With awareness and care, pregnancy is approached with serenity
The question
What to know about diabetes and pregnancy
Answer: Pregnancy is a unique and special time in a woman's life, but when it is accompanied by diabetes, it requires a little extra attention. However, this does not mean having to give up anything: today, thanks to early diagnosis and targeted therapies, it is possible to live a serene pregnancy even in the presence of the disease. When talking about diabetes and pregnancy, it is important to distinguish between two different situations. In the first case, the woman has pre-existing diabetes, type 1 or type 2, already before conception (pre-pregnancy diabetes). In the second case, she develops a form of diabetes during gestation, known as gestational diabetes, which usually appears in the second or third trimester of pregnancy and, in most cases, resolves after delivery. It is a condition that can occur even in the presence of a healthy lifestyle, but certain factors can increase the risk: age over 35 years, overweight or obesity, first-degree family history of diabetes, previous pregnancy with gestational diabetes, previous deliveries with babies weighing more than 4 kg, ethnic origin from areas with a high prevalence of diabetes: (South Asia, Middle East, Caribbean) or pre-pregnancy or early pregnancy fasting blood glucose between 100 and 125 mg/dl. Diagnosis is made with a test called the oral glucose load curve (OGTT), which is offered to all women with risk factors. It is a simple but valuable test because it allows early detection of any alterations in blood glucose levels. To take the test, the woman must have been fasting for at least 8 hours. After an initial blood sample to measure fasting blood sugar, she is made to drink a solution containing 75 grams of glucose. Two further blood samples are then taken, 1 hour and 2 hours after the drink, to assess how the body responds to the ingestion of sugar.
If one or more blood glucose values are above the established limits, a diagnosis of gestational diabetes is made. This allows early intervention with changes in lifestyle, diet and, if necessary, therapy, reducing the risks for mother and baby. To best manage gestational diabetes, the first strategy is lifestyle: balanced diet (rich in fibre, low in simple sugars), moderate physical activity (such as walking every day), and constant monitoring of blood sugar levels. If these measures are not enough, one can resort to drug therapy to be agreed with one's doctor. What are the risks if diabetes is not controlled? For the mother: hypertension, pre-eclampsia, polydramnios, premature birth, caesarean section, urinary infections, increased risk of type 2 diabetes after pregnancy. For the baby: excessive foetal growth (macrosomia), growth retardation, decreased lung maturity, hypoglycaemia at birth, long-term metabolic risk. This is why early action is essential.
Once the baby is born, blood sugar returns to normal in most cases. But don't let your guard down: women who have had gestational diabetes have a higher risk of developing type 2 diabetes in later years. Therefore, regular check-ups, an active lifestyle and attention to body weight are recommended. The situation is different for those who already have diabetes before pregnancy. In these cases, it is essential to plan conception with one's medical team, optimising glycaemic levels already in the preceding months to reduce the risk of maternal and foetal complications. During pregnancy, then, monitoring is even more careful, with close checks and adaptation of therapy to the body's new needs.
In any case, the key is multidisciplinary care: gynaecologist, diabetes team and, if necessary, other specialists work together to accompany mother and child on this journey.
The final message? A pregnancy with diabetes requires awareness and care, but can be approached with serenity.