Women with diabetes should plan a pregnancy well. Here you can read what is important in this time
In the case of diabetes, some precautions are useful before pregnancy
An information in advance: This text is about women who already had diabetes before they became pregnant. Information for women who develop diabetes during pregnancy can be found in the chapter " Pregnancy diabetes ".
Diabetes is a problem for women who want to become pregnant or who are pregnant. A pregnancy with diabetes is associated with risks for mother and child. Above all, increased blood glucose values during this period bring with it the risk of damage to the mother and with the child the risk of malformations as well as other damage. 8 Prevents through healthy lifestyle.
Info: Pregnancy with diabetes - what dangers are there? Depending on the change in metabolism before and during pregnancy, children of mothers with diabetes have an increased risk of miscarriage and premature birth. Malformations are also possible - especially in the heart, nervous system and lungs.
Too high blood glucose levels can lead to the baby being born with a heavily elevated birth weight of over 4500 grams. Because type 1 diabetes is partly genetic, the children are at increased risk for this type of diabetes.
The mother is at risk of metabolic dermatitis, primarily in the form of hypoglycemia, at the beginning of pregnancy. Diabetic sequelae in the eyes, kidneys and nerves may worsen during this period. Hypertension may develop during pregnancy.
A good blood glucose control during pregnancy and childbirth is the best protection for mother and child. Women with diabetes should plan their pregnancy well, clarify their own risks with their diabetologists and get the values ??as well as possible before conception. In our overview you will read what is important in the individual phases.
1. Before pregnancy
Women with diabetes usually discuss a planned pregnancy in advance with their treating diabetologist and the female doctor. The blood glucose long term HbA1c should be below seven, or better, 6.5 percent three months before conception. For an unplanned pregnancy, women should seek medical advice as soon as possible.
Before starting the pregnancy, women with diabetes should also be examined for existing lesions, such as the kidneys or the retina in the eyes. The sequelae also increase the risk of hypertension . Since the pregnant woman and her doctor should be particularly vigilant. Above all, network damage can worsen during pregnancy and should be treated.
An optimal blood glucose control is the basic prerequisite for mastering the new challenges of pregnancy despite diabetes.
Also, check the thyroid gland for an over or under function. It can also be useful to take prescription tablets with folic acid and iodine. For this reason, the best advice should be given by the physicians. And as for all women who want to become pregnant: Quit smoking.
Before starting the pregnancy, diabetic therapy may have to be adjusted. This depends on how good the glucose values ??have been. Failure to do so may cause the diabetologist to change insulin.
As for women with type 2 diabetes , many drugs that lower the blood glucose are taboo in pregnancy. Patients who have previously treated their diabetes with tablets must therefore switch to insulin before pregnancy. Injections and concomitant increased blood glucose measurements are often a major change for women who have not previously been dependent on insulin. It is therefore recommended to have the correct handling of the insulin pen in a training course.
2. During pregnancy
The following blood glucose levels should be aimed at women with diabetes in pregnancy:
Before the meal: 60 to 90 mg / dl (3.3 to 5.0 mmol / l) One hour after the meal: less than 140 mg / dl (7.7 mmol / l) Two hours after the meal: less than 120 mg / dl (6.6 mmol / l) Before sleeping: 90 to 120 mg / dl (5.0 to 6.6 mmol / l) At night (about two to four o'clock): over 60 mg / dl (3.3 mmol / l)
Hormone fluctuations during pregnancy make a good blood glucose adjustment difficult. At the beginning, the insulin requirement drops. Pregnant diabetics must therefore inject less insulin until about 14 weeks, in order to avoid hypoglycaemia. Later, during the 22nd week of pregnancy, the required amount of insulin increases, in order to fall sharply at birth. Regularly several times a day measuring blood glucose is therefore especially synonymous in pregnancy the A and O, in order to arm themselves against bad surprises.
The risk of hypoglycaemia (hypoglycemia) is increased during the initial period of pregnancy. Especially at night they can occur. This requires, on the one hand, a suitable blood glucose regulation by the diabetic strain, which keeps the risk to lower sugar values ??as low as possible. In addition, pregnant women with diabetes should be trained in the proper treatment of hypoglycaemia. The same applies to your partner and the surrounding environment.
Women should also clarify with their medical team, from which blood tests they make a acetone test. Too high acetone values ??can be an indication of an insulin deficiency, which threatens ketoacidosis, a dangerous metabolic disorder. A ketoacidosis is a real emergency. Pregnant women with diabetes should therefore have established behavioral rules with their diabetologists.
Important investigations during pregnancy:
Go to the diabetologist and the vet every two weeks, if necessary also more often. The physician will also check the blood glucose long-term value HbA1c approximately every four to six weeks.
Before the planned pregnancy, at the beginning of pregnancy and every three months afterwards an examination of the eyes on net skin damage is important. In the second gestation period, as from the gestational week (SSW) 20, the blood pressure can rise. In the case of long-term diabetes, the risk is increased. You should measure your blood pressure regularly at the latest.
Ultrasound examinations provide information on whether the child develops healthy in the mother's body. Three studies of this type are provided by the maternity guidelines: the first in SSW eight to twelve, the second in SSW 11 to 14, the third in SSW 19 to 22. Then every two to four weeks further ultrasound examinations are useful for control.
If everything is normal, a cardiothotogram (CTG) is used to control the heartbeat of the unborn child and the gestational activity of the pregnant woman from the 32nd week of gestation. Whether before and how often, the doctor will plan as required.
3. Birth
Women with diabetes should definitely release in a perinatal center with level 1 or level 2. These centers are specialized in premature births and risk swings. In this way, the affected person is as well supplied as well as possible in case of complications. The risk of premature birth is significantly increased in pregnancies with sugar. At the beginning of the pregnancy, however, mothers are already taking care of a place of birth.
Once the calculated birth date has been reached, the diabetic team will actively initiate birth during diabetes. If the fetus weighs 4500 grams or more, an emperor's cut is advisable. During labor, blood glucose levels should be between 70 and 110 mg / dL (3.9 to 6.1 mmol / L). For this reason, the doctors will determine the glucose levels every one to two hours and correct these if necessary with short-acting insulin.
After birth, mother and child need intensive care. In the case of the former, the insulin requirement drops in the hours after the delivery, the risk of hypotension is thereby increased. Newborn mothers with diabetes should be nursed and vaccinated normally. Breastfeeding not only reduces the risk of future diabetes in children, but also for overweight.
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