Thursday, May 1, 2014

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Diabetes in pregnancy is going to become a more common problem each year.  Between now and 2030, the incidence of diabetes is expected to rise from 20.9 million to 30.3 million people.  Diabetes is the 7th leading cause of death in the USA currently.

Complications of diabetes include:  stroke, retinopathy (retinal damage leading to blindness), heart disease, kidney/renal disease, peripheral neuropathy (nerve damage in the hands/feet), and more specific to my field-- Birth Defects.  It has been proven in MANY large studies that strict control of blood sugars can prevent or slow progression of diabetes complications and birth defects.

Disturbance in blood sugar levels has been associated with increased rates of stillbirth, newborn deaths, abnormal newborn weights (either low weight or large weights), and a 3-4 risk of malformations.  Birth defects occur in 6-10% of newborns born to diabetic mothers (baseline risk is 3% in healthy females).  In 2010, 8,000 babies were born with birth defects caused by diabetes.   Maternal diabetes increased neural tube defect (such as spina bifida) rates by more the 20 fold.

How can patients at risk prevent diabetes complications:  1) Keep blood sugar levels at as close to normal as possible  2) Maintain a healthy body weight  3) Keep blood pressure at <120/80 mmHg with medication, diet, and exercise.

Both injections of insulin and oral medications for diabetes are effective in preventing pregnancy complications.

When is the best time to achieve control of diabetes -- BEFORE pregnancy.  If you think you may be at risk of diabetes (which is often assymptomatic), get tested before becoming pregnant.  Controlling blood sugars before pregnancy prevents diabetes-associated birth defects.  Using vitamins/antioxidants (folic acid) before becoming pregnancy helps decrease the risk BUT does not prevent damage done by abnormal sugar/glucose levels.

Please be screened for diabetes before pregnancy.  You will be screened during the third trimester of pregnancy, but it may be too late if you have undiagnosed diabetes before conception.