Diabetes and Pregnancy

Patients from all different backgrounds arrive at LIMARP® because they’re looking to improve their quality of life and embark on a healthier path. Our multidisciplinary team, led by Dr. Liza María Pompa González, offers different health services to help you reach your weight goals and beat obesity: from diet and exercise plans, to psychological guidance and surgical intervention.

Diabetes is a chronic disease that affects the body, specifically the eyes, heart, kidneys, and nerves. This disease affects the processes of glucose, a type of sugar that serves as primary energy for the body. This condition is about how your body turns foods’ sugar into energy and around 422 million people worldwide have been diagnosed with diabetes[1].

Although there are several types of diabetes, specialists can manage the risks and complications associated with diabetes during pregnancy with proper planning and medication.

This article will dive into each type of diabetes that can present itself throughout a pregnancy.

Keep in mind that the following information doesn’t necessarily apply to every case and that if you recognize any symptom, you must contact your doctor right away.

Types of Diabetes in Pregnancy

Several types of diabetes may occur during pregnancy, such as gestational diabetes[2], which is the type of diabetes that appears during pregnancy, usually in the second or third trimester. In some cases, this type of diabetes disappears after delivery. However, women who develop gestational diabetes during pregnancy are at higher risk of developing type 2 diabetes later in life.

Type 1 diabetes is different. It occurs when the body’s immune system attacks the cells that produce insulin in the pancreas, so the body cannot use blood sugar for energy. Insulin is the hormone that regulates blood sugar levels[3]. 

Type 2 diabetes, on the other hand, appears when the body resists insulin or when the pancreas does not produce enough insulin to maintain normal blood sugar levels. This means that with type 2 diabetes your body does not use insulin well and cannot keep blood sugar at normal levels[4].

During pregnancy, the woman’s body demands more insulin due to the growing fetus needing energy to develop. Women diagnosed with any type of diabetes will need regular appointments to manage their blood sugar levels throughout pregnancy. This may involve adjusting medication doses, monitoring blood sugar levels more frequently, and making lifestyle changes.

Therefore, women with gestational diabetes or diabetes type 1 and 2 can manage their condition by changing their way of living, such as eating a healthy diet and establishing an exercise routine. Some women may also need to monitor their blood sugar levels and take medication, such as insulin.

Diagnosis, Management, and Preconception Planning

Diabetes diagnosed during pregnancy involves pregnant women getting a glucose tolerance test. If diagnosed with diabetes during pregnancy, treatment and management will depend on the type of diabetes and the severity of the condition.

As previously mentioned, preconception planning is key when managing diabetes during pregnancy. Women planning to become pregnant should work with their doctor to optimize their blood sugar levels before becoming pregnant.

Insulin in pregnancy is an option with irregular blood levels, but it is imperative to visit a personal doctor to take the necessary precautions. This may involve adjusting medication doses or making lifestyle changes to have better blood sugar control.

Insulin in Pregnancy

Pregnant women may experience insulin resistance, making the body less responsive to insulin. Insulin resistance during pregnancy is a natural physiological process that allows glucose to be delivered to the growing fetus for its growth and development. However, in some cases, insulin resistance can become more severe, leading to gestational diabetes.

Managing insulin levels during pregnancy is vital for both the mother and the baby since high blood sugar levels can increase the risk of complications during pregnancy. In addition, poorly controlled blood sugar levels during pregnancy increase the baby’s risk of developing health problems, such as hypoglycemia (low blood sugar)[5] and respiratory distress syndrome (RDS).

Diabetes Risks Factors in Pregnancy

Diabetes during pregnancy is risky for both the mother and the baby if not treated. Some of the risks and complications associated with diabetes during pregnancy include:

• Macrosomia: A condition in which the baby grows too large, which can lead to complications during delivery. Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large baby can lead to the mother needing a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery[6].
• Pre-eclampsia or high blood pressure: Pregnant women may present signs of damage to other organs, such as the kidneys, liver, or brain. This circumstance might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labor and delivery[7].
• Stillbirth or miscarriage: This is a serious complication that can happen when the baby dies in the womb after 20 weeks of gestation. A woman who has diabetes that is not well controlled has a higher chance of having a miscarriage or stillbirth.
• Birth defects: The organs of the baby form during the first two months of pregnancy, often before a woman knows that she is pregnant. Women with uncontrolled diabetes during pregnancy have higher risk of giving birth to a baby with birth defects, such as heart defects or neural tube defects.

Postpartum Care

Postpartum care is also essential for women with diabetes type 1, type 2, and gestational diabetes. The American College of Obstetrics and Gynecology (ACOG) and the American Diabetes Association (ADA) recommend that women with Gestational Diabetes receive care 6–12 weeks after delivery to assess blood pressure, body mass index (BMI), and metabolic profile, in addition to routine postpartum concerns[8]. As said before, women with gestational diabetes have a higher risk of developing type 2 diabetes later in life, so regular follow-up visits with their doctor are highly recommended to manage their condition after giving birth.

Gestational Diabetes Prevention

Although gestational diabetes is not always preventable, women can take action to reduce their risk of developing the condition during pregnancy[9]. Here are a few tips for its prevention:

• Keep a healthy weight: Being overweight or obese increases the risk of gestational diabetes. Women planning to become pregnant should aim to achieve a healthy weight before pregnancy and continue to maintain it throughout pregnancy.
• Eat a healthy diet: A balanced diet includes choosing foods that are low in sugar and refined carbohydrates and high in fiber, protein, and healthy fats. Eating regular meals and snacks is also important for stabilizing blood sugar levels.
• Exercise regularly: Regular physical activity that’s moderately intense, such as brisk walking, lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
• Monitor blood sugar levels: Women who are at high risk for gestational diabetes need to monitor their blood sugar levels at home. This involves testing blood sugar levels several times a day using a glucose meter.

Bariatric Surgery and Diabetes

Research has shown that bariatric surgery can lead to remission of type 2 diabetes in many patients, meaning that their blood sugar levels return to normal without needing diabetes medication. This effect is most pronounced in people who have had diabetes for a shorter period and who have better blood sugar control before the surgery.

Surgical operations with intestinal diversion and mainly duodenal-jejunal exclusion have consistently shown beneficial effects on glucose homeostasis by reducing insulin resistance and increasing insulin secretion[10].

In summary, bariatric surgery can help with diabetes by inducing weight loss, improving insulin sensitivity and glucose regulation, and leading to remission of type 2 diabetes in some patients. However, bariatric surgery is a major surgical procedure with potential risks and complications, and it should only be considered after careful evaluation and discussion with a qualified healthcare provider.

Contact Us to Learn More

If you want more information about diabetes and pregnancy, risks and complications, or diabetes related to bariatric surgery, schedule an appointment with us. We can help determine the right treatment for you. Contact us online anytime or call us at (619) 373-0229.

References

• [1]  “Diabetes”.  https://www.who.int/health-topics/diabetes. (Accessed April 24, 2023). 
• [2] “Pregnancy if You Have Diabetes”. https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy. (Accessed April 24, 2023). 
• [3] “An overview of insulin”. https://www.medicalnewstoday.com/articles/323760. (Accessed April 24, 2023).
• [4] “What is Diabetes?”. https://www.cdc.gov/diabetes/basics/diabetes.html. (Accessed April 24, 2023).
• [5, 7] “Type 1 or Type 2 Diabetes and Pregnancy”. https://www.cdc.gov/pregnancy/diabetes-types.html. (Accessed April 24, 2023).
• [6] “Diabetes and Pregnancy”. https://www.cdc.gov/pregnancy/diabetes.html. (Accessed April 24, 2023). 
• [8] Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol. 2017 Sep;217(3):314-321. doi: 10.1016/j.ajog.2017.04.033. Epub 2017 Apr 26. PMID: 28455081; PMCID: PMC5581263. 
• [9] “Gestational Diabetes”. https://www.cdc.gov/diabetes/basics/gestational.html. (Accessed April 24, 2023).  
• [10] Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017 Aug 10;17(1):50. doi: 10.1186/s12902-017-0202-6. PMID: 28797248; PMCID: PMC5553790.