(RxWiki News) Diabetes is a disease that needs to be carefully managed. And that couldn't be more true for pregnant women or those planning on getting pregnant.
A group of researchers has issued new recommendations on the management of diabetes before, during and after pregnancy.
These researchers recommended, among other things, pre-pregnancy counseling, weight management and close monitoring of women's blood sugar levels, as well as the kidneys and thyroid.
"Discuss the risks of diabetes and pregnancy with your doctor."
The lead author of this guideline was Ian Blumer, MD, from the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada.
The authors reviewed current and previous medical data to come up with an evidence-based guideline with recommendations for women who already have diabetes and women who develop diabetes during pregnancy (gestational diabetes).
The recommendations for pre-pregnancy are for women who were already diagnosed with diabetes.
First, the guideline recommended pre-pregnancy counseling for women with diabetes before deciding to get pregnant. The authors suggested that pre-pregnancy counseling can decrease the risk of complications such as birth defects or miscarriages.
Research has shown that pre-pregnancy counseling may give women with diabetes more control over their blood sugar levels because they can be closely monitored by one or more healthcare professionals.
The authors of this guideline emphasized that maintaining a normal blood sugar level leading up to pregnancy is extremely important because high blood sugar can increase the risk of fetal deformities, miscarriages and even fetal death.
Next, the guideline recommended that women with diabetes take a folic acid supplement every day for the three months before becoming pregnant. According to the authors, these supplements may help decrease the risk of damaging the development of the baby's central nervous system.
The guideline then recommended that women with diabetes get their kidneys tested to make sure they are functioning properly. The authors explained that kidney dysfunction can increase the risk of preeclampsia — a condition where the pregnant mother develops high blood pressure and abnormally high levels of protein in her urine.
Lastly, it is strongly recommended that women with diabetes monitor their thyroid function and weight — both of which can increase the risk of complications during pregnancy such as miscarriage or damaged brain development.
The guideline then discussed recommendations for testing women for gestational diabetes during their pregnancy. Women with gestational diabetes do not show symptoms or have a diagnosis of diabetes prior to being pregnant.
The authors recommended that all women without a previous diabetes diagnosis be tested for diabetes during the first 13 weeks of pregnancy. If the condition is caught early enough in pregnancy, the authors believe that early, rapid treatment may greatly decrease the possible risks to the mother and fetus.
If women have not been diagnosed with diabetes by the 24th week of pregnancy, the guideline suggested that they be tested for gestational diabetes between week 24 and week 28.
Blood sugar levels should be continuously monitored throughout pregnancy, according to the guideline, which also suggested using "lifestyle therapy" — nutrition and exercise — to maintain proper levels.
The authors explained that lifestyle therapy for gestational diabetes can decrease the risk of abnormally low or high birth weight and preeclampsia.
The authors suggested that infants born to women with gestational diabetes should be regularly monitored as well because they are at risk of becoming obese and/or developing diabetes later in life.
The guideline then recommended that women with any sort of diabetes should breastfeed their infant. The authors explained that the risk of the infant developing diabetes or obesity may be lowered through breastfeeding. Breastfeeding also might help the mother lose weight and therefore decrease the risk of developing diabetes later on.
The authors mentioned a few limitations of their recommendations.
First, the authors recognized that many people have lifestyle limitations — such as money — that would keep them from following every guideline. Second, some of the recommendations lack direct evidence and therefore should be considered suggestions.
This guideline was published in the November edition of The Journal of Clinical Endocrinology & Metabolism.
