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 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.