Diabetes Mellitus and Pregnancy

Pregnant woman experiences different physiological changes. This is the primary reason why presentation of diseases during pregnancy may vary from the usual. Pregnancy may even give rise to several diseases or mimic them but is only transient for the whole pregnancy period.

A major complication arising from pregnancy is a disorder called gestational diabetes mellitus. This is a condition that affects metabolism of carbohydrates. It results from the lack of the hormone insulin produced by the islets of Langerhans of the pancreas. This hormone is needed in the transfer of glucose to different cells of the muscle and adipose tissues.

There have been rise of the number of diabetes during pregnancypartly because of two reasons. First, it is now possible for diabetics to conceive and sustain pregnancy with the emergence of modern management.  Second, milder forms of gestational diabetes are now recognized.

Gestational diabetes or pregnancy-induced diabetes applies to situations wherein diabetes was diagnosed during pregnancy but regress after birth. Others call diabetes at pregnancy as type I diabetes pregnancy. Gestational diabetes is actually one of the five classifications of diabetes by the National Diabetes Data Group. The four others being type I diabetes, type II diabetes, secondary diabetes, and subclinical diabetes. Furthermore, the book also showed White’s Revised Classification of Diabetes in Pregnant Women as shown below in total:

A – Chemical diabetes; abnormal glucose test; initial onset during pregnancy

B- Maturity onset (age over 20 yr); duration under 10 years; no vascular disease

C1 – Age at onset 10-19

D1- Under age 10 years at onset

D2 – Over 10 years duration

D3- Benign Retinopathy

D4- Calcified vessels of legs

D5- Hypertension

E- Calcified Pelvic Arteries; no longer sought

F- Nephropathy

G- Many failures

H- Cardiomyopathy

R- Proliferating retinopathy

T- Renal transplant

Better pregnancy outcome are observed with classes A to C and poor for classes  D to T.

Gestational diabetes was further classified into Type A1, which only requires diet modification to obtain glucose level that is within the normal range and Type A2, wherein drug intervention together and diet is needed for results within the normal range.

Gestational diabetes is reclassified upon giving birth. If diabetes still persists, the patient has either type I diabetes used to be known as the insulin-dependent diabetes mellitus or type II diabetes formerly known as the non-insulin dependent diabetes mellitus otherwise just a gestational diabetes or type I diabetes pregnancy.

Some of the effect of diabetes on pregnancy includes the occurrence of larger fetus, higher incidence of pre eclampsia or eclampsia and great risk of infection specifically genitourinary tract infections.

The effects of pregnancy on diabetes on the other hand includes among others

• the production of human placental lactogen or  HPL which counteracts the action of insulin
• the production of estrogen and progesterone which changes the response of the pancreas to insulin
• decreased glucose reabsorption
• increased risk or starvation and hypoglycemia due to notable transfer of glucose and  certain amino acids to the embryo

HPL is readily cleared during the intrapartum and early post partum periods and so administration of insulin must be reduced or discontinued.

A well balanced diet is still the key for a properly controlled glucose level thus this must be observed by diabetics who expect pregnancy.  The caloric requirement is 2200 to 2500 calories comprising 45, 30, and 25 percent in forms of carbohydrate, fat, and protein respectively. Intake of food rich in complex carbohydrates is fundamental in order to delay the absorption of glucose. Vigorous exercise during pregnancy is not advisable since this activity lowers the levels of glucose in the blood as it is transferred into the muscles.