Latest Catalogue Diabetes - Pregestational

Diabetes - Pregestational

DEFINITION

Diabetes or diabetes mellitus is a metabolic disorder characterised by hyperglycaemia (high blood glucose levels) caused by impairment in insulin secretion and/or action.

Pregnant women with existing diabetes (referred to as Pregestational Diabetes) can minimise the risk of complications by maintaining optimal control of diabetes throughout pregnancy.


DESCRIPTION

Women with Pregestational Diabetes are at increased risk of pregnancy-related complications such as polyhydramnios (increased amounts of amniotic fluid around the baby), preterm labour, urinary tract infection, hypertension disorders and increased intervention at the delivery stage. Pregnant women with poor blood glucose control have a greater risk of miscarriage. The babies of women with diabetes are at greater risk of being born large, having respiratory distress, jaundice, hypoglycaemia, hypocalcaemia (low blood calcium levels) and congenital malformations.
However, by maintaining good blood glucose control before and during pregnancy, the risk of complications for mother and child can be greatly reduced.

The risks associated with Pregestational Diabetes can be minimised through:.
- Preconception counselling.
- Optimal diabetic control before, during and after the pregnancy.
- Careful management by a diabetes management team (Doctor, diabetes educator or Nurse, Dietitian, Paediatrician, Eye Specialist etc).
- Prompt diagnosis and treatment of both trivial and serious complications of pregnancy.
- Careful timing and suitable method of delivery.
- Presence of a Paediatrician with experience in the health management of infants of mothers with diabetes.
- Availability of a neonatal intensive care nursery.

PREGESTATIONAL DIABETES (TYPE I).
- Women with Type I diabetes should seek advice from their Doctor and diabetes management team before conception. Their blood glucose levels should be well controlled at conception and they should be checked for renal, retinal and cardiac complications.
- During pregnancy, diet should be individualised and coordinated with insulin administration, which should also be individualised.
- Blood glucose should be monitored at home.
- Patients should be educated about the dangers of hypoglycaemia during exercise and at night.
- The foetus should be monitored.

PREGESTATIONAL DIABETES (TYPE II).
- Women with Type II diabetes should seek advice from their Doctor and diabetes management team before conception. They should be encouraged to lose weight if obese. Hyperglycaemia and blood glucose levels should be controlled. Exercise and a low fat, high carbohydrate and high fibre diet should be recommended.
- During pregnancy, the amount and type of insulin should be individualised and blood glucose should be monitored at home.
- Diet and calorie intake should be individualised to avoid excessive weight gain in obese patients.
- Moderate exercise (e.g. walking after meals) should be recommended.
- Blood glucose levels should be monitored weekly by a Doctor.


TREATMENT OPTIONS

In no way is this information intended to replace the advice of a medical practitioner. Always consult your Doctor for diagnosis and advice.
It is important for a woman with diabetes to plan her pregnancy with her Doctor and diabetes management team to ensure that her diabetes is under control before conceiving. If any diabetes-related renal, retinal or cardiac complications exist, it is important that these are treated before a woman becomes pregnant.
It is important to maintain close contact with the diabetes management team (Doctor, diabetes Educator or Nurse, Dietitian, Paediatrician, Eye Specialist etc) during the pregnancy.
It is advisable to seek the advice of a Dietitian as dietary management is of great importance for diabetic control and a healthy baby.


DIET HINTS

It is important for women with Pregestational Diabetes to seek the advice of a Dietitian before conception and during pregnancy, as dietary management is of great importance for diabetic control and a healthy baby.
- For pregnant women with Type I diabetes, the diet should be individualised and coordinated with insulin administration.
- For pregnant women with Type II diabetes, a low fat, high carbohydrate and high fibre diet is recommended. Diet and calorie intake should be individualised to avoid excessive weight gain in obese patients.


ORGANISATIONS & SUPPORT GROUPS

See the Diabetes Australia topic on the Healthpoint.


PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) If you have any queries regarding your medication for diabetes, ask your Pharmacist.
2) Ask your Pharmacist about special diabetic products which are available (e.g. blood glucose testing monitors).
3) Always remember to inform a Pharmacist that you have diabetes when purchasing any oral medication as many mixtures contain sugar (e.g. cough mixture).
4) Try to lose weight if you are overweight. Ask your Pharmacist for the Weight Management - Meal Plan.