Pregnancy and diabetes: is it possible to have a healthy baby?

Around 30-40 years ago, doctors forbade women with diabetes to get pregnant and have children, because there was a big risk for both mother and the fetus.What has now changed and why women with insular diabetes givechildbirthmoreoften? This is whatin interview to a reporter of NEWS.am Medicine, told Elena Aghajanova, PhD, Associate Professor, Head of the Department of Endocrinology at Yerevan State Medical University and Head of Endocrinology Clinic at University Hospital "Muratsan".

Can women with diabetes have children?

The number of people with insular diabetes grows worldwide, and Armenia is not an exception. The number of women with insular diabetes, who want to become mothers and they become mothers, grow in our country, but there is no specific statistics for Armenia. There was a great risk that the child may be born with abnormalities, pathologies or be unviable. But now the situation has changed, because the treatment of diabetes is much more effective, than before. Now nobody can prohibit a woman with diabetes to give childbirth, exceptions are only those patients who have severe chronic vascular complications.They are contraindicated in pregnancy, as it may be the progression of vascular complications that will cause irreparable harm to women's health.In recent years women with diabetes become pregnant more often, because it is possible to better control the diabetes.

All women with diabetes must plan their pregnancy and prepare for it, to bring the organism and glucose to norm: below5.5 mmol / l in the morning on an empty stomach, but it is allowed to rise during the day to 8 glucose mmol / l.It is necessary to choose the correct treatment to adjust the dose. If a woman becomes pregnant spontaneously, the result is a large hormonal stress of the body, if not increase the dose of insulin, blood sugar levels will be so high that it would lead to ketosis and ketoacidosis - sufficiently serious metabolic diseases, associated with lack of insulin, which can cause irreparable harm to the mother and unborn child. The fetus and the mother have common blood circulation, that is why the glucose in the blood of mother should be at an ideal level. Regular glucose tests are needed, i.e. if the doctor recommends, that children or young adults, who have first type diabetes, measure their sugar 4 times a day, then during the pregnancy the checks must be 2-3 times more often. There are situations, when it is necessary to check the glucose levels every two hours and depending on that levels, adjust the treatment.

What has changed since then, when women with diabetes were forbidden to get pregnant and give childbirth? Experts have become professional or medicines of good quality?

Quality management of patients with diabetes has changed. There is nowan idea of «self-control», that the doctor teaches patients. Diabetics control their own blood sugar levels.Also changed the quality of care provided to patients with diabetes. Pregnant women with diabetes should eat like the healthy people. Of course, in this case, the amount of sweet is sharply limited, because it is necessary to avoid sudden changes in blood sugar levels.If the pregnant woman is not overweighed, it is not obligatory to limit fatty food. Pregnant woman with diabetes must eat lot of vegetables, greens and fruits. Number of fruits that contain a large amount of glucose is limited. We teach people with diabetes to understand that they can eat grapes and chocolate, but it should not be on regular basis. If you want to eat an extra piece of cake, you need to make an additional injection of insulin.

So the patients receive a great psychological support from their doctors?

Yes. It is a psychological help and support, which we show to the patients with diabetes of any age. But in case of children everything is much harder. Many patients, and, especially, their parents, have some "ostrich policy" because they want to hide from the disease, do nothing, do not see, do not know, and hope that everything will go. But this approach is totally wrong, because nothing will pass, unfortunately, not in case of this disease. That is why from the very beginning, when diagnosed with diabetes, the patient with his (her) parents must begin to attend courses to know how to behave.

The quality of life of children and pregnant women must not suffer. Children need to grow and develop normally and become productive members of society, to create healthy families and healthy children. Andthis is quite real.

Sometimes during the pregnancy it is possible that women obtain insular diabetes, which postpartum passes. This so-called «diabetes of pregnant women», or gestational diabetes. However, if there is a genetic predisposition to diabetes, the disease may remain after pregnancy.

And in what cases it is absolutely contraindicated for pregnant women with diabetes to give childbirth?

When a woman has a long record of diabetes, there are serious complications associated with the kidneys and eyes. Load of pregnancy on the body can bring to a deterioration of vision, and even - to blindness. There is also a risk of a renal failure - nephropathy. In such emergency casesthe doctor can prohibit pregnancy for the woman.

It is quite real for a woman who already has diabetes to get pregnant and give a birth to a healthy child. Endocrinologists advice girls with diabetes get pregnant soon and give childbirth untill they do not have complications of the disease, because its vascular complications are inevitable, here it is only a question of time. In some patients they occur early, in others they are coming later. Already in 10-15 years from the beginning of the diagnosis there will be manifestations of vascular complications, but if there is a good compensation of glucose in the blood, this period can be put off. It is not necessarily that a woman suffering from diabetes had a child with the same disease. Chance of a child with diabetes is 10-15%. But if the husband of a pregnant woman also has diabetes, and this often happens, the probability increases - up to 20-25%. But in both cases the probability is not 100%.

Interviewed Ani Liparityan

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