Treatment & Control of Diabetes in Pregnancy: Gestational, Type 1 & Type 2

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Both type 1 and type 2 diabetes present special risks during pregnancy, both to the mother and to her developing baby. Treatment for diabetes during pregnancy is crucial. A third type of diabetes, gestational diabetes, is found exclusively in pregnant women; this disease requires treatment as well.

The Importance of Treatment for Diabetes During Pregnancy

Pregnancy outcome for women with type 1 diabetes is poor compared to the general population (Nielsen et al. 2008). It may be even worse for women with type 2 diabetes (Clausen et al. 2005).

Maternal diabetes is associated with an increased risk of preterm delivery, preeclampsia, and perinatal mortality. Uncontrolled diabetes during early pregnancy increases the risk of birth defects, so treatment for mothers with type 1 and type 2 diabetes ideally should begin before conception. During later pregnancy, uncontrolled high blood sugar in all types of diabetes, including gestational diabetes, can lead to serious problems for the newborn, including macrosomia (large size, which can cause birth complications), jaundice, respiratory distress, and hypoglycemia.

Exercise and Diet

Diet modification, under the supervision of a nutritionist, and light to moderate exercise if the woman’s health permits, are invaluable in treating diabetes during pregnancy. Diet and exercise help maintain blood glucose in a healthy range and improve overall health. In many cases of gestational diabetes and sometimes in type 2 diabetes, diet and exercise alone are adequate treatment. In type 1 diabetes and some cases of type 2 and gestational diabetes, they are used in addition to insulin or other drug therapy.

Oral Diabetes Drugs

If a woman with diabetes is planning to become pregnant, oral diabetes medications are often discontinued in favor of insulin therapy because of potential danger to the developing embryo in early pregnancy (EVMS 2004). Evidence for the safety of oral diabetes drugs during pregnancy is lacking. One preliminary study showed that women taking metformin were not more likely to have poor pregnancy outcome, despite having more risk factors than the control group (Hughes and Rowan, 2006). Glyburide is now used sometimes in women with gestational diabetes (EVMS 2004). More research on the safety of these and other medications is necessary.

Insulin Therapy

In type 1 diabetes, insulin therapy is always necessary because the body cannot produce its own insulin. In some cases of type 2 and gestational diabetes, blood sugar cannot be adequately controlled without insulin. Insulin therapy may include injections of short-acting and long-acting insulin. For some women with pre-existing diabetes, an insulin pump may be used to provide continuous injection of fast-acting insulin (EVMS 2004).

Women with type 1 diabetes have a significantly higher risk of severe hypoglycemia during early pregnancy (Nielsen et al. 2008). This may be due to using insulin to control blood sugar during the nausea and vomiting of pregnancy sickness (“morning sickness”). Appetite disturbance and vomiting can wreak havoc on blood sugar and the need for insulin to control it. Insulin pumps are often a good option for women with a risk of severe hypoglycemia (EVMS 2004).