Diabetes and pregnancy

Diabetes and pregnancyWomen who have diabetes mellitus and become pregnant need careful specialist care. Then they have a good chance of a pregnancy without major complications and a healthy child.

Medical support for pregnant women with diabetes

Diabetes and pregnancy

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Just under one percent of all pregnant women in Germany, around 7.500 women, have diabetes – most of them type 1, about 20 percent type 2. There is also gestational diabetes, which only occurs during pregnancy. About 4.5 percent of pregnant women (nearly 35.000) are affected. However, gestational diabetes will not be discussed in detail below. For women with diabetes who become pregnant, it is important that they are closely monitored by diabetes specialists, midwives and gynecologists. With good blood glucose control and consistent adherence to the values, they have a good chance of experiencing a pregnancy without complications and of giving birth to a healthy child.

If you have diabetes type 1 or 2, it is best to plan your pregnancy. Then you can already positively influence the course of pregnancy in advance. If you are unplanned pregnant, it is advisable to talk to your diabetology and gynecology specialists as soon as possible.

Blood glucose: the best possible values during pregnancy

For a good pregnancy and healthy child development, it is particularly important that the blood glucose values are individually adjusted as optimally as possible. However, this is complicated by hormonal fluctuations during pregnancy. At the beginning of pregnancy until about 14. Insulin requirements drop during the first week of pregnancy. Rise steeply from mid-pregnancy onwards. Drops sharply again at birth.

For pregnant women with type 1 diabetes, it is therefore advisable to take at least seven measurements a day. It is best to measure in the morning on an empty stomach, one hour after breakfast, then before lunch, one hour after lunch, before and after dinner, and before bedtime. Modern measuring devices store the values, which your doctor can then read out and discuss with you. Many women also use apps to document blood glucose levels, their diet and exercise, and other relevant values.

The German Diabetes Society lists optimal blood glucose levels during pregnancy as:

– before eating: 60 to 90 mg/dl (3.3 to 5.0 mmol/l) – one hour after eating: less than 140 mg/dl (7.7 mmol/l) – two hours after eating: less than 120 mg/dl (6.6 mmol/l) – before going to bed: 90 to 120 mg/dl (5.0 to 6.6 mmol/l) – at night (about two to four o'clock): 60 to 90 mg/dl (3.3 mmol/l)

In addition, the HbA1c value is determined by a blood test at intervals of four to six weeks. It is a reliable long-term average value that provides information about how the blood glucose level has been adjusted in recent weeks.

You can also find out at what blood glucose levels a ketone test is required. If the ketone values are too high, there is a risk of a so-called ketoacidosis. Blood glucose levels are then so high that your metabolism is dangerously derailed. Ketoacidosis must be treated immediately, otherwise a life-threatening condition can occur.

The diet of pregnant women with diabetes

As for all pregnant women, it is also important for women with diabetes to adapt their diet to the special calorie and nutrient requirements during pregnancy. Diabetes nutrition counseling that specifically addresses pregnancy conditions may be able to give you helpful tips and support.

The B vitamin folic acid is particularly important for the healthy development of the child. It is best to start taking folic acid when you are planning a pregnancy. For women with diabetes, it may also be appropriate to take a higher dose than is recommended for healthy women. Foods containing folic acid also contribute to a good supply of folic acid during pregnancy. This reduces the risk of malformations of the child's spine, spinal cord and brain, as well as in the area of the lips, jaw and palate.

An adequate supply of iodine also contributes to the healthy development of the child. A daily intake of at least 0.1 to 0.2 mg (100 to 200 μg) of iodine and an iodine-rich diet are recommended. Since the individual iodine supply depends on many factors, such as personal eating habits, it is advisable to discuss your iodine requirements with your doctor at the beginning of your pregnancy.

If you are a smoker, be sure to quit for a good pregnancy outcome and healthy child development.

Diabetes therapy and medications during pregnancy

There is no binding therapy scheme for everyone – the best individual approach must be determined for each pregnant woman. Due to the metabolic fluctuations during pregnancy. Because of the individual differences in insulin requirements, the insulin dose must be well adjusted on an ongoing basis. Therefore, have your values checked every two weeks by your diabetologist.

Pregnancy care and check-ups

Good medical care can help you feel as safe as possible during pregnancy despite diabetes:

– Your specialist or. Your specialist may want to see you more often for prenatal care than a metabolically healthy woman would. – Have your retina checked once or twice before you plan to become pregnant, at the beginning of your pregnancy, and depending on your findings and risk. Measure your blood prere as regularly as possible. As part of your prenatal care, have your urine tested for protein. – Between the 18. and 22. Detailed fine diagnostics of the child's organs and organs of the child. Structures possible in a specialized center. Subsequently, further ultrasound examinations can be performed every two to four weeks. More frequent CTGs before birth to check the heart-. Labor and checking the thyroid gland for hyper- or hypothyroidism are recommended.

What are the risks for pregnant women with diabetes and their children??

During the first period of pregnancy, the child's internal organs are developing. If the blood glucose levels of the pregnant woman are not optimally adjusted during this time, this can lead to malformations in the child. If, on the other hand, the values are well adjusted, the risk of fetal malformations is significantly lower.

Children born to mothers with type 1 and type 2 diabetes have an increased risk of malformations, especially of the heart, lungs and nervous system, compared to children born to healthy women. Malformations of the bones, urinary tract, bile ducts and spleen are also more common. Because the child has to process the increased maternal blood sugar and produces a lot of insulin in the process, it may store more fat in the course of the pregnancy and therefore be born with a birth weight that is too high. In addition, the maturation of the lungs is delayed, which can be associated with breathing problems after birth.

For women with type 1 diabetes, there is a risk of blood glucose levels dropping too low (hypoglycemia), especially at the beginning of pregnancy and particularly at night. From the 20. In the second week of pregnancy, the risk is lower and blood glucose levels become more stable and calculable.

Based on current knowledge, occasional maternal hypoglycemia is not problematic for fetal development, but it does pose a risk to the mother. It is therefore even more important than usual for you to know which symptoms indicate hypoglycemia in order to be able to react appropriately.

If you have diabetes-related diseases, for example of the eyes, kidneys, thyroid or nerves, they can worsen during pregnancy. However, the changes often disappear after the birth. Retinal changes (diabetic retinopathy). Diabetic kidney disease (diabetic nephropathy) must be treated in time.

In the further course of pregnancy, high blood prere can develop, especially if diabetes has been present for a long time. In this case, it is best to check your blood prere daily yourself. The thyroid gland should also be tested for hyper- or hypothyroidism.

How does the birth proceed in women with diabetes??

Women with diabetes are recommended to have their child in a so-called level 1 or 2 perinatal center. Hospitals with this designation specialize in high-risk pregnancies and premature births and have an affiliated pediatric clinic with a neonatal intensive care unit. Because women with diabetes have a higher risk of preterm birth before 37 weeks of pregnancy, they need to be aware of the risks. If the risk of diabetes is significantly increased during the first week of pregnancy, it is a good idea to look for a suitable clinic with a diabetes-experienced team early on in the pregnancy.

If the calculated due date is reached, but the birth does not start on its own, women with diabetes are usually induced to give birth. If the weight of the child increases to more than 4.500 grams estimated, a cesarean section may be advised. During delivery, your blood glucose levels should be between 90 and 130 mg/dl (5.0 to 7.2mmol/l) if possible. To maintain these levels, blood glucose levels are usually checked every one to two hours and corrected as needed. After birth, mother need. Child needs intensive care. In women, insulin requirements decrease in the hours after delivery, increasing the risk of hypoglycemia. The insulin supply must therefore be adjusted to the new requirement.

If possible, start breastfeeding your baby within the first half hour after birth. If the baby is not yet able to suck itself, you or the midwife can also express the colostrum by hand and give it to the baby via an eyedropper. After that, his blood glucose levels should be checked every three hours for the first day until they are stable.

Breastfeeding and diabetes

breastfeed your child, if possible, for at least six months. Breast milk not only reduces the risk of later diabetes in children, but also of obesity.

Since your own insulin needs decrease when lactation begins, your insulin dose must be readjusted. As an orientation value, the requirement before pregnancy is used. If you do need to switch to bottle feeding, discuss the change with your diabetic team to.

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