Diabetes mellitus and pregnancy
Most women consider the birth of a child to be their main purpose. Diabetes mellitus seriously complicates the course of pregnancy and childbirth, therefore, it is necessary to approach the issue of the possibility of becoming a mother very responsibly. Unfortunately, pregnancy with diabetes is a process that is unsafe for both the woman and her unborn child. Not so long ago, it was believed that these concepts are absolutely incompatible, and even now there is no absolute consensus among doctors on this score.
Indeed, too many dangers await a woman and her unborn baby along the way. First of all, due to the high sugar level, the fertilized egg may simply not attach to the wall of the uterus, and everything will end as soon as it starts. If, nevertheless, the ovum has taken root and pregnancy develops, excess glucose and products of increased processing of fatty acids (ketone bodies) have a damaging effect on the rudiments of the fetal organs, causing gross malformations, which also inevitably leads to spontaneous abortion, or, more simply, miscarriage. With a glycated hemoglobin level of about 8%, the frequency of such complications is up to 20% (every fifth pregnancy).
Have these problems been avoided? It’s good, of course, but it’s too early to calm down: the placenta is forming. One of its functions is to ensure the exchange of nutrients and products of their processing between the mother and the fetus (the child receives all the substances he needs for life and growth, and gives back the resulting waste). This requires that the placenta be supplied with a huge number of blood vessels, which, as we know, in diabetes mellitus are damaged by inflammatory changes and atherosclerotic plaques. A full exchange of substances between a woman and a fetus becomes difficult, if not impossible. The result is the same – growth retardation, the formation of malformations, up to the death of the fetus (obstetricians call this a frozen pregnancy).
If this was avoided, a new problem arises: the placenta passes a lot of excess glucose in the mother’s blood into the child’s circulatory system, causing macrosomia – increased organ growth – which, in essence, is still the same developmental defect. From the 13th week, the fetal pancreas itself begins to produce insulin, and since glucose is supplied in excess, the gland also works with overexertion, releasing huge amounts of insulin.This leads to the appearance of specific changes in the work and structure of all organs and systems of the fetus, as well as premature emaciation of his pancreas. Such a child, after birth, will develop diabetes mellitus earlier than one whose mother had good diabetes compensation for nine critical months.At the same time, the placenta itself secretes a mass of anti-insulin (counterinsular) hormones, which, without timely correction of insulin doses, will lead to a deterioration in the condition of the woman herself. Doses have to be increased without waiting for decompensation, and this, with inept handling of insulins, causes hypoglycemic states. They also become more frequent at a later date, when the growth of the placenta stops (its contrainsular action weakens). This time also requires a revision of insulin doses, this time in the direction of decreasing. In order not to miss all this, a woman must carefully control glycemia – take 5-6 measurements daily throughout almost the entire pregnancy.
A characteristic feature of children born to patients with diabetes mellitus is the immaturity of their respiratory system. In this regard, as early as 36-37 weeks of pregnancy, a woman should go to the hospital so that obstetricians and endocrinologists can determine the maturity of the fetus in time and decide on the tactics of childbirth, as well as drug preparation of the child for birth. In no case should this process be allowed to take its course! How disappointing it is when a woman, having passed nine-month trials, is glad that almost all the torments of the rock are behind, relaxes, and the pregnancy ends in tragedy … Be patient and bring the matter to an end. The reward will be invaluable
Practice shows that modern methods of treatment and control of diabetes allow a woman suffering from diabetes to conceive, bear and give birth to a healthy child. Of course, if she strictly observes the conditions necessary for this. What are we talking about?
First of all – this is the most important thing – the pregnancy must be planned. Planning the birth of a child does not mean putting a cross on the calendar: on this day we will begin to get pregnant. In fact, this is a thorough preparation that can last 3-6 months, and sometimes up to a year. It includes an assessment of the risk for the unborn child and mother, an assessment of the woman’s condition at the time of making a decision, and the achievement of complete, ideal diabetes compensation.
Let’s start in order. So, the risk for the child. With regard to genetic factors, the risks are currently calculated only for type 1 diabetes mellitus.
It is known that if a family with diabetes mellitus is sick only to lie, the risk of developing diabetes in her children is not very high: if a woman is over 25 years old, the risk will be 1.1% (this is about 3 times higher than in healthy women), and if younger, the risk will be more significant – 3.6%. Is the future father sick? This means that the risk is even higher – 6%. A completely unfavorable prognosis will be if both future parents suffer from diabetes – the risk increases many times and is approximately 30%. The same 30% risk remains if one of the parents has a brother (sister) with diabetes, and the family already has a child with diabetes. For comparison: the risk of developing diabetes in a child in a family where there are no type 1 diabetes patients is 0.4%.
Studying the inheritance of type 2 diabetes mellitus is difficult, since there is no exact data on the incidence of it. Practice shows that relatives of people with type 2 diabetes should be wary of developing the disease when they become adults, and the older the person becomes, the higher the risk, but this process can be slowed down and even prevented by simple preventive measures, to which first of all, a healthy lifestyle applies.
The risk for the child is associated not only with the development of diabetes in the future, but also with serious complications during pregnancy, which we have already discussed. These are: the formation of severe malformations, premature birth, disorders of carbohydrate metabolism in the first hours of life, the presence of severe respiratory disorders. The worse the diabetes compensation at the beginning of pregnancy, the higher the incidence of all these complications. In this regard, if a woman already has severe nephropathy, has developed chronic renal failure, has severe arterial hypertension, proliferative retinopathy progresses or ischemic heart changes are expressed, pregnancy is considered absolutely contraindicated.
In such cases, the risk of death of a woman is very high, but the likelihood that the fetus will be viable, on the contrary, is too small. Such a pregnancy ends, as a rule, with an interruption for health reasons from the mother with a deliberately unviable fetus. Sometimes a woman decides to have a child in spite of her own safety. “Let me die, but after me there will be a little man … He will live happily ever after,” she says. Sometimes relatives require this from a woman, wishing to have an heir – the continuer of the family. So, in this situation, the goal will still not be achieved, since the fetus will die before the mother.