Diabetes, a complex disease, presents an even greater challenge if the patient wishes to give birth to a child.
Pregnancy in diabetes is not contraindicated, but it is a high-risk pregnancy that requires preparation months before conception, explains primary diabetes doctor Anca Roman, thus extending a discussion held with a patient in the office.
The patient diagnosed with diabetes has informed her doctor that she is going to have a child. Although the news is good, in order for the pregnancy to go as smoothly as possible without complications, it should be scheduled in the case of patients with diabetes, states Dr. Roman, in an informative post dedicated to patients.
The doctor explains why it is important to plan a pregnancy if the woman suffers from diabetes.
“It is important to have a correct glycemic control because during the first eight weeks the baby’s organs are formed. Therefore, patients with type 1 diabetes and type 2 diabetes:
1 – they are planning their pregnancy, they have a glycosylated hemoglobin below 6.5, ideally 6;
2 – a pre-conception assessment is made, i.e. before the test is positive, of the chronic complications of the thyroid gland, because they can get worse during pregnancy;
3 – in the case of patients with type 2 diabetes, certain oral antidiabetic drugs are discontinued. The only approved treatment during pregnancy is insulin,” Dr. Anca Roman explained.
What steps to follow before and during pregnancy
Pregnancy planning is an essential step because an essential monitored parameter, glycosylated hemoglobin, must be within a strict range. Thus, the first step in pregnancy planning is to optimize blood sugar before conception – HbA1c below 6.5% (ideally below 6%). “Organogenesis occurs in the first 8 weeks, often before the woman knows she is pregnant”explains the doctor, hence the need, in the case of patients diagnosed with diabetes, for the body to be prepared.
A second step in the planning process is the preconception consultation, which aims to assess chronic complications (such as retinopathy, nephropathy, neuropathy, complications that may accompany diabetes). “Some can get worse in pregnancy and need to be stabilized,” explains Dr. Roman.
Another step is to review the medication, given the fact that insulin remains the standard safety treatment during pregnancy, says Dr. Anca Roman, and metformin can only be continued in certain situations.
The administration of folic acid, on the other hand, in the case of the patient with diabetes is done in a higher dose than in the case of the general population. Thus, compared to a dose of 0.4 mg administered during pregnancy to a patient without diabetes, the patient suffering from diabetes will receive much higher doses of 5 mg/day.
The monitoring of the pregnancy must also be done much more carefully in the case of the patient with diabetes, as a strict glycemic control is necessary. This will require, notes Dr. Roman, more frequent visits to the diabetologist and the obstetrician.
