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Consequences of poor glycaemic (blood-sugar) control

The mother could become very seriously ill if her blood-sugar is allowed to drift wildly. Both very low and very high blood glucose can be dangerous, even life-threatening.

For the fetus, poor diabetic control is estimated to be responsible for close to half of all babies lost either in the form of stillbirth or infant death soon after delivery.

Ideal blood glucose levels during pregnancy

The affected mother will need to check her blood glucose anything between two to five times a day, throughout the course of the pregnancy.

She should be aiming for a level of between 4 and 7mmol/l. (This is the same as 72-126mg/dl in Imperial measurements). The glucose level should be nearer 4mmol/l (72mg/dl) before her breakfast and nearer 7mmol/l (126mg/dl) two hours after her main meal.

In reality, these levels may be difficult to achieve and a drift by a factor of one from this range is generally considered acceptable, provided it is not persistent.

Pre-existing diabetes eye complications and pregnancy

The most common diabetic eye complication is retinopathy. If she already has this, the symptoms may get worse. This is, however, strictly temporary and her eyes will go back to the pre-pregnancy status soon after the end of the pregnancy.

All diabetic expectant mothers should have their eyes examined during pregnancy, to keep track of existing retinopathy and to detect any retinopathy which may develop for the first time during pregnancy.

Pre-existing diabetic renal (kidney) complications and pregnancy

This will depends on the extent of renal disease. If the only detectable problem is loss of protein in the urine, then pregnancy should not have any significant effect. It would not make the renal disease worse and there will be only a slight increase in the possibility of fetal growth restriction. However, she is at a slightly increased risk of developing pre-eclampsia.

If, on the other hand, her renal disease has already caused hypertension before pregnancy, then the risk of developing pre-eclampsia is quite significantly increased. This, in turn, may lead to significant fetal growth restriction and/or prematurity. More than a third of such patients have premature delivery.

Prematurity in diabetes

In any situation, it depends on the degree of prematurity. As a rule, babies of diabetic mothers tend to fare less well at every stage of the pregnancy. Good diabetic control quite significantly reduces the difference, but it does not eliminate it altogether.