Although pregnant women with diabetes are considered high risk, their survival rate and that of their infants is the same as nondia-betic women. There are, however, things about which diabetic women need to be especially careful during pregnancy. You guessed it—the most important is keeping tight blood glucose control.
Deciding to become pregnant at any time is one of the most important decisions a woman can make. If she is diabetic, it is even more important because of two major factors: Your diabetes should be in excellent control before pregnancy begins, and you must make a commitment to keep it that way throughout the entire pregnancy. It can be difficult at times. There is no reason why you and your baby cannot come through the forty-week experience in fine health, but you should understand at the outset that there are risks you will take that nondiabetic women will not.
If you have complications of diabetes and are thinking of getting pregnant, you should first have a thorough medical and eye exam. Some complications worsen during pregnancy, although they usually even out after delivery. For instance, if you have diabetic retinopathy that has reached the stage where your ophthalmologist has noticed the formation of new blood vessels (neovascularization) in your eyes, you should think seriously about not becoming pregnant. You could go blind. Your kidneys are also especially vulnerable during pregnancy. If you find protein in your urine, postpone pregnancy until the problem is corrected because it could lead to serious hypertension.
Insulin requirements in nondiabetic women change during pregnancy because the placenta, which produces hormones of its own, makes insulin work less efficiently. In fact, by the last trimester, a pregnant woman requires (and her body manufactures) about twice as much insulin as needed in the nonpregnant state. Thus, if you took insulin before you became pregnant, you will likely need about twice as big a dose by the end. However, do not calculate your own insulin dosage. Your physician will decide how often and by how much to gradually increase your insulin dosage.
Think about what this hormone imbalance can do to a diabetic woman. A pregnant body that receives insufficient nutrients or other chemicals of any kind will use available stores of those nutrients or chemicals to nourish the fetus and maintain the pregnant woman’s health. Therefore, if there is not enough insulin in the first place to help turn available sugar into energy, the body will use stored fat for energy and “give” stored protein to the fetus. When this happens, ketoacidosis can result.
In addition to more insulin, you will need to eat more calories and an increased amount of carbohydrates and protein, and you will need to keep a careful balance among food intake, physical activity, and medication (both insulin and oral hypoglycemics). The best way to do this is to put yourself in the care of a nutritionist for the duration of your pregnancy and the weeks immediately after the delivery. Most obstetricians who care for high-risk pregnancies can recommend a nutrition professional, and many have someone on staff.
