Effects of Diabetes on the Mother
Effects of Diabetes on the Mother
Women with either Type 1 or Type 2 diabetes are at risk for several complications, some of which are specific to pregnancy and some to their diabetes. All of these complications occur more commonly in women with poor blood sugar control.
Women with long-standing pregestational poorly controlled Type 1 diabetes who already have significant vascular complications (eye and kidney problems in particular) from their disease are at particularly high risk for further complications during pregnancy. Preconception evaluation and management may significantly improve pregnancy outcome.
Women with pregnancies complicated by Gestational Diabetes or recently diagnosed Type 2 diabetes are at less risk for vascular complications. They are at increased risk for fetal macrosomia (large baby), cesarean delivery, and for developing problems associated with high blood pressure during pregnancy.
If diabetes has already caused damage to the small blood vessels of the eye (retinopathy), this damage may worsen during pregnancy particularly with poor blood sugar control. It is extremely important for women with diabetes to see an ophthalmologist (retinal specialist) preferably before becoming pregnant and certainly as soon as possible during pregnancy.
Many retinal changes are reversible after pregnancy 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 rather than a vaginal delivery may be recommended in order to avoid valsalva (pushing) because this might be hazardous to the delicate blood vessels in the eye.
The kidneys function as "body filters" keeping the good elements such as nutrients and excreting waste products. If diabetes has damaged the kidneys, the filtration process may be compromised and 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 of the kidney changes which occur during pregnancy are reversible, however, if the kidney damage is advanced when a woman becomes pregnant, further damage may be irreversible. Kidney function studies (24-hr urine collection to evaluate creatinine clearance and total amount of protein spilled in the urine over a 24-hr period) should be performed early in pregnancy and as often as necessary during pregnancy to assess kidney function.
Hypertension (High blood Pressure)
Hypertension caused by diabetes prior to pregnancy will potentially worsen during pregnancy. In addition, women with diabetes and preexisting hypertension are at significant risk (may be as high as 50%) for developing preeclampsia (toxemia). This condition is associated with 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 for GDM (e.g. increased maternal age, obesity). Occasionally, laboratory studies may also be abnormal (e.g. liver function, platelet count), neurological symptoms (headaches, blurry vision, seizures) and epigastric (upper abdomen) pain may occur. 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 cells of the body, the body will begin burning fat for fuel. The byproduct of burning fat is an acid called ketones. If acid builds up in the bloodstream, a life-threatening condition known as ketoacidosis may occur.
The symptoms of DKA are high blood sugars, nausea, vomiting, abdominal pain, fruity breath and ketones in the urine. Because a woman's body will more readily burn fat during pregnancy, DKA can occur at much lower blood sugar levels than when not pregnant. Conditions that may predispose a pregnant woman to develop DKA include: forgetting to take her insulin, nausea & vomiting of pregnancy (hyperemesis) and infections (urinary or other).
Some pregnancies are complicated by an excessive amount of amniotic fluid (polyhydramnios). This extra fluid may result from high blood sugars in the mother leading to high blood sugars in the baby, which make the baby urinate more often. The fluid may stretch the uterus and cause contractions. In addition, infections (urinary, vaginal or other) may also increase the risk for premature labor. Certain medications which are used in patients without diabetes to control premature contractions should be used with extreme caution in pregnant women with diabetes because they can significantly affect blood sugar control (e.g. terbutaline/brethine).
There is an increased risk for infection with diabetes particularly in the bladder and vaginal area (e.g. yeast).
Due to the increased risk for macrosomia (excessively large baby) particularly with poor blood sugar control, there is a greater chance of needing a cesarean section for delivery. In addition, complications such as preterm labor and hypertension may also increase the need for a cesarean delivery.