Overweight, Diabetes and Pregnancy! Oh My.Posted: July 15, 2009 in Obesity Medicine by Craig Primack MD FACP
USA Today has a story by Mary Brophy Marcus that highlights the problems with overweight and pregnancy.
Overweight women with diabetes are starting pregnancy with an increased risk of miscarriages, delivery complications, maternal health problems and birth defects. These problems can be treated with pre-conception counseling, better control of blood sugar and maintaining or achieving a healthy weight before and during their pregnancy.
“There are many concerns women with diabetes grapple with, everything from childbearing worries and premature cardiovascular disease to greater financial burdens,” says Ann Albright, director of Diabetes Translation at the Centers for Disease Control and Prevention.
Almost five out of every 1,000 women ages 18 to 44 have diabetes, according to the CDC. Most pregnant women with diabetes have type 2 diabetes which is linked to overweight and obesity. Weight loss does a great job at controlling type 2 diabetes.
Gestational diabetes, which typically is tested for around the 28th week of pregnancy, occurs in about 4% of pregnant patients, says Helain Landy, chairwoman of the department of obstetrics and gynecology at Georgetown University Hospital. “From an epidemiological standpoint, that is a lot,” Landy says.
Diabetes during pregnancy can cause high blood levels of glucose, which can lead to health problems in mothers and babies alike. When extra sugar in the mother’s blood crosses the placenta to the fetus, a baby can have organ malformation (in mothers with pre-existing diabetes) and grow too large, leading to delivery complications.
For women with diabetes, pre-conception treatment is important to a healthy pregnancy and baby and should begin when girls with diabetes are as young as 13.
In June, Diabetes Care published a study by University of Southern Denmark researchers who found that the risk of serious outcomes increased gradually when A1C levels were above 6.9%. Adverse outcomes doubled when A1C’s reached 10.3%, and readings 10.4% or greater quadrupled risks.
With gestational diabetes, Kirkman says, the key is to keep weight and blood sugar under control with a healthy diet, exercise and sometimes insulin. Insulin is a diabetes medicine that is safe to use during pregnancy.
Brown, who is studying cardiovascular risks in women who had gestational diabetes, says many do not realize that they are more likely to develop cardiovascular disease or that their baby has a greater chance of developing diabetes later in life.