Want to conceive? Don’t let diabetes defeat you

When Sujani came to me, she was confused. She wanted a second child and her family wasn’t sure if she could have a safe pregnancy with diabetes. Most people advised her to give up her desire for the fear of the complications both for Sujani and her unborn child. Sujani’s situation was different from women who are detected with gestational diabetes—which is diabetes that starts or is first diagnosed during pregnancy. Like Sujani, there are many women with diabetes who want to have a baby, but are fearful. But it is possible to have a safe pregnancy and deliver a healthy baby, provided proper care is taken before, during and after pregnancy.

Before conception

• It’s important to get the blood sugar to near normal levels before trying to conceive. This minimises the chance of birth defects, miscarriage, and other problems because the organs begin forming soon after conception, even before one becomes aware about the pregnancy.
• Women on oral diabetes medication may need to switch to insulin before conceiving [Insulin pens are the easiest way to take insulin]. This is essential as insulin being a natural hormone, is the safest for the baby. It is important that the sugar levels are controlled when making the switch. If correct insulin dose is taken before pregnancy, there are less chances of having problems with fluctuating sugar levels during pregnancy.
• A woman’s doctor may advise her to take a multivitamin or prenatal vitamin with folic acid for the baby. This is usually done in consultation with the obstetrician.

Diabetes is one of the best examples of how preconception planning can make a huge difference in a pregnancy’s outcome. Before insulin was discovered, diabetic women were rarely able to have successful pregnancies, but now the risks of losing a child are almost equal to those for non-diabetic pregnancies.

When pregnant

Good control over blood sugar is the key to the mother’s as well as baby’s health. In addition to the general precautions that all pregnant women must take, diabetic women should pay particular attention to their diet and sugar levels.

• As the pregnancy progresses, the insulin dose may have to be adjusted. For this, regular monitoring of blood sugar levels is essential. Also, regular consultations with the diabetologist and obstetrician are essential.
• Diet has a direct effect on blood sugar levels, which becomes all the more important during pregnancy. A diet that supplies the needs of pregnancy without excessive weight gain is needed. Women should discuss their diet with their doctors and dieticians on a regular basis.
• During this phase, the main goal of dietary modifications is to provide adequate nutrition for the baby and avoid peaks in blood sugar levels. Splitting meals into six smaller ones instead of three large ones a day helps in this. Healthy snacks are important, and should probably include a complex carbohydrate [such as whole-grain bread] or a protein [such as sprouts and paneer] or a serving of fruit or vegetable contrary to popular belief of high fat diet. It is important not to skip meals or snacks, since that can lower blood glucose.
• Exercise benefits both the mother and the baby. If one hasn’t been regular at exercise, now would be a good time to start, but not without first checking with the doctor about the activity. Strenuous activity, which can give jerks should be avoided. One needs to plan the period of activity along with food intake and insulin injections.
• The doctor may advise an ultrasound scan at regular intervals for monitoring proper development of the baby to maximise the chances of delivering a healthy baby.

Post delivery

• Most women are able to go back to their pre-pregnancy dosage of insulin soon after child birth.
• Breast feeding is highly recommended for the baby, as well as for women with diabetes as not only does it protect the baby but also can lower the amount of insulin the woman needs.
• Taking diabetes pills during breast feeding is not recommended and alternatives should be discussed with the doctor.

Giving birth to a baby is one of the best experiences for a woman, which a woman with diabetes too can enjoy. Sujani took all precautions and delivered a healthy baby. If Sujani, being a working mother can achieve this, so can any other woman.

This was first published in the August 2012 issue of Complete Wellbeing.