Diabetes and Pregnancy (Q&A)

So, diabetes is dangerous for a pregnant
woman because it can affect many organ systems. So,
typically if you’re diabetic you think, “Okay, if my sugar is fine, I’m okay,” but sadly it can be affecting the heart, okay, so it can cause ischemia within the heart and during pregnancy it’s a normal
physiological change for the heart to really increase its work. The blood volume increases by about 50
percent so the amount of blood circulating through your body
increases and that heart has to tolerate that and moves it forward to feed the placenta which feeds the fetus. So if you have underlying cardiac disease, don’t know about it, get pregnant…
pregnancy I always say is like a stress test for life and so something will come out. So, that’s just an example for diabetes for the
heart, diabetes with the kidneys… diabetes can affect the kidneys if you
don’t know about it, um, it doesn’t really typically have any
signs per se. We know glucose does a lot of things. One
of the things we know it can do is it can act as growth hormone, can cause the baby to grow very big and that can lend itself to a difficult
delivery vaginally or even needing a c-section with all the complications that can go along with c-sections. We also know glucose also has a impact
on just the tissues throughout our body. We haven’t
worked that out, we as a field of medicine, have not worked out all the pathways of how that happens,
but we certainly know that with diabetes those fetuses are at an increased risk of having structural problems especially the spine and the cardiovascular system. We think
something’s going on with the glucose and how it attacks the tissues, how it works for the tissues in terms of forming and so again diabetes can be
dangerous in that way because again, you think your blood sugar is okay
well-controlled, and you’re feeling okay but you also have a fetus on the other side of that placenta. I think it’s also important for patients to
understand that if diabetes when taken care of appropriately,
doesn’t mean that you can’t have a good pregnancy outcome. I think the key is making sure that
we maintain what is called euglycemia, making sure your blood sugar is in good
control and making sure that we’ve assessed for these other signs of what we call end-organ damage and they’re not
there or if they are there, optimizing that. It’s important for patients to understand that under appropriate care you can have a
good outcome with diabetes. I mean it’s definitely a partnership between
the patient, their general obstetrician, the maternal fetal
medicine specialist, maybe an endocrinologist. I think with a
multi-disciplinary team we certainly can have a good outcome
with diabetes, so I don’t want patients to believe that if they have diabetes they
cannot have a good outcome, but it is important for them to understand that it’s crucial to come pre-conceptually for
a consultation to understand you know, what it means to be pregnant with
diabetes, number one, and two, to allow us to take care of them and
knowing their kinda overall health status. So, if a woman has gestational diabetes
during her pregnancy, at some point in her lifetime she’ll have about a 40 percent
chance of having diabetes. That doesn’t mean it’s going to happen right
away, but at some point in their lifetime. So, the reason why that’s an important
statistic for women to know is that you know, obesity is increasing in our
population so obesity and gestational diabetes, they’re kind of increasing linearly together and so it’s important
for patients know when they come back for their postpartum visit they should have a screen to see
whether they have diabetes and if that’s normal they also should know that throughout their lifetime
when they’re not pregnant anymore, they’re going to see the primary care
physician, it’s important to know I should be screened for diabetes regularly
throughout my life.

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