for pregnancy should be educated about first, the risks of birth defects linked to unplanned pregnancies and inadequate blood sugar management.
Secondly, consistent use of reliable birth control methods must be maintained to avoid unintended pregnancies. Providing preconception guidance with developmentally suitable educational materials empowers young women to make informed choices. It is essential that preconception support resources designed specifically for teenagers be made freely accessible during prenatal appointments.
Preconception Testing
Prenatal counseling sessions ought to encompass tests for rubella, syphilis, hepatitis B virus, and HIV, along with performing a Pap test, cervical cultures, blood typing, prescribing prenatal vitamins (containing at least 400 μg of folic acid), and offering smoking cessation advice when needed.
Testing specific to diabetes should encompass measures such as A1C levels, thyroid-stimulating hormone, creatinine, and the urinary albumin-to-creatinine ratio. It also involves reviewing medication lists for potential teratogens like ACE inhibitors, angiotensin receptor blockers, and statins. Additionally, patients should be referred for thorough eye examinations. ACE inhibitors function by relaxing blood vessels and arteries to reduce blood pressure. These medications are prescribed to manage hypertension and diabetes, conditions prevalent among individuals who have obesity. Both high blood pressure and diabetes, along with obesity, elevate a pregnant woman's risk of experiencing a miscarriage.
Pregnant women who have diabetic retinopathy beforehand require careful monitoring throughout their pregnancy to prevent the condition from worsening.
Glycemic Targets In Pregnancy
In pregnant women with normal glucose metabolism, fasting blood glucose levels tend to be lower compared to the non-pregnant state because both the fetus and placenta absorb glucose without relying on insulin. However, after meals, these individuals often experience higher blood sugar levels and reduced tolerance to carbohydrates, which can be attributed to hormones produced by the placenta that have diabetic-like effects.
Insulin Physiology
During early pregnancy, women with type 1 diabetes experience increased sensitivity to insulin, reduced blood sugar levels, and decreased insulin needs. This changes quickly as insulin resistance rises sharply in the second and beginning of the third trimester, stabilizing towards the final stages of pregnancy. Women whose pancreases work normally can produce enough insulin to handle this natural increase in insulin resistance and keep their blood sugar within healthy ranges. Nonetheless, without proper adjustments in treatment, those with gestational diabetes (GDM) or pre-existing diabetes may develop high blood sugar levels.
Glucose Monitoring
In line with these physiological changes, it is advised to monitor both fasting and post-meal blood glucose levels in pregnant women with diabetes to attain optimal metabolic control. For those with pre-existing diabetes who use insulin pumps or basal-bolus regimens, pre-meal tests are also suggested to enable adjustments to their rapid-acting insulin doses before meals. Monitoring after eating has been linked to improved glycemic management and a reduced likelihood of developing preeclampsia. However, there have not been sufficiently large randomized studies conducted yet to compare various fasting and post-prandial glycemic goals specifically within pregnancies complicated by diabetes.
Dr. Taiwo Orebamjo is a seasoned Consultant Obstetrician with expertise in medical administration from the Kingston Academy of Learning and Career College in Canada. A graduate of the Royal College of Obstetricians and Gynaecologists in London, he currently serves as a Research Fellow specializing in assisted reproduction at St. George’s Teaching Hospital in Tooting, London. Additionally, Dr. Orebamjo holds positions as both a Consultant Obstetrician & Gynecologist and the Medical Director at Parklande Specialist Hospital and Lifeshore Fertility and IVF Clinic.
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