January 10, 2024
Understanding diabetes during pregnancy
Diabetes in pregnancy can impact women worldwide, with the latest estimates suggesting that approximately one in six pregnancies are affected by hyperglycaemia.
By Justine Evans
Diabetes in pregnancy affects a significant number of women worldwide, with the latest estimates suggesting that approximately one in six pregnancies — or 21 million women — are affected by hyperglycaemia.
Pregnancy can be an exciting but also challenging time for expectant mothers, especially those with diabetes. Whether you live with diabetes before pregnancy or develop diabetes during pregnancy, effectively managing the associated risks throughout is crucial for the health of both mother and child.
The international classification of pregnancy-related diabetes defined by the World Health Organisation (WHO) and adopted by the International Diabetes Federation (IDF), consists of pregestational diabetes, most commonly type 1 diabetes and type 2 diabetes; pregnancy-induced diabetes, also referred to as overt diabetes; and gestational diabetes mellitus (GDM), a diabetes-related complication.
While GDM accounts for most cases of pregnancy-related diabetes, according to research published in the International Journal of Environmental Research and Public Health, 10% of mothers affected have type 1 or type 2 diabetes before pregnancy, and 9% have their diabetes diagnosed during pregnancy.
Some risk factors for developing diabetes during pregnancy include a family history of diabetes, having previously given birth to a baby weighing more than four kilograms, being older than 45, and living with overweight or obesity. Additionally, diabetes in pregnancy varies by race, ethnicity and world region.
During pregnancy, the placenta supplies the growing foetus with nutrients and oxygen and produces hormones such as oestrogen, cortisol and human placental lactogen that maintain the pregnancy. As the placenta grows, it creates more of these hormones, increasing the risk of insulin resistance. In most cases, the pancreas can produce additional insulin to overcome this resistance. However, when it fails to do so, gestational diabetes can result.
Gestational diabetes develops between 24 and 28 weeks of pregnancy in approximately 3 to 9% of all pregnancies and usually resolves after childbirth. However, women who experience gestational diabetes are at higher risk of developing type 2 diabetes and their baby developing type 1 diabetes in childhood.
There's clearly a strong need for a single framework for GDM criteria to allow better comparisons. We need to have effective intervention strategies and policies to store the increase in the number of pregnancies affected by hyperglycaemia and improve hyperglycaemia pregnancy outcomes,” Prof David Simmons, Australia.
In most cases, pregnant women who develop GDM do not experience any specific symptoms. Regular testing and monitoring throughout pregnancy can help manage the risk and overall health.
Screening approaches for diagnosing hyperglycaemia in pregnancy vary according to regions and healthcare access. These approaches broadly fall into two categories. In the Universal Approach, all women undergo a glucose tolerance test, ensuring that no cases of diabetes go undetected. Meanwhile, the Risk Factor-Based Approach only screens women with certain risk factors, such as age and BMI. Both approaches have pros and cons, and no single approach applies to all instances.
The American Diabetes Association advises prenatal screening for type 2 diabetes in women presenting risk factors. ADA goes on to advise screening pregnant women without diabetes for gestational diabetes between 24 and 28 weeks of pregnancy. Furthermore, women diagnosed with gestational diabetes should be screened for persistent diabetes 6 to 12 weeks postpartum, with lifelong screening at least every three years after that.
If you live with diabetes, a healthy pregnancy is possible. You should consult your healthcare team to create a preconception plan. Many factors are the same for all women, such as eating a healthy diet, maintaining physical activity and taking necessary vitamin and mineral supplements. Additional behaviours include adjusting the times and frequency of glucose monitoring and adapting a treatment plan to your type of diabetes.
The maternal health of women with type 1 diabetes is such an important point. When I was thinking about becoming a mother, it was all about protection. I would have to get my blood sugar at this level and that level, but thankfully, I wasn't told that I should not have children”, Phyllisa Deroze, IDF Blue Circle Voice.
During pregnancy, your baby’s health is monitored through tests like foetal movement counting, ultrasound exams, non-stress testing, biophysical profiles and Doppler flow studies. These track your baby’s growth and inform changes to your diabetes management plan.
Babies born to mothers with diabetes may face complications, including congenital disabilities due to high maternal glucose, larger birth weight leading to delivery complications, breathing difficulties in the event of premature birth, hypoglycaemia after birth requiring glucose treatment, and preeclampsia in women with type 1 or type 2 diabetes.
After giving birth, your baby will be closely monitored, and glucose levels will be assessed. In the case of GDM, there is a risk of developing diabetes in the future, so maintaining a healthy lifestyle after pregnancy is crucial. When planning future pregnancies, ensure your glucose levels are well-managed, and consult your healthcare team to ensure optimal health for you and your baby.
Diabetes management during pregnancy involves careful planning, regular checkups, a healthy lifestyle, and, in some cases, medication adjustments. With the proper care and support, women with diabetes can enjoy a healthy pregnancy and deliver a healthy baby.
Justine Evans is Content Editor at the International Diabetes Federation