Complications of Diabetic Pregnancy Delve into the Consequences of Not Treating Gestational Diabetes - Literature review Example

COMPLICATIONS OF DIABETIC PREGNANCY Complications of Diabetic Pregnancy Delve and the Consequences of not Treating Gestational Diabetes Introduction Expectant women suffering from diabetes normally have personal health concerns. Therefore, pregnancy increases the health demands and hence women with diabetes while pregnant should cautiously monitor and control their blood sugar as well as manage their diabetic condition. According to Pramila, Miles, & Thakurta, (2006), gestational diabetes is a kind of diabetes that occurs in an expectant woman who never had diabetes before she was pregnant. Some women normally get more than one pregnancy being affected by gestational diabetes. Normally, a gestational pregnancy occurs in the middle of expectancy and hence doctors are supposed to test for gestational diabetes between twenty four and twenty eight weeks of pregnancy. Basically, in most cases the gestational diabetes fades soon after women deliver and in case it doesn’t go away after delivery, it is known as type 2 diabetes. Even when gestational diabetes goes away after the baby is born, most women develop diabetes type 2 later in life. Gestational diabetes can take place in 2 to 12% of each and every pregnancy and this is dependant of the ethnic background of the mother. Controlling the diet, efficient monitoring of the blood sugar as well as taking of insulin is at times necessary to treat gestational diabetes. If someone gets gestational diabetes, there is a high probability that it will recur again when such a person gets pregnant again. Normally, gestational diabetes comes with various complications for both mother and the baby (Pramila, Miles, & Thakurta, 2006). Altman (2005) argues that a frequent problem that affects the infants of expectant diabetic women is a condition known as “macrosomia”. This simply means “large body” and this implies that diabetic women are likely to give birth to babies that are considerably bigger than others. This takes place since most of these infants receive too much sugar through the placenta since the diabetic mothers normally have high blood sugar levels. As a result, the pancreas of the baby detects the high sugar levels from the mother and hence produces more insulin while trying to make use of the extra sugar. Consequently, the extra sugar gets converted into fat and this is what enlarges the baby. At times, the baby becomes too large to be delivered through the vagina and hence such mothers have to deliver the baby through caesarean. Apparently, pregnant diabetic women can have large babies because of the high blood sugar levels and this can be decreased through maintaining the blood sugar levels close to normal in the best way possible. Obviously, a large baby leads to a difficult delivery and this is why caesarean sections are normally performed in diabetic expectant mothers (Merkus, 2004). Still, the diabetic expectant mothers experience high blood sugar levels, in most cases during the twenty four hours before delivery and hence the baby is likely to get dangerously low blood sugar levels immediately after delivery. This occurs as a result of the baby having high levels of insulin to utilize the additional sugars, but on the other hand the source of this sugar is suddenly taken away, and this leaves high insulin levels and hence their blood sugar levels go down rapidly. Furthermore, the infant can experience mineral imbalances, for instance calcium or magnesium (Merkus, 2004). Another complication that a diabetic pregnant woman is likely to have is delivering the baby through caesarean section whereby she delivers the baby via the mother’s belly. This happens since a diabetic pregnant woman is not effectively controlled and hence she a greater chance of requiring a caesarean section to deliver the baby. Consequently, when the baby is delivered through a caesarean section, it normally takes longer for the woman to recover from the child birth. Soon after a woman with gestational diabetes delivers, her insulin requirement drops and hence she will require less insulin. This condition normally lasts for several weeks and also the additional activity of taking care of the baby reduces the mother’s insulin needs for a while. This requires some careful care since such a woman experiences some changes and thus is required to adjust to the insulin reaction (Gregory & Aynsley-Green, 2003). A pregnant diabetic woman is also likely to suffer from preeclampsia. In such a case, the pregnant woman normally experiences high blood sugar; proteins within their urine and such women regularly have their fingers and toes swelling and if this does not go away the woman can have preeclampsia. This is normally a very serious complication and hence it requires close and constant watch by a doctor Gregory & Aynsley-Green, 2003). High blood sugar may harm both the mother and the unborn child and it can also result into the baby being born pre-maturely and can lead to either seizures or stroke to the woman while she is delivering or during labour pains. Still, a blood clot or bleeding within the brain can result into brain damage to the woman. This condition of the pregnant women having the high blood pressure is very common in diabetic pregnant women. Oedema is also a frequent occurrence in diabetic pregnancies. This can be reduced by the diabetic women through limiting their salt intake since it can reduce the excessive building up of the fluid. In case the swelling takes place during a diabetic pregnancy, such a woman is supposed to seek medical advice from the doctor (Pramila, Miles, & Thakurta, 2006). Hypoglycaemia or low blood sugar is another condition that is likely to occur in pregnant diabetic women. This is because individuals having diabetes and as a result take insulin or other diabetic medications might develop low blood sugar. Normally, low blood sugar can be very serious in addition to being fatal, especially if not treated and tackled quickly. The only way that low blood sugar can be avoided in such diabetic pregnant women is through watching their blood sugar carefully and treating low blood sugar promptly and on time (Altman, 2005). In case the diabetes in pregnant woman is not effectively controlled over the pregnancy, the infant rapidly develop low blood sugar after the delivery. As a result, the blood sugar of the baby should be watched for numerous hours after birth. Infections as well as ketones are another complication during a diabetic pregnancy. This is because most of the expectant women having diabetes have a higher rate of getting skin, vaginal in addition to urinary tract infections. However, with care such infections are not supposed to be major problems during the pregnancy since they can be effectively managed and controlled with medications as well as proper care (Altman, 2005). According to Steel (2004), miscarriage is another problem that diabetic pregnant women are likely to experience. Normally, women with poor control of blood sugar or several serious complications are at higher risk of experiencing miscarriage. In other words, a diabetic pregnant woman has a very high probability of miscarrying as compared to a non-diabetic woman especially during the early stages of the pregnancy (Steel, 2004). Moreover, diabetic expectant women are likely of having polyhydramnios. This is a condition whereby the woman normally has a lot of amniotic fluid during the pregnancy, even if this condition is somehow rare (Steel, 2004). Apart from the discomfort that such women normally experiences from the overly distended belly as a result of this condition, polyhydraminos rarely has destructive results. Nevertheless, if this condition takes place in a diabetic pregnant woman, it shows that the diabetes has not been controlled optimally. The amniotic fluid accumulates since the baby urinates large amounts because of the increased glucose levels (Visser, 2003). Research carried out by Hemel (2005) reveal that neonatal morbidity can take place during diabetic pregnancy and to be specific, neonatal hypoglycaemia is very frequent. There are cases of brain abnormalities especially when glucose drops below 2.6 mmol/l.39. Such high occurrence low rate is an indication that more comprehensive preventive management is necessary when handling such pregnancies. If appropriate care is offered during gestational age infants, there is a probability of lowering the risk of neonatal hypoglycaemia as when compared to other infants even though the incidence of hypoglycaemia is still high during gestational diabetes. This calls for attention from paediatricians handling such infants as well as their mothers. The high macrosomia rate in gestational diabetes also explains the high incidence of neonatal morbidity. Congenital malformations are also common during gestational diabetes. Toxaemia is another problem that diabetic pregnant women are likely to undergo. The key characteristics of toxaemia include raised blood pressure, presence of proteins in the urine as well as the swelling of both hands and feet of such women. There before, toxaemia was a frequent complication in diabetic pregnant women, but with effective sugar blood control, the problem is no more frequent that in a non diabetic pregnancy (Visser, 2003). Conclusion In order to control and reduce the negative effects that come with gestational diabetes, there are some several measures that such women can take. These measures include eating healthy meals following a diabetes patient meal plan as this will help the woman control the blood sugar while pregnant and exercising also helps in controlling the blood sugar and assists in balancing food intake. Monitoring of the blood sugar regularly is also important since pregnancy leas to the body’s requirement for energy to change and also the blood sugar levels might change rapidly. Therefore, it is important for one to check blood sugar levels according to doctor’s directives. Finally, taking of insulin is important since a woman with gestational diabetes is supposed to take insulin at times. In case the doctor advises for insulin intake, it is advisable to take it since it assist in maintaining blood sugar under control for during gestational diabetes (Macgillivray, 2007). References Altman, D. G. (2005). Practical statistics for medical research. London: Chapman and Hall. Gregory, J.W. & Aynsley-Green A. (2003). The definition of hypoglycaemia. Baillieres Clin Endocrinol Metab. Vol. 7: 587–90. Hemel, O. (2005).The reliability of perinatal and neonatal mortality rates: differential under- reporting in linked professional registers vs. Dutch civil registers. Paediatric Perinatal Epidemiol. Vol. 15: 306–14. Macgillivray, I. (2007). The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol. Vol. 158: 892–8. Merkus J. M. (2004). The perinatal database of the Netherlands. Eur J Obstet Gynecol Reprod Biol. Vol. 125–38. Pramila, S. Miles, D. & Thakurta, G. (2006). Factors predicting peri- and neonatal outcome in diabetic pregnancy. Early Hum Dev. Vol. 59: 61–70. Steel J. M. (2004). Can pre-pregnancy care of diabetic women reduce the risk of abnormal babies? BMJ. Vol. 301: 1070–4. Visser, GHA. (2003). Poor glucose control in women with type 1 diabetes mellitus and ‘safe' haemoglobin A1c in the first trimester of pregnancy. J Maternal Fetal Neonatal Med. Vol. 13: 309–13. Read More