Diabetes  and  pregnancy  was  one of  the  topics  listed  for  discussion  in  our  talk  show  on  west  coast  Radio as part of activities  in celebration  of  World  Diabetes  Day  2008.

Unfortunately  none of  the  Doctors  who  were  supposed  to  speak  on the  Topic  was  available. This  is  an  attempt  of the  secretariat to educate the public on the above.

Historical  background
Historically  it is  recorded  that  the  History  of pregnancy in  women  with  diabetes  is a fascinating  one. It is  also  recorded  that  as late  as the  50s few  women  with  diabetes  even  got  pregnant. A  combination of  crude insulin preparation  and  a lack  of  appreciation,  even  among  diabetes  experts, of  the need for  tight blood  glucose  control  ensured  that  women  with  diabetes  either did  not conceive,  or miscarried  soon  after.

Those  whose pregnancies survived  had  enormous  babies  who  behaved  like  tiny  premature  newborn  in  that  their  organs  were  unable  to cope with  life  outside  the  womb. Terminating  pregnancies  by  Caesarean  section  at  36  weeks  meant  smaller  babies  who  were  even  more  immature.

It  wasn’t  until  the  late 70s  when  it  was  realized  that  tighter  blood  glucose  control  during  pregnancy  largely  prevented these  large immature, so that  more  pregnancies  in  women  with  diabetes  were  able to progress to  full  term, with  fewer  requiring  surgical  intervention (  Caesarean  Section).

But  still  there  were  problems. An  unacceptably high  proportion of  the  pregnancies  of women  with  diabetes  resulted  in  infants  with  serious  congenital  abnormalities(  serious  abnormalities) at birth , until  gradually, in  the late 80s, when  it was  realized  that  good  blood  glucose  control  right  from  the  time of  conception was  necessary if  normal  babies  were  to  result.

So  the  watch word  became ‘Preconception’ control. It is now  accepted  that  for women  with  Diabetes  to have the same  chance  of happy  outcome pregnancies, there  has to be  a  concerted  team approach  which begins  long  before  pregnancy, and  continue  for  some  time  after  delivery.

The  team  has  to  include  a  competent  diabetologist ( A  doctor  specialized  in Diabetes)  to monitor  control  in the  woman  with  diabetes  desirous  of pregnancy, to ensure  that  conception occurs  at  a  time  of immaculate  blood. Glucose control. This  control  should  continue  throughout  the pregnancy  especially  during  the  difficult  first  three months, a  period  usually  characterized by nausea  and  vomiting and  the last  few months  when  control  is often  difficult  to achieve, and  when  insulin  requirement  rise.

Women  with  diabetes  need  to be  empowered  and  aware  of what  they  need  in  terms of adequate  health  care  before, during and  after pregnancy. The  diabetic pregnancy  team  must  work  together  and  share  the  difficult  task of  bringing  pregnant mothers  with  diabetes to safe  and  happy  conclusions(  Delivery).

The  diabetic  pregnancy  team
•  The  patient:  The  woman suffering from  diabetes
• The  obstertrician:  A  Doctor  whose  job it is  to  check  the  health  of  a woman  who is  pregnant  and help  with  the  birth of her child.
• The  diabetologist:     A  doctor  who  specializes  in  diabetes  treatment
• The  diabetes  care  sister:  Sister  who  cares  for  diabetes patients
• The  dietician:  Some  one  whose  job is to  advice people  about  the  kind of  food  they  should  eat.
•  The  opthalmologist:   A specialist in the  branch  of medicine dealing  with  the  structure  functions and diseases of the eye.
• The  prediatrician :  A specialist  in  dealing  with the  disorders of childhood.
• Neonatologist:  A  doctor  who  specializes  in looking  after  a baby  during its  first weeks of life.

Next  we  shall  look  at  gestational  diabete, a  diabetes,  a  diabetes  that  develops  during pregnancy.