The decision to have a child is a major decision for a diabetic woman. The pregnancy will be a
high risk situation.
Before the discovery of insulin, diabetic pregnancies were almost unheard of. Until about 25 years ago, many physicians discouraged women with diabetes from attempting pregnancy, since the risks of health problems for both the mother and child were too great. However, with the development of new tests and new theories about managing diabetes, it is reasonable for a young woman with diabetes to plan to have a family.
The decision to have a child is a major decision for a diabetic woman. The pregnancy will be a high risk situation, with respect to physical health, emotional responses, and financial concerns. It will require close cooperation between the patient, her obstetrician, her diabetologist, and a pediatrician. There are substantial risks involved in these pregnancies. There is a higher than average chance of miscarriage and of major abnormalities in the developing fetus. Fortunately, it is now possible for obstetricians to identify some of these abnormalities early in the pregnancy. This allows the parents to know about the problem and plan accordingly.
The best chance for a normal pregnancy will occur when the diabetes is brought under excellent control before the pregnancy begins. The young woman can begin to work to control her blood glucose levels months before the planned conception. The idea of "tight control" means aiming for normal glycohemoglobin values, probably increasing the number of daily insulin injections (or using an insulin pump), doing multiple blood sugar tests every day, and dealing with the possibility of occasional insulin reactions.
It's a lot of work. But, when the glycohemoglobin can be brought into the normal range before conception, and when tight control of the blood sugar is maintained throughout the pregnancy, it is clear that the chances of a successful pregnancy will improve considerably.
Additional comment, February, 2001
What about women with type 2 diabetes, who are taking diabetes pills, or women who have had gestational diabetes in the past? Will they need insulin, or will diabetes pills be okay to use during pregnancy?
It has been traditional to think that women with diabetes, whether type 2 or gestational diabetes, should plan to control their diabetes with insulin, if medications are needed during pregnancy. However, there was an intriguing article recently (see below), about the use of glyburide (a sulfonylurea diabetes pill) during pregnancy instead of using insulin. This article only addressed the issue of using one pill (glyburide), and only in one specific group of women: women with gestational diabetes. It did not study women with type 2 diabetes. Nor would the study have any relevance whatsoever to women with type 1 diabetes.As of the moment of this writing (February, 2001), it is the opinion of the editors that it is inappropriate to use sulfonylureas (or other diabetes drugs) during pregnancy unless part of a fully-informed situation, such as a Phase 4 clinical trial protocol, where the risks as well as the benefits are fully discussed and understood. It is also recognized that in a carefully selected group of patients, that an oral agent could be a good alternative.
In the case of diabetes developing during pregnancy (gestational diabetes) insulin is needed only for a few months during the third trimester of the pregnancy, and has several relative advantages to offset the one minor disadvantage of the nuisance of giving injections: doses of insulin can be rapidly adjusted (on an hour-by-hour basis if needed), and the present study using pills has not been thoroughly replicated with sufficient power to watch for the possibility of rare side-effects.
| -- WWQ |
Also see
Planning a pregnancy. At the DiabetesMonitor
A comparison of glyburide and insulin in women with gestational diabetes mellitus New England Journal of Medicine, 343 (16):1134. Langer O, Conway DL, Berkus MD, Xenakis EMJ, Gonzales O.
