Antenatal care protects diabetic women against complications


Good antenatal care among would be mothers, suffering from diabetes, protects them and their babies against serious and debilitating complications.
A report published in Diabetes Digest, the monthly magazine of Diabetic Association of Pakistan, said “Gestational Diabetes Mellitus,” is fast emerging as a frequently noticed health condition among pregnant women in most parts of the world. The situation was attributed to more sedentary life styles, changes in diet, continued immigration from high risk populations and the virtual epidemic of childhood and adolescent obesity in most parts of the world.
It revealed that abnormal maternal glucose regulation occurred in three to 10 per cent of all pregnancies in the world, while gestational diabetes mellitus was said to account for 90 per cent of diabetes mellitus in pregnancy.
Gestational diabetes mellitus was defined as a glucose intolerance of variable degree with onset or first recognition during pregnancy. Type two diabetes mellitus accounts for eight per cent of the cases of diabetes mellitus in pregnancy, said the report.
There was also said to be increasing incidence of preexisting diabetes mellitus with the surge in diabetes type two. The report warned that infants of mothers with preexisting diabetes experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery and quadruple the incidence of new born intensive care unit admission.
It indicated that risk of these morbidities were directly proportional to the degree of maternal hyperglycemia and therefore could be considered preventable with early diagnosis and effective treatment. It identified “Miscarriages”, as a threat for pregnant women with preexisting diabetes mellitus and referred to studies showing sub-optimal glycemic control to double the miscarriage rate in women with diabetes.
Women with overt diabetes and suboptimal glycemic control prior to conception were cited to have all likelihood of a structural anomaly or major birth defects in babies born to them.
It was suggested that periconceptional glycemic control was the main determinant of abnormal fetal development in diabetic women. “As birth defects occur during the critical three to six weeks after conception, nutritional and metabolic intervention must be initiated well before pregnancy,” stressed compiler of the report.
Growth restriction was identified as a major problem in pregnancies in women with preexisting type one. Maternal obesity, common in type two diabetes appeared to accelerate the risk of infant being large for gestational age and therefore comparatively more at risk to be inflicted with birth injury. Glucose intolerance and higher serum insulin levels were said to be more frequent in children of diabetic mothers as compared to normal controls. Neonatal respiratory distress syndrome was also suggested to be among a common and serious morbidity in infants of diabetic mothers.