Controlling Diabetes Before Pregnancy
By Danielle M. Esters, MD, FACOG
Poorly controlled diabetes prior to
conception and during the fi rst trimester
of pregnancy may cause major birth
defects in 5 to 10 percent of pregnancies,
and miscarriages in 15 to 20 percent
of pregnancies. This startling statistic
demonstrates how important it is that
would-be moms control diabetes before
becoming pregnant.
During early pregnancy, before a
woman may even know she is pregnant,
cells contribute to organ formation in
the developing embryo. High blood
glucose levels may interrupt proper organ
formation and cause malformations in the
fetal brain, spinal cord, heart, kidneys and
limbs. Controlling blood glucose levels
once pregnancy is diagnosed may be too
late to prevent miscarriage or congenital
defects. The good news is that the chance
of these problems occurring in pregnancy
may be decreased by adequately
controlling blood glucose levels before
conceiving.
The preconception consultation is
a vital aspect of care for women with
diabetes who are considering pregnancy.
Preconception is the time to more strictly
monitor glucose levels and possibly
adjust diabetes therapy. Nonpregnant
women with diabetes treated with
oral medication will likely need to
switch to insulin. Women already being
treated with insulin may need dosage
adjustments to achieve glucose control
that is acceptable for pregnancy. The
preconception period is also a good time
to make needed dietary modifi cations.
If weight loss is needed, this should be
attempted before becoming pregnant, not
during pregnancy.
Once pregnant, frequent glucose
monitoring during the day is needed to
confi rm optimal glucose control and is
essential for the entire pregnancy through
delivery. Although pregestational diabetes
is a signifi cant risk factor, adverse
effects to the pregnancy may be reduced
by appropriate preconceptional and
antenatal care.
Diabetes is a medical condition
in which there are abnormally
high levels of blood glucose due
to defects in insulin production, insulin
action or both. Of the 8.1 million women
with diabetes in the United States, almost
25 percent are of childbearing age.
Danielle M.
Esters, MD,
FACOG, is a
maternalfetal
medicine
specialist and is
board certifi ed
in obstetrics
and gynecology, maternal-fetal
medicine and clinical medical genetics.
She is in private practice in West Palm
Beach and receives patients with
diabetes and other complications of
pregnancy for prenatal care as well as
for consultation from referring doctors.
For an appointment, please call
561-790-0472.
 |
Wellington Regional Medical Center, 10101 Forest Hill Blvd. Wellington, FL 33414 (561) 798-8500 |
