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November 5, 2008 > Managing Diabetes in Pregnancy Can Deliver 'Sweet Success'

Managing Diabetes in Pregnancy Can Deliver 'Sweet Success'

Pregnancy can be an exciting experience - feeling the baby's first kick, hearing the heartbeat for the first time, seeing your baby's growth on a sonogram. But pregnancy can also be a bit scary, worrying about the baby's health and your own. That worry is especially pronounced for women who are diagnosed with diabetes either before or during their pregnancy.

A woman with diabetes (type 1 or 2) before pregnancy might not know that diabetes increases the risk of complications for the mom and the baby during the pregnancy. "They really need to have good blood glucose control before they become pregnant and good prenatal care that helps manage their diabetes," says Washington Hospital Diabetes Education Program Coordinator Vida Reed, RN, CDE.

"High blood glucose levels during early pregnancy can cause birth defects," she explains. "Most women don't even know they are pregnant until the baby has been growing for two to four weeks. That's why pre-conception counseling is important for women with diabetes who would like to become pregnant. You should delay becoming pregnant until your diabetes is in good control."

In some cases, women who have never had diabetes before will develop "gestational" diabetes during pregnancy. The American Diabetes Association estimates that gestational diabetes affects approximately 4 percent of all pregnant women in the U.S. each year.

Women who are receiving prenatal care are automatically screened for gestational diabetes between 24 and 28 weeks after conception. Some women may be screened earlier than the 24th week, especially if they had gestational diabetes in a previous pregnancy. While any woman can develop gestational diabetes, women of certain ethnic groups - Hispanic/Latina, Asian Pacific Islander, African American, Southeast Asian or Asian Indian - have a greater risk.

"Gestational diabetes occurs when the hormones of pregnancy interfere with insulin in the mother's body," Reed says. "As the pregnancy progresses and the level of hormones increases, the mother's body may not be able to use the insulin well, leading to gestational diabetes. When gestational diabetes is not controlled, it can lead to serious complications for both the mother and the baby."

A certified diabetes educator, Reed notes that women should manage their diabetes throughout pregnancy since a mother's high blood glucose levels can cause complications during pregnancy and at delivery for mom and baby.

"When you have excess sugar in your blood, the baby gets extra sugar, too," she says. "All that extra sugar can make the baby too large, which can lead to complications in delivery and increase the chances of needing a cesarean section."

In addition to facing possible complications in delivery, mothers with unmanaged diabetes may also be at risk for high blood pressure or problems with their kidneys or eyes. While gestational diabetes usually goes away after pregnancy, two-thirds of women who experience gestational diabetes in one pregnancy will go on to have it again in subsequent pregnancies. Many women who have gestational diabetes will develop type 2 diabetes within the first five years after delivery.

Reed cautions that babies born to mothers with unmanaged diabetes also face a number of risks. "When the blood sugars are too high, the baby gets less oxygen," she says. "Some babies do not handle this stress well, and it is thought to be one of the reasons for stillbirths. After delivery, the baby continues to face increased risks, including low blood sugar, jaundice, respiratory distress, childhood obesity and the development of type 2 diabetes later in life. These facts are not meant to frighten you. Today with good health care before, during and after pregnancy, you can expect to do well and have a healthy baby."

To help women with type 1, type 2 or gestational diabetes manage their blood sugar during pregnancy, the Diabetes Education Program at Washington Hospital offers a "Sweet Success" program that is designed to reduce the risks of diabetes-related complications for mothers and infants. The program is based on guidelines established by the California Diabetes and Pregnancy Program developed by the California Department of Health Services. Each patient receives regular counseling from a registered dietician and a registered nurse, both of whom are certified diabetes educators.

"The goal of Sweet Success is to ensure that both mom and baby are healthy," Reed says. "We work with the moms to minimize their risks by managing their blood sugar through diet, exercise and sometimes insulin."

Careful meal planning is the cornerstone of treatment in the Sweet Success program, and expectant mothers meet with a dietitian every one to three weeks, depending on their personal needs.

"A woman's nutrient needs naturally increase during pregnancy, especially in the second and third trimesters," says Washington Hospital dietitian Anna Mazzei. RD. "Consuming a well-balanced diet that contains a minimum amount of carbohydrates is critical to ensure the baby develops properly. Of course, this includes women with type 1, type 2, and gestational diabetes who often severely limit or eliminate carbohydrates in their diet to control blood sugars. We don't want moms to avoid eating!"

Sweet Success dietitians work to make meal planning as simple and convenient as possible, Mazzei notes. "We individualize their diets by considering medical history, medications, work schedule, financial issues, family responsibilities and support," she says. "Taking into account a patients' ethnic or cultural background and food preferences such as vegetarianism are a must."

Most patients are started on a basic diet that includes the minimum amount of carbohydrates required in pregnancy and modifying it according to specific needs. "We work very closely with vegetarians, whose diets tend to be high in carbohydrates," Mazzei explains. "Our goal is maintaining healthy blood sugars by controlling carbohydrates and at the same time not compromising the intake of other important nutrients".

Mazzei notes most pregnant moms would benefit from spreading out their meals. "Instead of eating three large meals a day, we recommend six small, frequent meals, about two to four hours apart," she says. "That not only helps control blood sugar levels, it may also improve morning sickness and heartburn."

In addition to the therapeutic diet, planning appropriate exercise at certain times in the day aids in promoting blood sugar control, ensuring a healthy weight gain, avoiding constipation and creating a sense of well being.

As the pregnancy progresses and hormone levels increase, the diet and increased activity may not be enough to mange blood sugars. Therefore, some patients may require insulin, more of the hormone they already produce. "People fear insulin because it cannot be taken by mouth and must be injected," Mazzei says. "A fear of needles is not uncommon, but a person's anxiety can be relieved with proper education. It's important for them to know insulin is natural and will not hurt the baby - it is essential for their babies' health and to prevent complications."

Participation in the Sweet Success program requires a physician's referral. For more information, please call (510) 745-6556.

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