Expectant mothers with diabetes face risky challenge

Before she became pregnant, Molly Duerr never understood why expectant moms would say they didn’t care if it were a boy or a girl, only that the baby be healthy.

“I thought, ‘Of course you’d want to know what the baby’s going to be,’ ” says Duerr, 30, who has type 1 diabetes. But after becoming pregnant last year and realizing all the health risks associated with diabetes, she says, “I got it.”

A growing number of women, like Duerr, are either heading into pregnancy with diabetes — type 1 and type 2 — or developing gestational diabetes while pregnant, says endocrinologist Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. Kirkman says diabetes raises the risk of miscarriages, delivery complications, maternal health problems and birth defects, but she adds that the risks can be slashed with pre-conception counseling, tight control of blood sugar and maintaining a healthy weight before and during pregnancy.

“There are many concerns women with diabetes grapple with, everything from childbearing worries and premature cardiovascular disease to greater financial burdens,” says Ann Albright, director of Diabetes Translation at the Centers for Disease Control and Prevention.

Women who go into pregnancy already diagnosed with diabetes have what’s called pre-gestational diabetes. Diabetes that develops during pregnancy is referred to as gestational diabetes.

Almost five out of every 1,000 women ages 18 to 44 have diabetes, according to the CDC. Most have type 2 diabetes, which is linked to obesity.

Gestational diabetes, which typically is tested for around the 28th week of pregnancy, occurs in about 4% of patients, says Helain Landy, chairwoman of the department of obstetrics and gynecology at Georgetown University Hospital. “From an epidemiological standpoint, that is a lot,” Landy says.

Problems linked to the disease

Diabetes during pregnancy can cause high blood levels of glucose, which can lead to health problems in mothers and babies alike. When extra sugar in the mother’s blood crosses the placenta to the fetus, a baby can have organ malformation (in mothers with pre-existing diabetes) and grow too large, leading to delivery complications.

For women with existing diabetes, pre-conception counseling is paramount to a healthy pregnancy and baby and should begin when girls with diabetes are as young as 13, says Denise Charron-Prochownik, associate professor of health promotion and development at the UPMC School of Nursing and Graduate School of Public Health. “But it’s not happening,” she says.

Though Duerr and her husband sought out medical advice about six months before she conceived, Kirkman says surveys suggest only about half do the same.

A pre-gestational diabetic woman’s hemoglobin A1C, a test that gives an average blood glucose reading over a two- to three-month period, should be in the 6% to 7% range before conception, says Florence Brown, co-director of the Joslin Beth Israel Deaconess Medical Center’s Diabetes and Pregnancy Program in Boston. Brown says some may aim lower, but not if they have frequent or severe bouts of low blood sugar, called hypoglycemia.

In June, Diabetes Care published a study by University of Southern Denmark researchers who found that the risk of serious outcomes increased gradually when A1C levels were above 6.9%. Adverse outcomes doubled when A1C’s reached 10.3%, and readings 10.4% or greater quadrupled risks.

Increasing awareness

With gestational diabetes, Kirkman says, the key is to keep weight and blood sugar under control with a healthy diet, exercise and sometimes insulin.

It’s not easy, Charron-Prochownik says. “Women have to be very motivated.”

Brown, who is studying cardiovascular risks in women who had gestational diabetes, says many do not realize that they are more likely to develop cardiovascular disease or that their baby has a greater chance of developing diabetes later in life.

To help lower the risk of similar pregnancies and health risks, next month the ADA and the American College of Obstetricians and Gynecologists plan to launch a joint awareness campaign that targets women during and after pregnancy.

“We’re giving ideas to help continue healthy behaviors for the whole family,” Kirkman says.

Duerr says she’s not sure about getting pregnant again anytime soon.

“Having diabetes during pregnancy took a lot of work. It was very challenging,” she says. “There were a lot of nights my husband and I were both up because my glucose monitor was going off because my sugar was too high or too low. To have that level of commitment, to think about doing it again now with our baby, is hard.”

	THE DANGERS OF DIABETES Diabetes before pregnancy •About one in 100 women have pregestational diabetes, diabetes before they became pregnant. •Women with poorly controlled pregestational diabetes are three to four times more likely than non-diabetic women to have babies with serious birth defects, including heart, brain and spinal cord problems. •Poorly controlled diabetes during early pregnancy can lead to ?miscarriage and stillbirth. •Poorly controlled high blood sugar during pregnancy leads to large-birthweight babies, causing risks during birth to mother and child. Gestational diabetes •Gestational diabetes affects about 4% of all pregnant women, that’s about 135,000 cases in the USA each year. •Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians, and among obese women and those with a family history. •Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. •Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next five to 10 years. •Women who have gestational diabetes are at higher risk for obesity, high blood pressure, cholesterol problems, metabolic syndrome and clogged blood vessels. •Babies of women who have had gestational diabetes are at a ?higher risk of developing diabetes during their lives. Sources: March of Dimes, American Diabetes Association (ADA), Diabetes Care, Centers for Disease Control and Prevention, (CDC), endocrinologist Sue Kirkman (ADA), The American College of Obstetricians and Gynecologists. (ACOG).

FACTS ABOUT DIABETES • Nearly 24 million Americans have diabetes. • Of those, the number diagnosed: about 18 million. • Diagnosed with type 1 diabetes: 5% to 10%. • People with pre-diabetes: about 56 million. • The cost of diabetes: $174 billion a year. • Diabetes is a group of serious diseases characterized by high blood glucose levels that result from defects in the body’s ability to make or use insulin. • A leading cause of death in the USA, diabetes can lead to debilitating or fatal complications, including heart disease, stroke, blindness and kidney disease. • More than 65% of people with diabetes die from heart disease or stroke. • Diabetes can cause heart attacks earlier in life. Source: American Diabetes Association and Centers for Disease Control and Prevention