Archive for December, 2014

Posted on 25 Dec 2014
Pregnancy

Canadian Health Care Mall: Pregnancy – Complications

COMPLICATIONS

I have had diabetes for five years. My second son was born with multiple defects and later died. Are women with diabetes more likely to have an abnormal baby?

Pregnancy: Complications

Pregnancy: Complications

 It is a terrible tragedy to lose a baby as a result of birth defects and we hope you can pick yourself up and approach your diabetes in a positive way. The secret to a successful pregnancy is excellent blood glucose control starting before conception and continuing throughout pregnancy. There is good scientific evidence to suggest that developmental defects are caused by poor control in the first few weeks of pregnancy and that the risk of this can be reduced by ensuring perfect control when the baby is conceived. This means aiming for an HbA1c of less than 7.5%. The risk of multiple congenital defects is confined to the early stages of the pregnancy. This is hardly surprising because this is the stage when the various components of the baby’s body are beginning to develop and when other illnesses such as German measles (rubella) can also affect development. However, this means that there is no time to improve control once you discover that you are pregnant and it is crucial to plan the pregnancy and make sure that you have good control before you conceive. Some people have difficulty in achieving this degree of control, however hard they try. It is important to understand that the risks to the baby increase as the HbA1c rises and that the closer you get to 7.5% the lower the risk.

All women planning a pregnancy are advised to take supplements of folic acid (a type of vitamin) which reduces the risk of spina bifida. The dose of folic acid recommended for women with diabetes is larger than that advised for those without diabetes. You need to start taking 5 mg of folic acid daily before you try to conceive and your doctor will be able to prescribe this for you.

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Good control is also needed for the rest of the pregnancy because the development and growth of the baby can be disturbed by poor control. In particular, the baby grows faster than normal and is large in size. If the baby has to be delivered early because it is big, it will be premature and therefore at risk of the many problems that can affect premature babies.

During my last pregnancy I had ‘hydramnios’ and my obstetrician said that this was because I had diabetes. Is this true? And is there anything that I can do to avoid it happening in any future pregnancies?

Hydramnios is an excessive amount of fluid surrounding the baby and it is more common in mothers with diabetes. It is related to how strictly you control your diabetes throughout pregnancy. Our advice is that you can reduce the risk to an absolute minimum in future pregnancies by aiming to keep your HbA1c and blood glucose levels as close to normal as possible from the beginning of pregnancy.