The Affects of Pregnancy on Diabetes

A woman with diabetes can be significantly affected during a pregnancy. Insulin requirements can be drastically altered from the physiological changes brought about by a pregnancy. There is also the chance that pregnancy can quicken the progress of vascular disease that is a secondary condition brought on by diabetes.

Insulin requirements for the pregnant woman are always changing making it more difficult to control the disease. During the early parts of the first trimester insulin needs frequently decrease. Levels of hPL, an insulin antagonist, are low; energy demands of the embryo are low; and the woman may be consuming less food because of nausea and vomiting. Nausea and vomiting may also cause dietary fluctuations, which can increase the risk of hypoglycemia or insulin shock.

Insulin requirements usually begin to rise late in the first trimester as glucose use and glycogen storage by the woman and fetus increase. As a result of placental maturation and production of hPL and other hormones, the requirements for insulin may double or quadruple by the end of pregnancy.

During labor energy needs increase which may require an increase in insulin to balance glucose that is given intravenously. After the baby is born and the placenta is delivered insulin needs decrease abruptly with the loss of hPL in the mother's circulatory system.

There are also other factors that will contribute to the difficulty in controlling diabetes during pregnancy. As the pregnancy progresses the renal threshold for glucose decreases. There is an increased risk of ketoacidosis, which may occur at lower serum glucose levels in a pregnant woman with diabetes than a non-pregnant woman with diabetes. The vascular disease that comes with diabetes may progress during a pregnancy. High blood pressure may occur. Nephropathy may result from renal blood vessel impairment, and retinopathy may develop from occlusion of the microscopic blood vessels of the eye.

The primary concern for the pregnant woman who has diabetes is control of circulating blood glucose levels. If control can be achieved and maintained, diabetes generally does not worsen during pregnancy. The woman's health status may even improve because of close medical supervision.