The Affects of Diabetes on Pregnancy

Health problems for the pregnant woman with diabetes have been greatly reduced due to an increased emphasis on maintaining tight control of blood glucose levels, early prenatal care, and a team approach by health professionals. The prognosis for the diabetic woman with gestational type 1, or type 2 diabetes is positive if significant vascular damage has not occurred. Even with the advances in medical care and technology diabetic pregnancy is still at a higher risk for complications than a normal pregnancy.

Hydroamnios is an increase in the volume of amniotic fluid that occurs in 10% to 20% of women with diabetes during a pregnancy. It is believed that fetal hyperglycemia causes excess urination that leads to this condition. Preeclampsia-eclampsia also occurs more often in diabetic pregnancies, particularly when the diabetes has already caused vascular changes.

Hyperglycemia due to insufficient amounts of insulin can lead to ketoacidosis as a result of the increase in ketone bodies in the blood released when fatty acids are metabolized. Ketoacidosis usually develops slowly, but it may develop more rapidly in the pregnant woman because of the hyperketonemia associated with accelerated starvation in the fasting state. The tendency for higher postprandial glucose levels because of decreased gastric motility and the contrainsulin effects of hPL also predispose the woman to ketoacidosis. If the ketoacidosis is not treated, it can lead coma and death of both the mother and fetus.

Another risk to the pregnant woman with diabetes is a difficult labor, caused by fetopelvic disproportion if fetal macrosomia exists. The pregnant woman with diabetes is also at increased risk for recurrent monilial vaginitis and urinary tract infections because of increased glycosuria, which contributes to a favorable environment for bacterial growth. If untreated, asymptomatic bacteriuria can lead to pyelonephritis, a serious kidney infection.

Research has shown that pregnant women with diabetes suffer from worsening retinopathy. It is vitally important that during a diabetic pregnancy that blood glucose levels are kept under control to help to help prevent the retinal hemorrhage associated with diabetes. Laser photocoagulation can also be used when retinal blood vessels begin to show signs of change. Pregnant women with diabetes should be seen by an ophthalmologist regularly during their pregnancy.

There are higher risks of complications for women with diabetes who are pregnant that include congenital defects and increased risk of perinatal mortality. Even though the risks can be lessened with strict blood glucose control, they are still very real and any diabetic woman who is trying to get pregnant or is pregnant must be carefully monitored by their health care providers.