Every woman hopes for a pregnancy without any complications. But for women with diabetes — both those who have the disease before or who get it during pregnancy — the risks for potential problems are a little higher. And a new study shows that far more women of childbearing age now have the condition than in years past, which can put them and the babies they may eventually have at risk.
Looking at the medical information of more than 175,000 women who'd given birth in Kaiser Permanente hospitals in southern California from 1999 to 2005, researchers aimed to estimate how many women develop diabetes both prior to and during pregnancy.
What they found: The rates of gestational diabetes (which usually develops after the first trimester of pregnancy and then goes away after labor and delivery) stayed pretty much the same. But their findings about pre-pregnancy diabetes are a bit more worrisome, considering that the condition dramatically increased among every age, race, and ethnicity category of women before they were expecting.
In fact, the study shows that preexisting diabetes (diabetes that came on before pregnancy):
- doubled (from 10% of the diabetes cases among women who'd given birth in 1999 to 21% in 2005)
- affected five times as many teens (ages 13 to 19)
- was found in 40% more women 40 and older who'd given birth
- occurred in twice as many women ages 20 to 39
These rises in diabetes rates among potential moms-to-be are reason for serious concern. That's because when a woman with diabetes is pregnant and doesn't get adequate treatment for the condition early on, it increases the risk of:
- miscarriage
- stillbirths
- birth defects (from exposure of the embryo/fetus to high sugar levels)
- having much larger babies (which also makes a C-section more likely)
- children becoming overweight or obese later (because the abnormal energy and hormonal balance these babies experience in the womb may make them handle energy differently after birth)
How Diabetes Works
Diabetes is a disease that affects how the body uses glucose. Glucose, the main type of sugar in the blood, comes from the foods we eat and is the major source of energy needed to fuel bodily functions. And the body needs the hormone insulin to help control the level of glucose in the blood. But if someone has diabetes, the body either can't make insulin or the insulin doesn't work as it should.
There are two major types of diabetes:
- In type 1 diabetes, a person's immune system attacks the pancreas and destroys the cells that make insulin. (The pancreas is a long, flat gland that lies in the abdomen behind the stomach. It produces enzymes that are released into the small intestine to help with digestion and contains clusters of cells called islets that produce hormones like insulin.)
- In type 2 diabetes, the pancreas can still make insulin, but the body doesn't respond to it properly.
In both types of diabetes, glucose can't get into the cells normally, so a person's blood sugar level gets too high. High blood sugar levels can make people sick if they don't receive treatment.
During pregnancy, the placenta not only provides the fetus with nutrients and oxygen, it also produces hormones that change the way insulin works. A pregnant woman develops gestational diabetes when her pancreas can't make enough extra insulin to overcome the effects of placental hormones. This causes high levels of glucose to build up in her blood. That extra glucose can then cross the placenta, giving her growing baby a high blood sugar level, too.
The baby's own pancreas then also starts making more insulin to handle the extra glucose. The calories from the extra blood sugar are stored by the baby as fat, causing the baby to gain more weight than normal.
What This Means to You
If you're pregnant, a glucose screening for gestational diabetes is a must. This simple prenatal test involves drinking a sugary liquid and then having your blood sugar level checked.
Women with a higher risk of having gestational diabetes are screened at 12 weeks. That includes expectant moms who:
- have previously had a baby that weighed more than 9 pounds at birth
- have a family history of diabetes
- are obese
- are older than 30
All other pregnant women are tested for diabetes sometime between the 24th and 28th weeks. But if you've tested positive for sugar in two of your routine urine tests, your health care provider may order blood testing earlier.
Although gestational diabetes usually goes away after the birth — and it's very manageable when caught and treated early — many women with the condition may still experience it again with future pregnancies. They also have a higher risk of developing type 2 diabetes later.
If you have gestational diabetes, your health care provider will work with you to create a treatment plan that will include a well-planned diet, an exercise regimen, and sometimes medication. Keeping your blood sugar levels in check now can make for a healthier you and a much healthier start for your growing baby.
If you don't have diabetes and aren't expecting, you can still be proactive and help prevent type 2 diabetes at any age by living a healthy lifestyle and maintaining a healthy weight, which really boils down to:
- making exercise a regular part of your routine — at least half an hour of moderate physical activity most days of the week
- eating a well-balanced diet that's long on nutrient-rich foods and short on sugary, high-calorie, and fatty fare
Talk to your doctor about your medical history — both your own and your family's — to find out your risk of developing type 2 diabetes and what you can do about it. Unlike type 2 diabetes (which can be prevented, in part, by diet and exercise) there's no way to prevent a person from getting type 1 diabetes.
And if you have preexisting diabetes and are trying to get pregnant, talk to your doctor as soon as possible about what extra steps you need to take to keep your blood glucose levels in check and create the best start for you and your baby-to-be.
Reviewed by: Steven Dowshen, MD
Date reviewed: May 2008
Source: "Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/Ethnically Diverse Population of Pregnant Women, 1999–2005," Diabetes Care, May 2008.
