Dr M Prabhakaran talks about the need of Care during pregnancy in Diabetes

What is the care to be taken

Diabetes mellitus is caused by a problem with insulin. Insulin moves glucose out of the blood and into the body’s cells where it can be turned into energy. Pregnancy health care professionals often call diabetes that is present before pregnancy pregestational diabetes mellitus. When the body does not make enough insulin or does not respond to it, glucose cannot get into cells and instead stays in the blood. As a result, the level of glucose in the blood increases. Over time, high blood glucose levels can damage the body and cause serious health problems, such as heart disease, vision problems, and kidney disease.

If you have diabetes pregnancy presents unique challenges. It is very important for your health and for your baby's health that your blood sugar levels are kept stable.

If your diabetes is not managed well, you are at increased risk of several of the complications associated with diabetes. The following problems can occur in women with diabetes: Birth defects, High blood pressure, Hydramnios—there is an increased amount of amniotic fluid in the amniotic sac that surrounds the fetus. It can lead to preterm labor and delivery, Macrosomia (very large fetus)—The fetus receives too much glucose from the mother and can grow too large. A large fetus can make delivery more difficult.  

You can control your glucose level with a combination of eating right, exercising, and taking medications as directed by your health care professional. You may need to see your healthcare professional more often. Your healthcare professional will schedule frequent prenatal visits to check your glucose level and for other tests.

Checking your blood sugar (blood glucose)

It is very important for your health and for your baby's health that your blood sugar levels are kept stable. You will be asked to check your blood sugars multiple times a day and send your sugar log to us weekly.    

Your blood sugars should ideally be within this range: (ADA 2021)

• Fasting <95 mg/dL
• One hour after breakfast ≤140 mg/dL
• One hour after lunch ≤140 mg/dL
• One hour after dinner ≤140 mg/dL

Your blood sugars are reviewed weekly via e-mail or phone. If diet and exercise are not enough to control blood glucose for the entire pregnancy, necessary steps are taken and reassessed routinely to achieve optimal outcomes. Poorly controlled diabetes can lead to stillbirth. It is very important that you monitor your blood sugars. Pregnancy can also make symptoms of low blood sugar hard to detect. The blood sugar checks you do at home are a key part of taking good care of yourself and your baby before, during, and after pregnancy. Blood sugar targets are designed to help you minimize the risk of birth defects and miscarriage, and help prevent your baby from getting too large. If you have trouble staying in your target range or have frequent low blood sugar levels, talk to your healthcare team. Target blood sugar values may differ slightly in different care systems and with different diabetic teams. Work with the health care team on determining specific goals before and during pregnancy.    

Insulin and diabetes pills

Insulin is the traditional first-choice drug for blood sugar control during pregnancy because it is the effective for fine-tuning blood sugar and it doesn’t cross the placenta.    

If you have type 1 diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body's need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes to help the baby grow. At the same time, these hormones block the action of the mother's insulin. As a result, your insulin needs will increase. If you have type 2 diabetes, you also need to plan ahead with health care team about the medications. For women with gestational diabetes, meal planning and exercise often work to keep blood sugar levels in control. While some people can control their type 2 diabetes with diet and exercise, others take medications to help control blood sugar.  

Food

When pregnant, it’s especially crucial to make sure your blood sugar is at an appropriate number. It’s also important to make sure you’re eating a well-balanced, nutritious diet. During pregnancy,   your dietitian may need to change your meal plan to avoid problems with low and high blood sugar levels.  For most women, the focus of a good meal plan during pregnancy is improving the quality of foods you eat rather than simply increasing the amount of food eaten. A good meal plan is designed to help you avoid high and low blood sugar levels while still providing the nutrients your baby needs to grow. A healthy prenatal diet is similar to a healthy regular diet, incorporating a lot of different foods and taking care not to overeat. “Eating for two” isn’t necessary, so there’s no need to overeat.

Including a variety of different foods and watching portion sizes is key to a healthy diet. Healthy eating is important before, during, and after pregnancy, as well as throughout your life. Healthy eating includes eating a wide variety of foods, including:

• fruits and vegetables
• whole grains, beans, and legumes
• lean meats, including chicken
• fish, though you should avoid raw preparations and varieties with high mercury content
• low-fat dairy products

You only need to increase your calorie intake by about 300 more calories each day. If you start pregnancy weighing too much, you should not try to lose weight. Instead work with your dietitian or doctor to curb how much weight you gain during pregnancy.  Each individual is different, and depending on your medical history, your doctors might provide you with more personalized recommendations. The American Diabetes Association offers a simple method for meal planning. Follow these steps when preparing your plate:

• Fill half of your plate with non-starchy vegetables, such as spinach, carrots, cauliflower, beets, cabbage, okra, beans or tomatoes.
• Fill a quarter of your plate with a protein, such as tuna, lean pork or chicken.
• Fill the last quarter with a whole-grain item, such as brown rice, or a starchy vegetable, such as green peas.
• Include “good” fats such as nuts or avocados in small amounts.
• Add a serving of fruit or dairy and a drink of water

Exercise is a key part of diabetes treatment.  Discuss your exercise plans with your diabetes care team, and ask for guidelines.  Regular physical activity is not only safe for pregnant women, it benefits health by offsetting some of the problems of pregnancy. For women with diabetes, exercising after meals may help the muscles use the sugar in the bloodstream, and help keep your blood sugar levels in your target range. However, if you have any of the following conditions, then you will need to talk to your diabetes care team about the risks of exercise during pregnancy: High blood pressure, Eye, kidney, or heart problems, Damage of the small or large blood vessels, Nerve damage

In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics. Activities to AVOID during pregnancy include:

• Activities that put you in danger of falling or receiving abdominal injury, such as contact sports
• Activities that put pressure on your abdomen (exercises done while lying on your stomach)
• Vigorous, intense exercise, such as running too fast to carry on a conversation
• Activities with bouncing or jolting movements (horseback riding or high-impact aerobics)

Ref: https://www.diabetes.org/resources/women/prenatal-care

https://www.acog.org/womens-health/faqs/a-healthy-pregnancy-for-women-with-diabetes

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