September 23, 2009 > Minimizing Diabetes Risks for Pregnant Moms and Their Babies
Minimizing Diabetes Risks for Pregnant Moms and Their Babies
Learn More at Upcoming Diabetes Matters Class
Every pregnancy carries some risk for both the expectant mother and the baby, but women who are diagnosed with diabetes either before or during their pregnancy face even greater risks to their health and that of their babies.
"Pregnant women with diabetes often have a higher rate of blood pressure disorders, which puts them at risk for an early delivery as well as for strokes and bleeding problems," says Dr. Elizabeth Kurkjian, an obstetrician-gynecologist at Washington Hospital. "They also face the risk of having a larger baby and a more difficult delivery, perhaps requiring the use of vacuum, forceps or a Cesarean-section delivery."
High blood sugar levels in the mother also can cause complications for the baby. When there is excess sugar in the mother's blood, the baby gets extra sugar, too, which can make the baby grow too large. Unmanaged diabetes during early pregnancy also can cause birth defects.
"When a baby is a large size, there is more risk of birth trauma," Dr. Kurkjian notes. "For example, in some cases, the head will pass through the birth canal, but the shoulders get stuck, which can cause nerve damage. Babies born to mothers with unmanaged diabetes also can have problems adjusting their own blood sugar levels and may need closer monitoring and perhaps intravenous fluids."
To help women learn more about managing the risks of diabetes during pregnancy, Washington Hospital is sponsoring a free "Diabetes Matters" class featuring a lecture by Dr. Kurkjian followed by a question-and-answer session. The class is scheduled for Thursday, October 1 from 7 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. (The Diabetes Support Group will take place immediately after at 8 p.m.)
"Women who know they have type 1 or type 2 diabetes really need to have good blood sugar control before they become pregnant and good prenatal care that helps manage their diabetes," says Dr. Kurkjian. "Pre-conception counseling is important for women with diabetes who would like to become pregnant. You should delay becoming pregnant until your diabetes is under 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 routinely screened for gestational diabetes between 24 and 28 weeks after conception. Women who are considered at risk for diabetes are screened earlier than the 24th week, especially if they had gestational diabetes in a previous pregnancy. While gestational diabetes usually goes away after pregnancy, two-thirds of women who experience gestational diabetes in one pregnancy will have it again in subsequent pregnancies. Many women who have gestational diabetes will develop type 2 diabetes later in life.
"Any woman can develop gestational diabetes, but women of certain ethnic groups - Hispanic/Latina, Native American, African American, Southeast Asian or Asian Indian - have a greater risk," Dr. Kurkjian explains. "Other risk factors for gestational diabetes include obesity, a strong family history of diabetes, high blood pressure and smoking. Women who have borderline fasting glucose levels between 100 to 125 mg/dL are also at risk."
Dr. Kurkjian cautions that babies born to mothers with unmanaged diabetes face a number of risks in addition to high birth weight and size. "There is a higher rate of miscarriage, stillbirth and heart defects when the blood sugars are too high," she says. "After delivery, the baby continues to face increased risks for low blood sugar, jaundice, respiratory distress, childhood obesity and the development of type 2 diabetes later in life."
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 to reduce the risks of diabetes-related complications. The program is based on guidelines established by the California Diabetes and Pregnancy Program developed by the Department of Health Services. Each patient receives regular counseling from a registered dietician and a registered nurse, both of whom are certified diabetes educators.
"For women who have type 1, type 2 or gestational diabetes, we recommend that they test their blood sugar levels four times a day - a fasting test in the morning and testing one hour after each meal," Dr. Kurkjian says. "Keeping blood sugar levels under control requires dietary management, exercise and possibly medications, including insulin.
"Some women are concerned about the risks of using medications while pregnant, but the risks to the fetus are greater with poor diabetes management than they are from the medications," she adds. "Most of the time, pregnant women with diabetes who require medication are put on insulin, which is naturally found in the body anyway and will not hurt the baby."
Dr. Kurkjian notes that management of diabetes during pregnancy needs to be aggressively pursued. "In general, management of type 2 diabetes involves more gradual steps, perhaps starting with dietary changes and then waiting for a month or so before progressing to other measures such as medication," she explains. "In pregnancy, though, we don't have the luxury of taking several months to get blood sugars under control. Because so many young women today have diabetes or borderline blood sugar levels, it's important to consult your doctor before getting pregnant."
For more information about the Diabetes Matters class or to register, call (510) 745-6556 or visit www.whhs.com/diabetes. Participation in the Sweet Success program requires a physician's referral. For more information, please call (510) 745-6556.
Come to the Diabetes Support Group
Success in managing diabetes has a lot to do with receiving and giving social support. For people who suffer from diabetes, Washington Hospital's Outpatient Diabetes Program offers a support group that allows people to have in-depth conversations about what's happening in their lives and share information about dealing with diabetes in a positive and caring environment. The support group meetings are held at 8 p.m. every month immediately following the hour-long Diabetes Matters lecture which begins at 7 p.m. the first Thursday of each month.
Family members and friends are also welcome. For more information about the support group or other classes and programs, call the Diabetes Services program at (510) 745-6556 or visit us on the web: www.whhs.com/diabetes