Pregnancy Preparedness: the Importance of Preconceptual Counseling for Women Living With
Total Page：16
File Type：pdf, Size：1020Kb
Pregnancy Preparedness: The Importance of Preconceptual Counseling for Women Living with Diabetes Mellitus By Terri L. Woodard MD, Fellow in Reproductive Endocrinology and Infertility, OB/GYN at WSU School of Medicine and DMC.
We all know that good glycemic control is important to prevent long-term complications of diabetes, such as cardiovascular disease, retinopathy, renal failure and neuropathy. But did you know that excellent glycemic control is VITAL to having a healthy baby in the future? Women with diabetes can have a happy, healthy pregnancy by becoming PREPARED prior to conceiving.
What you should do now….
Preparing for a healthy pregnancy begins years before a woman is interested in becoming a mother. As a teenager or young adult, you can do a lot to ensure that you will be ready for a healthy pregnancy! This starts with maintaining good control of your diabetes by adopting a healthy lifestyle that includes good nutrition, exercise, blood sugar monitoring, taking your medications and good communication with your diabetes team.
If you are (or are thinking about) becoming sexually active, make sure you discuss birth control and safer-sex practices with your doctor so that you can prevent sexually transmitted infections and unintended pregnancy. Becoming pregnant before you (and your body) are ready is very risky!
Before trying to conceive….
In addition to adopting a healthy lifestyle, all women trying to conceive should take a prenatal vitamin with a minimum of 400 mcg of folic acid. You should make sure that you are getting enough sleep and minimizing stress. Also, refrain from smoking and drinking alcohol.
Women with diabetes should seek Preconceptual Counseling from an obstetrician who specializes in high-risk pregnancies (a Maternal Fetal Medicine specialist). Ideally, this should occur several months before you try to conceive.
A Preconceptual Counseling session will educate you on how diabetes may affect your pregnancy and enable you to discuss your individual risk. During this session, your medical history will be reviewed and a physical examination may be performed. The Maternal-Fetal specialist doctor will also request labs to assess your level of glycemic control, as well as thyroid, renal and liver function. If you have not had an EKG or eye exam you may need to have these tests done.
Once everything has been completed, the doctor will review the results and recommend a plan to optimize your success of having a healthy pregnancy. Often, you will have a team of people working together to help you, which may include your endocrinologist, obstetrician, a nutritionist or dietician, nurse educator and social worker. All of these individuals will give you the support you need to achieve your health goals. Once excellent glycemic control has been achieved for 3-6 months, you may be ready to conceive!
Created on 11/4/2010 10:03:00 PM Out of control diabetes in pregnancy increases the risk of many problems for the developing fetus, the pregnant woman, and the infant after birth.
Fetal Complications Miscarriage and Stillbirth: Women with uncontrolled diabetes have a higher rate of miscarriage (pregnancy loss before 20 weeks) and stillbirth (pregnancy loss after 20 weeks) than women without diabetes.
Birth Defects: A baby’s organs form during the first two months of pregnancy—often before a woman even knows she is pregnant! High blood sugars act like a poison to a developing baby and can cause birth defects of the heart, spine, brain, abdomen and limbs. However, if good glycemic control is achieved prior to conception, the rate of birth defects decreases back to normal.
Maternal Complications Hypertension and preeclampsia: Women with diabetes are more likely to develop high blood pressure and a disorder called preeclampsia, which is characterized by high blood pressure, high levels of protein in the urine and swelling in the hands, legs or feet. In the worst situations this can lead to severe complications such as seizures or stroke.
Eye and kidney health: Women with diabetes who have out-of-control blood sugars during pregnancy may develop or have a worsening in eye disease (retinopathy) and kidney disease (nephropathy). These problems last beyond the pregnancy.
Infant Complications Large babies: If blood sugars are too high during pregnancy the baby may be “overfed” and become very large. As a result, the baby may have a difficult vaginal birth or need to be delivered by cesarean section.
Newborn Health Problems: Babies born to mothers with diabetes may experience difficulty breathing (respiratory distress), hypoglycemia (low blood sugar because the baby is used to “higher sugars” from mom) and jaundice (yellow discoloration of the skin due to high levels of bilirubin). All of these problems may keep a newborn in the hospital for extra days.
Pregnancy preparedness is power to achieve a healthy pregnancy. Healthy moms make healthy babies! For more information on the subject of diabetes and pregnancy, please check out these resources: http://www.diabetes.org/living-with-diabetes/complications/pregnant-women/ http://www.cdc.gov/ncbddd/pregnancy_gateway/diabetes.html http://www.marchofdimes.com/pnhec/188_1064.asp http://www.michigan.gov/documents/mdch/DiabetesTeensFactCard_281491_7.pdf
Feel free to speak with your diabetes team about unprepared pregnancy prevention and pre- conceptual counseling!
Created on 11/4/2010 10:03:00 PM