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Diabetes in Pregnancy Loss

Understanding the Role of Diabetes in Miscarriage and Stillbirth

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Updated January 19, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Diabetes in Pregnancy Loss
Photo © CDC / James Gathany

What Is Diabetes?

When humans eat, foods are broken down in the digestive tract into the simplest elements, including glucose (a type of sugar). Glucose is a needed fuel for almost every process in the human body, including brain function. For the body to use glucose as energy, it requires a hormone known as insulin, which is produced by an organ called the pancreas. In diabetes, a person’s insulin supply is not sufficient, making it impossible for the body to get and use the energy it needs from glucose.

Types of Diabetes:

Type 1 – Type 1 diabetes (sometimes called insulin-dependent diabetes mellitus, or IDDM) is a chronic, often life-long condition, in which the pancreas does not produce insulin. The exact causes of the disease are unknown, but it is clear that the immune system is somehow triggered to begin attacking the pancreas. It is usually diagnosed in childhood. The common symptoms are fatigue, extreme thirst and hunger, excessive urination, and weight loss. This type of diabetes requires a person to receive insulin, either through multiple injections each day, or a continuous pump. There is no cure for type 1 Diabetes.

Type 2 – In type 2 diabetes the cells of the body develop a resistance to insulin, even when the pancreas is able to produce enough insulin. Type 2 diabetes (also called non-insulin dependent diabetes mellitus, or NIDDM) is most common in adults, but it can develop in children. It is usually triggered by obesity, a sedentary lifestyle, age, and genetic predisposition. here is an increased risk of type 2 diabetes for people with a family history of the disease, people of African-American, Native American, Asian-American, Latino, and Pacific Islander heritage, and women who have had gestational diabetes. The symptoms are similar to type 1 diabetes. Treatment can vary from nutritional changes and exercise, to oral medications, or possibly insulin injections. There is no cure for type 2 diabetes, but the condition can be so well controlled that no medical treatment is required outside of lifestyle changes.

Gestational – Gestational diabetes(GDM) only occurs during pregnancy. Like type 2 diabetes, in gestational diabetes, the body is unable to effectively use the supply of insulin produced by the pancreas. Nearly all pregnant women have some impairment of their ability to use glucose effectively as a result of the natural hormonal changes of pregnancy, but not all will develop gestational diabetes. Only about 4% of women will develop GDM. The risk factors are similar to those for type 2 diabetes, but also include a history of high blood pressure, a previous delivery of a large baby (greater than 8 lbs 5 oz), or if you are over 35 at the time of pregnancy. GDM can be treated with diet changes, but may require insulin injections if blood sugars cannot be controlled through diet alone.

How Does Diabetes Affect Pregnancy?

Since the entire body is fueled by glucose, insulin is crucial to proper functioning of all body systems. Poorly controlled blood sugar can lead to many complications in pregnancy for both mother and baby.

  • Polyhydramnios – This means having too much amniotic fluid, and women with diabetes are more likely to experience this.
  • Hypertension - known more commonly as high blood pressure, can lead to intrauterine growth restriction (IUGR), stillbirth, and may be an indication for preterm delivery, which carries its own risks for the baby.
  • Growth Restriction - IUGR tends to occur as a result of hypertension, which can develop in women who have diabetes during pregnancy. However it also can be caused by vascular disease, usually in type 1 diabetics, who don't have high blood pressure. It is a risk factor for many medical complications for babies after birth. Low birth weight is also the leading cause of infant mortality in the United States.
  • Birth Defects – Infants born to women with diabetes have a higher risk of developing congenital abnormalities, such as heart defects and neural tube defects.
  • Miscarriage – Diabetic women are at increased risk for miscarriage.
  • Macrosomia (or Excess Birth Weight) - When a newborn weighs above average (usually more than 9 pounds, 4 ounces, or above the 90th percentile for expected size for gestational age), it is called macrosomia. Large infants are at risk for complications in delivery like shoulder dystocia, and may lead need to be delivered via c-section.
  • Preterm Delivery - Diabetic women are at risk for preterm delivery. Infants born before 37 weeks gestational age are at risk for feeding and breathing difficulties, long-term medical problems, and death.
  • Stillbirth - While women with diabetes have an increased risk of having a stillborn, good blood sugar control virtually eliminates this risk.

Management of Diabetes

The better controlled your blood sugar is during pregnancy, the better chance you have for a healthy, normal pregnancy. It is crucial to follow your doctor’s instructions as carefully as possible. A woman’s insulin needs change throughout pregnancy, so if you notice a pattern of change in your blood sugar readings, you should notify your doctor.

  • Blood Sugar Monitoring – Pregnant women with diabetes are expected to check their blood sugar multiple times a day to determine how well their diet and medication regimen is controlling your blood sugar. Monitoring is done with a special machine and requires you to prick your finger or forearm (depending on your monitor) to obtain a small drop of blood. If you are diagnosed with gestational diabetes during your pregnancy, you will be instructed on how to use your monitor and expected to demonstrate correct use.
  • Medications and Insulin - While some Type 2 diabetics can use oral medications to control their blood sugar while not pregnant, not all oral medications are safe in pregnancy. Insulin injections offer the best and most precise control of blood sugar during pregnancy. Even women who were using insulin prior to pregnancy will require a new regimen to manage their blood sugar while pregnant. It is important to follow your medication instructions carefully.
  • Nutrition – Following a diabetic diet during pregnancy is one of the most important ways to manage your blood sugar. Whether you are newly diagnosed with gestational diabetes, or you’ve been living with Type 1 diabetes your whole life, meeting with a nutritionist can help you learn how to make the right food decisions while you’re “eating for two.”
  • Diagnostic Testing – Since women with diabetes are at risk for so many complications in pregnancy, they require more prenatal testing. You may have some or all of the following:

When to Call Your Doctor

If you have diabetes of any time during your pregnancy, prenatal care is essential. You will require help managing your blood sugar monitoring and medication regimen. Due to the risks associated with diabetes in pregnancy, you should be aware of the following warning signs. Contact your doctor if you experience any of the following, and if you have any other questions or concerns.

  • Symptoms of low blood sugar: dizziness, sweating, shaking, tingling of the lips or tongue, racing heart, confusion, difficulty speaking. If low blood sugar goes untreated, it can result is unconsciousness, coma, or even death.
  • Symptoms of high blood sugar: excessive thirst, increased urination, dry mouth, nausea/vomiting, confusion, rapid breathing, fruity smelling breath, unconsciousness. Uncontrolled high blood sugar can result in coma and death.
  • Decreased fetal movement
  • Severe headache that is not relieved by Tylenol
  • Frequent painful contractions
  • Vaginal bleeding that is heavy like a menstrual period
  • A gush of clear fluid from the vagina
  • Severe abdominal pain

Sources:

American Diabetes Association. Statistics. Accessed: 12 Jan 2012.

Centers for Disease Control and Prevention. National Diabetes Fact Sheet 2011. Accessed: 12 Jan 2012.

March of Dimes, Diabetes in Pregnancy>. Accessed 12 Jan 12.

National Institutes of Health. For Women with Diabetes: Your Guide to Pregnancy. National Diabetes Information Clearing House. Accessed: 12 Jan 2012. http://diabetes.niddk.nih.gov/dm/pubs/pregnancy/

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