Years ago, pregnancy for women with chronic diseases was frowned upon by many obstetricians. Learn how advances in medicine and proper prenatal care can lead to a healthy pregnancy and delivery.
You’ve just taken The Test and it came back with those unmistakable two lines—your intuition was right, you’re pregnant! But instead of feeling overjoyed and excited, you find yourself worried and anxious. You’re pregnant and you’re a diabetic. How will your illness affect your pregnancy and your unborn baby?
Years ago, pregnancy for women with chronic diseases such as diabetes, epilepsy, and asthma was frowned upon by many obstetricians. Today, with advances in medicine and proper prenatal care, healthy pregnancies and deliveries are possible for women with chronic illnesses.
Diabetes
The human body breaks digested food down into sugar and moves it into the bloodstream. At the same time, the pancreas produces a hormone called insulin that moves the sugar from the blood into your cells for energy. When too little insulin is produced, or none at all, diabetes occurs.
According to the March of Dimes, one in 100 women has diabetes before getting pregnant, and 3 to 5 percent of women develop diabetes during their pregnancy (known as gestational diabetes).
There are three different classifications of diabetes: Type 1, Type 2, and gestational.
- Type 1 diabetes, commonly referred to as insulin-dependent or juvenile diabetes, occurs when the pancreas does not produce any insulin. Type 1 diabetics need daily injections of insulin to survive.
- Type 2 diabetes is the most common of the three, found in 90 percent of people in the United States with diabetes. With Type 2, the pancreas does not make enough insulin, or the insulin that it produces doesn’t work correctly. Type 2 diabetics’ conditions are usually controlled through daily glucose monitoring, oral medications, a modified diet, and exercise.
- Gestational diabetes develops in pregnancy and often disappears after childbirth. Gestational diabetes shares similar symptoms with Type I and Type 2, and occurs when there is too much glucose in the blood. Women are tested for gestational diabetes during the 24th to 28th week of pregnancy, though women classified as high-risk (those who have diabetes or who may have had gestational diabetes during previous pregnancies) are usually tested earlier.
The test for gestational diabetes involves drinking a very sweet glucose solution. A blood sample is taken after one hour to measure the effects of the glucose. If the test comes back positive, the obstetrician monitors the mom-to-be closely.
“Since mothers who are diagnosed with gestational diabetes are at risk of developing preeclampsia and tend to deliver overweight infants, they undergo more ultrasounds to check on the baby’s development and blood tests,” says Dr. Jane L. Davis, MD, associate program director, Department of Obstetrics and Gynecology Residency Program at Cedars-Sinai Medical Center in Los Angeles, California. Even if the test comes back normal, these at-risk moms-to-be are usually retested later in the pregnancy.
During a pregnancy, high blood sugar levels can pass through the placenta to the developing baby, increasing the risk of birth defects. Uncontrolled blood sugar can also affect a growing baby, since the extra sugar goes through the placenta to the baby, adding to the fetus’s weight.
According to the American Diabetes Association, a developing baby’s pancreas will make extra insulin to balance out the extra sugar from a diabetic mom. When the baby is born, his pancreas may not stop creating this extra insulin.
A diabetic pregnant woman’s blood sugar levels are checked frequently, and if they are kept in a near normal range, the chances of having a healthy pregnancy and delivery are often as good as those for a non-diabetic women. “It is so important for women with diabetes to get their blood glucose level under control, through diet and exercise, prior to conception,” says Dr. Davis.
“Women with poor control of their diabetes at the time of conception have a higher risk of having a pregnancy complicated by birth defects,” states Dr. Geeta K. Swaamy, MD, associate, Division of Maternal-Fetal Medicine at Duke University Medical Center’s Department of Obstetrics and Gynecology in Durham, North Carolina.
The medical community stresses that for a woman with diabetes to achieve a healthy pregnancy, she must keep her condition well monitored and under control. “Adequate glucose control is achieved through dietary modification and management, exercise, and anti-hyperglycemic agents such as oral tablets or insulin,” says Dr. Swaamy. Pregnant diabetics are monitored closely throughout pregnancy through the use of ultrasound. “Obstetrical ultrasounds are performed more frequently in order to monitor fetal growth, usually every four weeks,” says Dr. Swaamy.
Epilepsy
Epilepsy is a disorder of the brain’s electrical system that can lead to seizures. Many triggers can cause this abnormality including infections, head injury, brain tumors, and brain injuries at birth. Women with epilepsy face many health issues that may affect their reproductive systems and lead to osteoporosis, weight gain, and sexual dysfunction.
According to the Epilepsy Foundation, all epileptic women should be in good general health and pay close attention to their nutritional needs before and during pregnancy. This includes taking vitamins fortified with folic acid. Studies have shown that if a woman takes Vitamin B (folic acid) before conception and during the first few weeks of pregnancy, it may help reduce the risk of neural tube defects (spina bifida) in her baby. Epileptic women have a greater risk of giving birth to a baby with this birth defect, and, according to Dr. Swaamy, “it is recommended that they take 4 mg of the B vitamin daily.”
Obstetricians stress that if epilepsy is kept under control, the chances for a healthy pregnancy and birth can be equivalent to those in women without a chronic condition. If a woman with epilepsy is planning on becoming pregnant, Dr. Swaamy says she should consult with her physician before conception “to determine if anti-seizure medication(s) are appropriate to take at the time of conception and during pregnancy.”
The dosage of anti-seizure medication (commonly referred to as AED) that a mom-to-be might be prescribed may need to be adjusted. “A woman’s metabolism changes during pregnancy, and therefore the same dosage of a medication may be inadequate to prevent seizures,” says Dr. Swaamy.
Dr. Davis says preconception medical counseling is vital for women with epilepsy. “If a woman has been seizure-free for two to five years, we try to slowly tamper them off as much medication to where it may be a single dose, instead of a multi-dose.”
Asthma
Asthma is a lung disease caused by the constriction of the pulmonary bronchioles (the branches of the trachea). Asthma is usually treated with oral or inhaled corticosteriods or steroids.
Many asthmatics find changes in their conditions during pregnancy. Dr. Davis believes these changes are related to the severity of a woman’s condition prior to conception. “The steroid-dependent asthmatic who has been intubated may have a greater problem with a pregnancy,” she says. “However, those women who have not had such serious episodes are just as likely to experience a healthy pregnancy.”
“It is likely that the overwhelming majority of women with asthma will have no change or improvement in their condition,” says Dr. Swaamy. Asthmatics who want to plan for a healthy pregnancy should consult with their primary care physician and/or pulmonologist.
The usual treatment for asthmatics may involve steroids such as prednisone. Dr. Swaamy and Dr. Davis agree that prednisone does not harm a developing baby since there is no evidence that it crosses over the placenta. However, it is important that asthmatic women consult with their physicians before they start taking new medications or discontinue any prescribed asthma medications before conception.
