So, a diabetic pregnancy is essentially a pregnancy in a woman who has diabetes. Now,
that is split into two types. So either a woman will already have diabetes, so this
would be pre-existing diabetes, that can be type 1 diabetes or type 2 diabetes and they
both have slightly different problems before the pregnancy and around the time of conception,
and then the second type of diabetes is what we call gestational diabetes and that means
that the woman does not have diabetes normally, but develops high blood sugars or diabetes
during the pregnancy. So those are essentially the two types, but both of them essentially
lead to high blood sugars during the pregnancy which needs to be diagnosed and need to be
dealt with. The first type of diabetes affects the earlier part of pregnancy, whereas gestational
diabetes tends to affect the middle and latter parts of pregnancy.
The symptoms of gestational diabetes can be exactly the same as diabetes outside of pregnancy.
These symptoms would be feeling very thirsty, passing lots of urine and the urine may be
very clear and quite large volumes, and occasionally people can get blurred vision and outside
of pregnancy, one could get weight loss as well. However, gestational diabetes is usually
quite mild. So most women don't experience these symptoms and in fact, many women won't
have any symptoms at all. Therefore, it has to be tested for proactively and we do a screening
test here in the UK and internationally, and there are different ways of doing it in different
countries and usually it is done between 24 to 28 weeks of gestation. It involves a glucose
drink and then a blood test before and after and this is pretty standard practice throughout
the world, although done slightly differently and that's the way that we diagnose gestational
diabetes because in the vast majority of women, they won't feel any symptoms at all.
The criteria for the testing will depend a little bit on the risk factors for the woman.
So not everyone will get tested.
Again, this depends a little bit on whether this is truly gestational diabetes. That is
a woman who has developed diabetes only in pregnancy or whether a woman already has diabetes
before pregnancy. For the woman who has diabetes before pregnancy, the risks are a little bit
higher. The reason is because the blood sugars might be high right at the beginning of pregnancy
and in the first 12 weeks of pregnancy, this is when the baby develops all its major organs:
the heart and the brain and everything else, so that is a very crucial time for the baby
and that really is only in women who already have diabetes before pregnancy. So it is very
important that we get the blood sugars controlled in that period. For women with gestational
diabetes, they only get high blood sugars later in pregnancy. So they don't have those
problems. Sadly if the blood sugars are not controlled at the beginning of pregnancy,
there is a higher risk of some congenital problems to do with the hearts or to do with
the brain or the nervous system. Later in pregnancy, and this would be women who have
gestational diabetes primarily, the baby can get too big because the baby's being seen
too much blood sugar and you can have problems with difficult labour, more caesarean sections
and admissions to the special care unit for the baby.
With gestational diabetes, the problems can be split into the problems for the mother
and problems for the baby. So the problems for the mother can be because the baby has
become too big, so the mother is more likely to have problems with labour and an increased
chance of a caesarean section. There is also an increased chance of what we call gestational
hypertension. So that means blood pressure can go up and that may need treatment during
pregnancy and rarely, although it is increased in women with gestational diabetes is a condition
called preeclampsia. This is where the blood pressure has become really quite out of control
and it can affect the blood vessels and some of the other organs and potentially can be
quite dangerous. We all look out for it very carefully and thankfully it's very rare for
it to be serious. For women who have pre-existing diabetes, there is a small, slight chance
of eye conditions becoming worse during pregnancy and kidney conditions becoming worse during
pregnancy. So again, we look out for those very carefully.
I think with regards to before pregnancy and this is really for women who already have
diabetes, it really is about blood sugar control, stopping any harmful medications that might
not be safe in pregnancy, certainly starting folic acid at a high dose. We'd like to start
at least three months before pregnancy and basically planning pregnancy. So we really
like to get blood sugars very good before women even start trying for a baby. So when
they do become pregnant that they're at the ideal blood sugar control. During the pregnancy,
we will be monitoring very closely with growth scans. The woman will be testing her blood
sugars either with a sensor or with the blood glucose meter and we will be reviewing these
results very regularly and the treatment is essentially diet which is a big part of the
treatment and for some cases will be a tablet called metformin and for other cases it may
be an injection which would be insulin. It needs very careful monitoring and one would
expect to be having contact with the pregnant lady easily a couple of times a week, right
the way through the pregnancy. We can offer this in some of the private clinics here and
we can liaise with the obstetricians very closely and make sure that we're all working
together to ensure a successful pregnancy.