Diabetes’ effects on pregnancy and babies

Women who have diabetes before pregnancy may have problems with their blood-sugar control throughout the pregnancy, says Jean Lawrence, the lead author of the recent study and a research scientist at Kaiser Permanente’s Department of Research and Evaluation.

“But the crucial time when the baby’s organs are developing occurs in the early part of the pregnancy, perhaps before a woman even knows she is pregnant. Women need to reduce their risks before getting pregnant.”

Type 1 diabetes is an autoimmune disease in which the body destroys the insulin-producing cells in the pancreas. Type 2 diabetes occurs when the body responds to insulin in an abnormal way. Though doctors don’t know how to prevent Type 1 diabetes, much can be done to prevent Type 2 diabetes and reduce its consequences. The latter form is usually caused by obesity.”Obesity puts a lot of extra stress on the cells that make insulin,” says Dr. Thomas Buchanan, a professor of medicine, obstetrics and gynecology, physiology and biophysics at the USC Keck School of Medicine. “That kind of wears them out. We’re used to seeing that in people in their 50s and 60s. Now we’re seeing that in people in their 20s and 30s.”

In a publication of updated guidelines for treating diabetes in pregnancy, health officials in the United Kingdom in April recommended that preconception advice and the importance of avoiding unplanned pregnancy be included in the routine care of adolescent women with diabetes.

The American Dietetic Assn. has asked doctors who treat diabetic women of reproductive age to counsel them on family planning, Buchanan says, including informing women that being obese or diabetic can cause infertility.

“If women conceive with diabetes, even the mildest forms of diabetes, they double their risk of a birth defect in their babies,” he says. “Women who have diabetes at a young age should have family planning as part of their general healthcare.”

As for women, Bernstein says, “you can’t fool yourself into thinking an unplanned pregnancy could never happen to me.” Reducing weight to a healthful level and getting diabetes under control is something all women should aim for.

“Good health for women will have the added benefit of being good for pregnancy outcomes,” he says.