Effects of Diabetes on the Mother

Women with either Type 1 or Type 2 diabetes are at risk for several complications, some specific to pregnancy and some relating to their diabetes. All of these complications occur more commonly in women with poor blood sugar control. In addition, women with long-standing pregestational, poorly controlled Type 1 diabetes who already have existing significant vascular complications (eye and kidney problems in particular) from their disease before getting pregnant are at particularly high risk for further complications during pregnancy.

Preconception evaluation and management may significantly improve a pregnancy. Note that women with pregnancies complicated by gestational diabetes or recently diagnosed Type 2 diabetes are at less risk for vascular complications. However, they are at increased risk for a large baby), cesarean delivery, and developing problems associated with high blood pressure during pregnancy.

Eye problems

If diabetes has already caused damage to the small blood vessels of the eye (retinopathy), this damage may worsen during pregnancy, particularly when blood sugar control is not being controlled well. If you have diabetes, it's extremely important to see an ophthalmologist (retinal specialist), preferably before becoming pregnant, or as soon as possible during pregnancy.

Many retinal changes disappear after giving birth and do not require treatment. Others may require close monitoring and treatment with laser therapy during the pregnancy in order to prevent further damage.

In the rare event that retinopathy worsens significantly during pregnancy (active proliferative retinopathy), a cesarean delivery  may be recommended to avoid pushing, as this might be hazardous to the delicate blood vessels in the eye.

Kidney problems

Kidneys are the body's filters, retaining nutrients while excreting waste products. If diabetes has damaged the kidneys, the filtration process may be compromised and certain important elements, such as proteins may be lost in the urine.

Having kidney disease can significantly increase the risk for developing high blood pressure problems during pregnancy.

Most kidney changes during pregnancy are reversible. However, if kidney damage is advanced when a woman becomes pregnant, further damage may be irreversible. Kidney function studies should be performed early in pregnancy and as often as necessary during pregnancy in order to assess kidney function.

Hypertension (High blood pressure)

Hypertension caused by diabetes prior to pregnancy can worsen during pregnancy. In addition, women with diabetes and preexisting hypertension are as high as a 50% risk for developing preeclampsia (toxemia). Symptoms are high blood pressure, increased swelling (particularly of the hands and face) and protein in the urine. Some of this additional risk may be related to the underlying risk factors, including increased maternal age and obesity.

Women who do not have hypertension before pregnancy have about a 10% chance of developing preeclampsia. This risk may be increased substantially if they also have kidney disease.

Diabetic ketoacidosis (DKA)

This condition only occurs in people with Type 1 diabetes. When blood sugars are high and there is no insulin to transfer the sugar into the body’s cells, the body will begin burning fat for fuel, producing acids called ketones. Ketone build up in the bloodstream can cause a life-threatening condition known as ketoacidosis. The symptoms of DKA are high blood sugar levels, nausea, vomiting, abdominal pain, fruity breath and ketones in the urine.

Because a woman's body burns fat more easily during pregnancy, DKA can occur at much lower blood sugar levels than when a woman is not pregnant.

Conditions that may increase the likelihood of a pregnant woman developing DKA include forgetting to take insulin, nausea & vomiting of pregnancy (hyperemesis) and urinary tract or other infections.

Premature labor

Some pregnancies are complicated by an excessive amount of amniotic fluid (polyhydramnios). This extra fluid may result from high blood sugars in the mother causing high blood sugars in the baby, which make the baby urinate more often. Extra fluid can stretch the uterus and cause contractions.

In addition, urinary, vaginal or other infections may also increase the risk of premature labor. Certain medications used by patients without diabetes to control premature contractions should be used with extreme caution in pregnant women with diabetes, as they can significantly affect blood sugar control.

Infections

Diabetic mothers are at an increased risk for yeast infections, particularly in the bladder and vaginal area.

Cesarean delivery

Mothers who do not manage their blood sugar levels are at an increased risk for delivering an excessively large baby which means there’s a greater chance of a cesarean section being necessary. Complications, such as preterm labor and hypertension, may also increase the need for a cesarean delivery.