Diabetes (type 1 or 2) in women does not prevent a pregnancy from being carried to term under good conditions, nor from having a perfectly healthy baby. However, the risks of complications are higher, in particular when the follow-up is defective. We make the point.
Revelation of Dr. Arsène Ininahazwe, Head of the Medical Center of Hope of Kayogoro set up by the Association IPROSARUDE
Type 1 and 2 diabetes: what are the risks during pregnancy?
The pregnancy of a woman suffering from type 1 diabetes or type 2 diabetes must be particularly monitored (preconceptional examinations, fundus, systematic screening for urinary tract infections…) because of the risks :
an increase in diabetes-related complications: common complications of diabetes such as retinopathy or nephropathy (damage to the retina and kidneys) may worsen during pregnancy, particularly because of the inevitable variations in blood sugar levels. In case of pathology associated with diabetes, pregnancy may even be discouraged (and the desire for pregnancy postponed).
Miscarriage: this risk during the first trimester is greater in pregnant women with diabetes if their blood sugar levels are poorly controlled, especially at the time of conception. This is why it is so important to be monitored before becoming pregnant.
Pregnancy hypertension: arterial hypertension is a pathology to be closely monitored in diabetic women. It can indeed be complicated by pre-eclampsia (or pregnancy toxemia), a pregnancy hypertension (HTA) associated with the appearance of proteins in the urine. This serious disease can lead to in-utero growth retardation, premature delivery and even endanger the life of the mother-to-be and the baby.
Premature delivery: the risk of premature delivery in the pregnant woman with diabetes is especially accentuated by :
– Hydramnios, which is more frequent in cases of diabetes. It is the abnormal increase of the amniotic liquid which causes a premature rupture of the water bag, and thus the delivery.
– Pre-eclampsia, which requires the birth to be induced.
– Urinary tract infections, which may be more common in pregnant women with diabetes and predispose to premature delivery.
Delivery by cesarean section: the delivery of a diabetic woman is usually scheduled, as it requires increased monitoring (delivery induces a drop in hormones and therefore a sudden drop in blood sugar). It takes place around the 38th or 39th week of amenorrhea. The medical team will be particularly attentive in the diabetic woman to :
– Fetal suffering.
– The increase of the baby’s weight in the last weeks of pregnancy. If the baby’s weight is estimated to be more than 4.2 kg or if vaginal delivery seems unsuitable, the mother-to-be will be referred for a cesarean section.
Type 1 and 2 diabetes during pregnancy: what are the risks for the baby?
Why can diabetes cause heart defects in the child?
According to a study published in the British Medical Journal, women with type 1 diabetes have twice the risk of giving birth to a baby with a heart defect (3.3% of babies with a heart defect in women with type 1 diabetes versus 1.5% in women without diabetes), even if their blood sugar level remains stable throughout the pregnancy.
Moreover, if blood sugar levels are poorly controlled in early pregnancy, the risk of heart defects rises to 10%. In any case, a well-balanced blood sugar level before conception and during the first two months of pregnancy is the best way to prevent possible malformations.
Diabetes: what impact on the baby’s birth weight?
Fetal macrosomia occurs when the baby’s weight at term exceeds 4.2 kg. This is common in cases of diabetes, especially because of “natural” hyperglycemia during pregnancy (even with good monitoring).
If the mother has diabetes, will the baby have it too?
Diabetes is not necessarily a disease that is transmitted from mother to child. Type 1 diabetes in particular: there is only a 2 to 3% risk of transmitting type 1 diabetes from the mother to the child.
For type 2 diabetes, on the other hand, the figures are more marked: it is estimated that a woman with type 2 diabetes has a 30 to 40% risk of transmitting the disease to her baby. Hence the interest of an early treatment.