“I had a miscarriage in 2012,” says Indian expat Betty Sebastian, “it was because of diabetes.”
The now 41-year-old finance manager already had two children when she was diagnosed in 2008 with late onset Type 1 diabetes. Years on, on medication, she would lose her baby at five months and be asked by her doctors not to try for another. But then she would conceive.
In 2019, the pregnancy was discovered; it brought joy of course – and dread. “We were very cautious,” she says,”We took a lot of care – we monitored my diet, the kind of stress that I was in; it was a very high-risk pregnancy.”
From a laissez-faire style of condition management, Sebastian turned to keeping a steely eye on the numbers. “So before pregnancy, blood sugar levels of 140 for fasting and 180 after food are still acceptable, if you are diabetic. Once I got pregnant, my counts had to be between 90-110 fasting and they’d still allow me to go up to 150-180 after food. I monitored my glucose levels constantly with a stick-on monitor. I worked with a nutritionist, but my doctor was pretty hands-on, so she had already told me [in the first session itself], ‘this is what you eat, this is what you don’t eat’,” she explains.
High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are also at higher risk of developing diabetes in the future.
Monitoring sugar levels takes on exceptional importance when it comes to a pregnancy. Dr Yasmeen Ajaz, Specialist Endocrinologist, Medcare Hospital Al Safa, explains that keeping glucose levels in check can increase a woman’s chances of delivering a healthy baby. He adds: “High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are also at higher risk of developing diabetes in the future.
“I really clipped down what I was eating and I would have a huge throw up every time I was nauseous – which was all the time. I couldn’t eat much,” she recalls. The things she said helped were yoghurt, bananas, tea and biscuit, nuts. She was banned from drinking juices and even coconut water. Her doctor had upped her protein and cut her carbohydrates to keep the sugar levels in check.
Then, just as Sebastian were heading into her 34th week, a doctor’s visit showed foetal distress; she had pre-eclampsia. She had an emergency C-section and gave birth to a beautiful baby girl.
Two years on, Sebastian’s sugar levels are under control and she finds herself grateful. “My middle daughter is also diabetic so if I hadn’t had this pregnancy and had to look after her pregnancy many years later … this was just a great learning experience,” she says.
Diabetic and trying to conceive?
Here’re some answers to some frequently asked questions
Why is pregnancy difficult for those with diabetes?
Dr Roohi Mushtaque Shaikh, Specialist Obstetrics and Gynaecologist, Aster Clinic, Sheikh Zayed Road, explains: “A major health concern among women with both type 1 and type 2 diabetes is whether they will be able to conceive a baby. Studies have shown that diabetes mellitus type 1 and type 2 cause menstrual problems and infertility. It has been observed that the reproductive period of women with type 1 diabetes may be reduced due to delayed menarche (onset of menses) and premature menopause. Also, menstrual problems are twice as frequent in diabetic women. Type 1 diabetes in itself is associated with longer cycle length (> 31 days), long menstruation (≥ 6 days) and heavy menstruation as there is delayed or no ovulation. This leads to decreased fertility. Women with type 2 diabetes experience longer time to conceive because of poor egg quality. Type 2 diabetes is associated with obesity and polycystic ovary syndrome, which in turn lower the fertility.” Still, she does offer hope.
“The key for success is to do proper planning prior to becoming pregnant, control the sugars, see the doctor regularly, eat healthy food and exercise regularly,” adds Dr Ajaz.
What steps should a diabetic take during pregnancy?
Dr Ajaz says the following steps should be taken to prevent problems:
• plan for the pregnancy
• see your doctor early and often
• eat healthy foods
• exercise regularly
• take pills and insulin as directed
• control and treat low blood sugar quickly, monitor blood sugar often
High sugar impacts a woman’s eggs but do they also effect sperm?
Dr Shaikh says: “Diabetes-related fertility issues are observed equally in both women and men. Type 1 and 2 diabetes have detrimental effects on male fertility especially on sperm quality, sperm motility and sperm DNA integrity. It can cause genetic modification during sperm formation which may get transferred to the next generation and increase the risk of diabetes in the offspring.”
Is a gestational diabetes mum at risk of getting diabetes post-delivery?
Yes, says Dr Ajaz. They are at risk of getting diabetes in future and need to be screened every three years if the first screening after three to-six month is normal.
Most women with diabetes should aim for HbA1c (tight blood sugar control) as close to normal as possible (ideally below 6.5 per cent) before getting pregnant. If HbA1c is more than 8 per cent, it is better to avoid pregnancy.
What are the pregnancy complications that can occur?
Dr Ajaz explains: “Untreated diabetes increases your risk for pregnancy complications, like high blood pressure, depression, premature birth, birth defects and pregnancy loss.”
Dr Shaikh says: “Uncontrolled diabetes leads to short- and long-term adverse effects in the mother and the baby. There is an increased risk of early miscarriage and birth defects. Both of these are associated with high blood sugar levels around the time of conception. High blood sugar can lead to a large-sized baby which increases risk of shoulder injuries during delivery and also increases the likelihood of caesarean delivery. High blood glucose levels during pregnancy increase complications for the baby like premature birth, breathing problems and low blood glucose level at birth. It also increases the chances of a stillbirth. Long-term risks include obesity and diabetes in the offspring.
“Certain diabetes-related issues like vision problems and kidney diseases can worsen in pregnant women. There is also a greater chance of developing high blood pressure (pre-eclampsia) during the second half of pregnancy. Pre-eclampsia can cause serious life-threatening problems for the mother and the baby.”
Who will monitor the baby and mums progress?
A team consisting of gynaecologist, neonatologist and endocrinologist and well-trained nurses are needed to monitor the pregnancy.
Is there a change in the way you inject insulin during pregnancy?
Insulin is injected into your fatty tissue. The best place to use during pregnancy is your abdomen (stomach, belly). You can use your arms or legs if you cannot use your abdomen, adds Dr Ajaz.
Will the person have to have a C-section or is normal delivery possible?
“If you are healthy and your diabetes is well controlled when you become pregnant, you have a good chance of having a normal pregnancy and birth,” says Dr Ajaz. “Diabetes that is not well controlled during pregnancy can affect your health long-term and can also be risky for your baby and may need C-section.”
What can someone with diabetes do to better their chances of success?
Dr Shaikh explains: “Most women with diabetes should aim for HbA1c (tight blood sugar control) as close to normal as possible (ideally below 6.5 per cent) before getting pregnant. If HbA1c is more than 8 per cent, it is better to avoid pregnancy. Losing weight, eating healthy, exercising regularly and taking any necessary medications can all help increase the chances of conceiving. It is necessary to visit a doctor (obstetrician and endocrinologist) at least six months prior to planning a pregnancy. Get a complete health check-up especially for any vision or kidney problems. Women with established diabetic complications such as retinopathy or nephropathy may experience a worsening during the pregnancy.
“These aspects should ideally be assessed prior to any pregnancy and/or at such intervals during the pregnancy as clinically indicated. So, it is important to visit the doctor early and often during pregnancy. During pregnancy, the body’s need for energy changes rapidly and so blood sugar levels can change very quickly. So, a pregnant woman needs to check her blood sugar often as directed by the doctor.”
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