Period of pregnancy is in itself highly promising time full of hope but if a woman happens to suffer from chronic diseases like diabetes or hypertension, then it may consist of numbers of apprehensions and complications also. These diseases are accompanied by severe implications on pregnancy, affecting the well-being of both mother and the new born-thus requiring proper management coupled with appropriate health care support to make such pregnancies and deliveries healthy.
Knowing how diabetes and hypertension can affect the pregnancy along with the steps taken to mitigate these risks will ensure the best of outcomes for mother and baby.
Diabetes and Pregnancy
Diabetes develops where the body does not produce enough insulin (Type 1 diabetes) or can't use well the available insulin (Type 2 diabetes), thereby making sugar levels too high in the blood. Another type is gestational diabetes, which develops during pregnancy and usually disappears after delivery. No matter what type of diabetes exists, maintaining a normal, stable range of blood sugar levels throughout pregnancy is critical in preventing complications.
How Diabetes Affects Pregnancy
Increased Risk of Birth Defects: Poorly controlled diabetes at the start of pregnancy may increase the risk of birth defects, particularly in the form of neural tube, heart, or brain abnormalities. High blood sugar levels can impair fetal development at this incredibly sensitive stage within the first three months.
Miscarriage and Stillbirth: In those with very poor diabetes control, miscarriage and stillbirth are more common. Proper control of blood sugars significantly reduces the incidence of miscarriage and stillbirth.
Macrosmia or Large Baby: The babies of diabetic mothers are bigger in size and measurements as compared to normal. This condition is usually referred as macrosomia. Vaginal delivery becomes more complicated, and chances of a caesarean section would increase, thus increasing the chances of shoulder dystocia and birth injuries at the shoulders.
Diabetic pregnancies are more susceptible to preterm delivery, and this later causes various complications since the baby is born premature that face respiratory distress, organs underdeveloped, and cannot feed.
Pre-eclampsia: It can cause the life-threatening condition associated with high blood pressure and damage to one organ, for instance liver or kidneys. Then a complication is premature birth or placental abruption where the placenta becomes separated from the uterus prior to its time.
How Diabetes Affects Delivery
C-section: The babies of diabetic mothers tend to be either too big or complicated because the blood sugar is higher. Women with diabetes can give birth vaginally, though a C-section delivery may be advised for delivery if the baby is too big or when complications arise with the mother's health or even the baby's.
Induced Labour: Once it is established that a diabetic woman will develop complications, like pre-eclampsia or a large baby, labor would be induced long before time.
Controlling Diabetes in Pregnancy
Pre-pregnancy planning: If you have a diagnosis of diabetes before you conceive, plan with your healthcare provider prior to pregnancy. Such preconception care can minimise the risk of complications when you are pregnant.
Monitoring of Blood Sugar: Blood sugars should also be controlled and monitored during pregnancy. This would be through an adjustment of your insulin doses, diet, or oral medications from your antenatal carer depending on the kind of diabetes diagnosed.
A healthy diet, which helps in regulating the blood sugar concentration in the blood, along with regular, safe exercises during the gestation period, can greatly improve the general health condition and reduce complications.
Frequent Prenatal Visits: Pregnant women with diabetes must visit their doctors more than other women. This is because of the frequency of ultrasounds to check on the baby and a few tests for complications to occur.
Hypertension in pregnancy
Another associated condition is high blood pressure, or hypertension. The term chronic hypertension is known if a woman already faces a state of high blood pressure before conception or is diagnosed with it before 20 weeks of gestation. High blood pressure that develops after 20 weeks of gestation is referred to as gestational hypertension. In both conditions, if left uncontrolled, this may result in complications.
How Hypertension Affects Pregnancy
Pre-eclampsia: One complication of hypertensive disease has been termed as one of the most dangerous: pre-eclampsia. Pre-eclampsia is characterised as high blood pressure with protein in the urine. The sudden onset of hypertension causes damage to the mother's organs and prevents proper blood flow to the baby. Such devastating effects result in births, low birth weights, and even loss of life if it does not receive treatment.
Growth Restriction: High pressures may restrict blood flow to the placenta, thus the baby does not grow normally and this is referred as intrauterine growth restriction (IUGR). This situation increases the chances that at birth, it could be a preterm baby or have developmental problems.
Placental Abruption: High blood pressure increases the risk for placental abruption, when the placenta detaches prematurely from the uterine wall before delivery. This is a life-threatening condition for mother and baby, since it may cause severe hemorrhage.
How Hypertension Affects Delivery
Induced Labor: The woman should be induced if she develops severe hypertension or develops pre-eclampsia, in order that complications can be prevented. If the condition worsens, it may be induced before the due date.
C-Section: If complications such as foetal distress or placental abruption are present, it cannot be avoided that the baby and mother both need to be saved; so there will be a C-section.
Conclusion: Counseling for Pregnancy, Diabetes and Hypertension
While known complicators of pregnancy and delivery, diabetes and hypertension do have the potential to be treated very effectively by modern medical care. If you suffer from diabetes or hypertension, then this is a great opportunity to work closely with your health care providers monitoring your health, living a healthy lifestyle, and following an individualised care plan for a healthy and safe pregnancy.
Good prep and regular follow ups with the doctor, good rapport with your health practitioner, will guide you to make the right decisions, think constructively and face pregnancy with confidence.
Reviewed by
Dr. Lakshmi Kumari A - Consultant - Reproductive Medicine, Milann - Sarjapur.
