The relation between pregnancy and diabetes is something that cannot be overlooked as it presents risks for both the mother to be and the baby. At the Anadolu Medical Centre Endocrinology Department, Metabolic Diseases and Diabetes Specialist Dr. Mithat Bıyıklı says that serious risks do exist for the mother and the baby if adequate attention is not given to diabetic mother candidates and women who are diagnosed as diabetic during their pregnancy. 

Two different conditions can be observed when we take a closer look at the relation between pregnancy and diabetes. First the pregnancy of diabetic women and points of attention during pregnancy; second, women whose diabetes is identified during pregnancy. Women without previously diagnosed diabetes exhibiting high blood glucose levels during pregnancy are termed gestational or in other words pregnancy induced diabetics. Whilst gestational diabetes can recede after giving birth there are instances when it remains as a condition after birth. 

Pregnancy in Diabetic Patients
Dr. Mithat Bıyıklı underlines the importance of gestational diabetes patients getting close attention by a gynaecologist and endocrinologist as significant hazards exist both for the mother and the baby. According to Dr. Bıyıklı insulin demand increases remarkably during pregnancy. This demand becomes more pronounced in diabetic patients, especially during the last three months of pregnancy. Dr. Bıyıklı says, “This situation ultimately demands an adjustment to the insulin dosage. Otherwise there is the heightened risk for serious health problems including ketoacidosis, in other words sugar coma.”

Dr. Mithat Bıyıklı stresses poorly managed pregnant diabetic patients have significantly increased risk of developing serious urinary tract infections, other infections like vaginal candidiasis and pregnancy induced hypertension otherwise known as preeclampsia.

Uncontrolled blood glucose increases risk of still birth
High blood glucose levels not only adversely affect the mother to be but also the baby. According to Dr. Mithat Bıyıklı high blood glucose levels in the early stages of pregnancy can cause serious developmental problems, not forgetting the risk of premature abortion. The risk of giving birth to children with anomalies rises three to four times especially for women starting their pregnancy term without control over their blood glucose levels. Underlining the heightened risk of sudden death of the baby in the womb in all stages of pregnancy due to prolonged high blood glucose levels Dr. Mithat Bıyıklı goes onto say:

“Uncontrolled diabetes can cause the baby to be born overweight (above 4 kg), an increase in amniotic fluid, delay in the development of lungs and related respiratory problems after birth. Babies developing in the womb of diabetic mothers that have developed preeclampsia may have intrauterine developmental deficiencies. Oversized babies may experience difficulties at birth such as distress and shoulder jams. After birth the newborn baby may also face important problems such as hypoglycaemia, low calcium levels and high billirubin levels medically termed as hyperbilirubinemia.” Above all, HbA1c levels are very important. This allows monitoring the course of diabetes in the final three months of pregnancy in all diabetic mothers to be. Dr. Mithat Bıyıklı shares the following information concerning the monitoring of mother candidates with high HbA1c levels:

 “In addition to the triple test examination, which is in itself adequate for normal pregnancies, we conduct additional tests and examinations for pregnant diabetics including an ultrasound at 18th gestational week allowing detailed examination of the baby and foetal echocardiography at 20th gestational week to identify potential cardiac and venous anomalies. If any abnormality is spotted with these examinations, conducted for routine scanning, special advanced interventional examinations such as a amniosynthesis or cordiosynthesis might be necessary.

Gestational Diabetes
Although previously non-diabetic, five percent of women have the chance of developing diabetes during pregnancy. According to Dr. Mithat Bıyıklı pregnant women present heightened risk of having gestational diabetes if they have previously given birth to an overweight baby (more than 4 kgs), given birth to a child with anomalies, experienced multiple abortions, developed gestational diabetes, overweight in the period prior to pregnancy or have diabetics amongst immediate relatives, have experienced still-birth, have excess amniotic fluid, and those who have gained more weight than expected. Only half of pregnant women diagnosed with gestational diabetes show one of these risk factors. This is why it is extremely important for all pregnant women to get a diabetes scan test at 24th to 28th gestational week. 

Follow-up and Treatment for Gestational Diabetes
Dr. Mithat Bıyıklı says that it is essential for all pregnant women diagnosed with gestational diabetes to undergo a complete organ system function test. “After this point, patient follow-up is no longer the same as a regular pregnant woman. The frequency of check-up examinations must increase. Specialists must assess the effect of diet and/or insulin treatment on blood glucose levels. We also need to evaluate the blood glucose measurements recorded by the pregnant patient at home. The diet and insulin treatment should be reviewed and re-organised accordingly. Using ultrasound we will look for growth in babies and polyhydramnios (excess amnion fluid). After the 36th gestational week the condition of the baby is monitored on a weekly basis with special tests. The frequency of this test will increase to twice a week after a certain gestational week. Towards the end of pregnancy period (after week 38) insulin-using mothers will be hospitalised to allow frequent blood glucose levels and to evaluate the most suitable method of birth. Most likely we will wait for the birth to initiate naturally for pregnant diabetics regulating their blood glucose with diet. However we don’t recommend pregnancy to exceed 40 weeks for insulin users. This is why, if the process has not started naturally for insulin using pregnant diabetics by week 40, we will initiate the birth externally using a method called induction. Caesarean birth is preferred if the baby is oversized or a special condition exits for mother and/or baby. If no special conditions exist a pregnant diabetic under control can execute normal birth. As a matter of fact this is preferable. Pregnant diabetics must give birth at a fully equipped hospital under supervision of a specially trained gynaecologist and having notified an experienced and prepared child diseases specialist.”
Dr. Mithat Bıyıklı says that even if a woman previously diagnosed with gestational diabetes has resumed normal healthy conditions she remains to be in the risk group for future terms and pregnancies. “A repeated sugar load test with 75 grams of glucose at the end of her puerperal period will give a good idea of the extent of risk. Following birth, I recommend these patients to remain under observation of an endocrinologist or internal diseases specialist.”

Who are considered to be in the risk group in regards to gestational diabetes?
• Pregnant women who are over 25 years of age,
• Pregnant women who are above normal body weight,
• Pregnant women who have a history of diabetes amongst their relatives,
• Pregnant women who have previously diagnosed glucose tolerance disruption, and
• Pregnant women who have a history of giving birth to children over 4000g, unexplained intrauterine foetal exitus, birth with congenital anomalies and adverse obstetric conditions