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Classical (pre-existing) diabetes and pregnancy
Good diabetic control before conception is of utmost importance for a diabetic mother’s
and her baby's ultimate wellbeing. If she has decided to try for a baby, her doctor
can arrange a simple blood test to determine how good her blood-
If control is found to be unsatisfactory, it is best to put the plans on hold un
til
the diabetes control has been optimized. Alteration in the insulin regime will be
made until the blood sugar (glucose) level control is good and stable. This may
take several weeks to achieve, but is well worth it.
There is no doubt that poor diabetes control at the time of conception is by far the leading cause of major fetal malformation among diabetic mothers.
Where pre-
There is strong evidence that most malformations are already in place by eight weeks of gestation.
Diabetes and fetal malformation: Identifying an affected baby
The only reliable test to detect possible major malformation is an ultrasound scan ideally performed at about eighteen to twenty weeks of gestation. Detection is possible a few weeks earlier, but a negative result may not be as reliable. Ultrasound will detect most major malformations.
Changes that occur during pregnancy for an insulin-dependent diabetic
In the beginning (i.e. the first ten to twelve weeks), the tendency is for insulin requirements to decrease. This is because blood glucose is being transported from the mother's bloodstream to the fetus. This means she ends up with less blood glucose and is prone to low blood glucose (hypoglycemia). Gradually, she develops insulin resistance and this means her insulin requirements will start going up again.
In summary, at the beginning, the tendency is to require less insulin and, about one third of the way through, the trend is towards more insulin.
What all this means is, she should expect a few adjustments in the insulin regime during her pregnancy and expert input in this is not only desirable but essential.