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Growing danger: diabetes during pregnancy

/ Source: contributor

Diabetes is on the rise among pregnant women, posing the risk of serious health problems for mothers-to-be and their unborn children, according to one of the first and largest studies of the issue.

The rate of type 1 or type 2 diabetes among expectant mothers more than doubled between 1999 and 2005, according to research that examined more than 175,000 women in California during the seven-year period.

Diabetes can be a dangerous complication during pregnancy, endangering the mother and also raising the risk of miscarriage, stillbirth or birth defects, said Jean M. Lawrence, lead author of the study published in the May issue of the journal Diabetes Care.

It also can lead to bigger babies and to children who are at risk of developing diabetes and obesity later in life, said Lawrence, who is also a research scientist at Kaiser Permanente in Pasadena, Calif.

"Having diabetes during pregnancy has implications for the baby," she said.

The rise in diabetes in pregnant women is “a big problem” because it’s probably a nationwide trend occurring hand-in-hand with obesity, which also carries other risk factors for birth complications, said Dr. Raul Artal, chairman of the department of obstetrics, gynecology and women’s health at St. Louis University’s School of Medicine in Missouri.

Artal noted that in addition to diabetes, obese women often develop high blood pressure, which can lead to pregnancy complications. Also, some birth defects, such as neural tube defects —in which the brain or spinal fail to develop normally — are more common among infants born to obese moms.

The researchers partially attributed the spike in diabetes to rising rates of obesity among  younger and younger women.

That was the problem faced by Sandy Kaplan, a 36-year-old new mother in Fremont, Calif., who struggled to become pregnant until she got her weight and diabetes under control.

Kaplan weighed 300 pounds when she became pregnant 10 years ago, but lost the child after only three months. She’s not certain that diabetes led to the miscarriage, but she wasn’t able to conceive again until last year, after she dropped 65 pounds through diet and exercise.

"After I got pregnant, that totally changed everything because I realized I was not only doing this for me but also for my baby," Kaplan said.

Four months ago, she gave birth to a healthy daughter, Mia Marie Kaplan.

More young people diagnosed

In the study, Lawrence’s team used medical records to ascertain the diabetes status of 175,249 southern California women between ages 13 and 58 who gave birth between 1999 and 2005. Among the women, 2,784 had either type 1 or type 2 diabetes before getting pregnant and 15,121 developed gestational diabetes, which occurs during pregnancy but usually resolves after birth.

In 1999, 10 percent of all the diabetes cases consisted of pre-existing type 1 or type 2 diabetes, with gestational diabetes accounting for the rest. By 2005, the pre-existing diabetes cases had more than doubled, accounting for 21 percent of the total diabetes cases.

The researchers did not have access to information on the patient’s weights or the particular type of diabetes they had, but both type 1 and type 2 pose risks to the developing baby.

Highest spike among teens

Pre-existing diabetes cases increased for all age groups, but the biggest jump was in teens, where rates of the disease rose five-fold. For women between 20 and 39 years of age, rates of diabetes doubled. In women 40 and older, diabetes cases rose 40 percent.

Getting the disease under control is crucial for women who hope to become pregnant, experts said.

Those who already have type 2 diabetes should ensure their disease is kept in check by consuming a healthy diet and exercising, Lawrence recommended. Type 1 diabetes can’t be prevented, but it can be managed with diet, exercise and medications, such as insulin shots.

Women who are overweight or obese should see a doctor before becoming pregnant to make sure they don’t have diabetes, Lawrence said. They should also work to shed a few pounds before becoming pregnant to reduce the risks to their babies.

Don't wait for pregnancy to act

But women shouldn’t delay getting their weight or diabetes under control, Lawrence stressed.

“In the U.S., up to half of all pregnancies are unplanned or unintended, so young women with diabetes shouldn’t wait to become pregnant to take care of this,” she said.

Artal said a healthy diet and exercise, such as walking 30 minutes per day, has been shown to reduce by half the risk of gestational diabetes in obese pregnant women. He suspects the same would hold true for type 2 diabetes.

In general, he added, obese women should not gain any weight during their pregnancy, or at least keep it to less than 10 pounds, to help keep their diabetes in check. However, he stressed that women attempting to limit their weight gain during pregnancy should only do under strict medical supervision to ensure they are getting adequate nutrition for themselves and the developing fetus.

While there’s no way to know for sure, Kaplan attributes her successful pregnancy to adopting a healthy diet and frequent exercise, including long walks, which helped her shed dozens of pounds and gain control of her diabetes.

Mia Marie has become an inspiration for Kaplan, who is still exercising, eating right and continuing to lose weight. Kaplan lost her mother eight years ago to diabetes and doesn’t want to repeat the pattern.

“I want to be there for my own daughter,” she said.