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There have been a lot of research and studies that have advanced the effective diagnosis and treatment of diabetes over the years. One of the more complicated situations where one with diabetes has to carefully take extra care of the disease is pregnancy. Diabetes involves the body not being able to convert glucose into energy vital for bodily functions because of either not being able to produce enough or utilize insulin, the hormone that functions in the breakdown of glucose. Because of this, pregnant women with inadequate care of their diabetic conditions not only put themselves at greater risks of the complications but also risk giving birth to babies with defects.

Out of 100 women in their childbearing age, at least 1 has diabetes. Medical professionals used to recommend not having pregnancy for women with diabetes but with the advances in medical science, women can now have the joy of pregnancy and motherhood even in diabetic conditions.

Before Pregnancy

It is very important that women with pre-existing conditions of diabetes to take extra care, planning, and control before deciding for a pregnancy. Diabetes experts recommend at least three to six months before pregnancy that extra control on blood sugar levels is done. A woman with diabetes needs to consult the following medical experts prior to deciding on pregnancy: a diabetes-trained doctor, who has experienced handling pregnant women with diabetes, an obstetrician who has a background in high-risk pregnancies, a pediatrician or neonatologist who can handle and treat diabetes-caused problems that might afflict the baby after birth, and a dietician who has special background on diabetes education who will manage the nutrition and diet as the pregnancy progresses.

During Pregnancy

Although the continuing intake of regular oral anti-diabetic medications was found to be safe during pregnancy, there are some that have to be changed. One is blood pressure medication, which can be very dangerous to the fetus especially during the first trimester when the vital organs are still being developed.

Proper nutrition and insulin ingestion is of course of high importance for diabetic pregnant women. A strict dietary plan, which of course includes balanced and proper food intake (includes daily calorie and carbohydrates level), also entails the timing of eating. The insulin treatment will also have to change especially during the last few months of pregnancy when insulin needs will increase.

Proper exercise regimen will also have to taken into major consideration during pregnancy especially for women with type 2 diabetes. This will help enhance the body’s response to insulin. Those with type 1 diabetes may do a stricter regimen prior to the pregnancy.

Women with diabetes can still enjoy themselves and live normal lives during pregnancy just as pregnant women without diabetes would as long as they religiously follow their diabetes care regimen. With a strictly carried out diabetes regimen during pregnancy, a pregnant women can look forward to that long awaited and exciting day of delivery.

Delivery and After Delivery

Although a pregnant woman with diabetes can still opt to have a normal delivery (vaginal) on the expected due date, most doctors would recommend inducing delivery a week or two prior to the due date using a caesarian section. This is to avoid possible delivery risks for both the mother and the baby. This would depend on the baby’s condition before the expected delivery date such as size and position, lung maturity, movements, heart rate and the amount of amniotic fluid. It would also depend on the mother’s general health and her blood glucose and blood pressure levels.

After the baby arrives, just as in any other cases, breastfeeding will be very essential to keep the baby healthy and well nourished. Of course the mother should continue to consult her dietician on the best and proper meal plan. Less insulin will also be recommended and diabetes pills will not ber recommended during the breastfeeding stage.

Indeed, becoming a mother is a life-changing event and this can never be denied even to a woman with diabetes. Thanks to the wonders of scientific advancements. The presence of a supportive and loving partner of course completes the arduous task of preparing for emotional and lifestyle changes and of going through pregnancy under diabetic conditions.

Women with gestational diabetes, a form of the disease that occurs during pregnancy and usually disappears afterward, risk having babies who are born oversized, with excess insulin, low blood sugar and possibly breathing problems.

But the risks to their babies may start to rise earlier than previously realized, even when the mother’s blood sugar levels are within what is now considered the normal range for pregnancy, says research presented at a meeting of the American Diabetes Association in Chicago.

In a study of 23,325 women, scientists at Northwestern University found that as a mother’s blood sugar rises, the risks of having a large baby, a cesarean delivery or low blood sugar in the newborn all increased. Researchers could not say at what point increased blood sugar should trigger medical treatment, but they say the level at which gestational diabetes is diagnosed likely will be lowered based on these findings.

Other topics discussed at the meeting, ending Tuesday:

•Diabetes management. Many diabetics can’t get blood sugar levels to a safe range even with drugs, but some doctors fear that more aggressive treatment could cause extreme drops in sugar levels that can lead to coma. But a new study followed 8,641 patients at a hospital and found no association between intensification of treatment and hypoglycemia. It concludes that there is no reason to temper efforts to improve sugar control.

•Diabetic complications. A new study found hearing loss is more common among people with diabetes, although the reasons are not clear. Another report says cases of diabetic retinopathy, a leading cause of blindness, could triple from 5.8 million in 2005 to 17.7 million in 2050.

•Drugs. Studies involving drugs that act on gut hormones to improve the balance between insulin and blood sugars offer new information on their safety and versatility. These new drugs act when blood sugars are too high and turn off when levels get back to normal, reducing the risk of low sugar levels. Merck presented studies showing that Januvia, licensed in October, is safe when used as long as two years and as a first-line treatment in combination with metformin. Novo Nordisk studies showed that its experimental drug, liraglutide, safely reduces blood sugar levels with the added benefit of weight loss and requires no dosing changes in patients who have kidney or liver problems. The company plans to submit a license application early next year to federal regulators.

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Vision problems can occur during pregnancy, and women should talk to their doctor if they do notice any vision changes, say experts at Prevent Blindness America.

April is Women’s Eye Health and Safety Awareness Month, according to the volunteer eye health and safety organization.
Discomfort with contact lenses, refractive changes, dry eyes, puffy eyelids that obscure side vision and sensitivity to light due to migraines are among vision changes that may occur during pregnancy. Some vision changes, such as blurred vision and seeing spots, may indicate serious problems.

“Women who have any pre-existing conditions, like glaucoma, high blood pressure or diabetes, must let their eye doctor know that they are pregnant or planning to become pregnant, so the doctor can monitor closely for any changes in vision,” Daniel D. Garrett, senior vice president of Prevent Blindness America, said in a prepared statement.

Problems that pregnant women may experience include:

Refractive changes. During pregnancy, changes in hormone levels may affect the strength a women needs in her contact lenses or eyeglasses. This slight change is usually no cause for concern. Women should talk to their eye doctor about it.Dry eyes. This problem is usually temporary and goes away after delivery. Lubricating or rewetting eye drops are safe to use during pregnancy or while nursing.Migraines. These are caused by hormonal changes and are common among pregnant women. In some cases, migraine headaches can make eyes feel more sensitive to light. Talk to your doctor before you take any migraine headache medications.Diabetes. Pregnant women are at increased risk for developing diabetes. Blurred vision may be an indication of elevated blood sugar levels. All women who are pregnant or planning to get pregnant and have been diagnosed with diabetes should get a full, dilated eye exam.High blood pressure. Blurry vision and seeing spots may be a sign of high blood pressure during pregnancy. Very high blood pressure can cause retinal detachment.

SOURCE: Prevent Blindness America, news release, March 27, 2007

Exposure to agricultural pesticides in the first-trimester increases a woman’s risk of developing diabetes during pregnancy, research shows.
Previous studies have examined the relationship between pesticides and diabetes, the authors explain, but none have focused on pregnancy-related or “gestational” diabetes.

Dr. Tina M. Saldana from the National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina and colleagues assessed the risk of developing gestational diabetes following pesticide exposures among wives of farmers enrolled in the Agricultural Health Study.

Of 11,273 women who became pregnant within 25 years after entering the study, 506 (4.5 percent) reported having gestational diabetes.

Overall, 57 percent of women reported having mixed or applied pesticides at some time in their life, and the proportion was similar for those with and without gestational diabetes mellitus, the authors report in the journal Diabetes Care.

However, women who mixed or applied pesticides or repaired pesticide-related equipment during the first trimester of pregnancy had a more than twofold increased risk of developing gestational diabetes, the report indicates.

In contrast, there was no increased gestational diabetes risk among women with residential exposures to pesticides or indirect exposures during the first trimester.

Similarly, the researchers note, women who had mixed or applied pesticides at any time before enrollment in the study did not face an increased risk of gestational diabetes compared with those who did not.

Although much is known about common risk factors for pregnancy-related diabetes, “our understanding of whether and how environmental exposures may affect risk is still limited,” the authors conclude.

Understanding any potential effect of environmental exposures on glucose (sugar) tolerance during pregnancy “may have substantial public health importance beyond the direct effects on gestational diabetes.”

SOURCE: Diabetes Care, March 2007.

Babies whose mothers had diabetes during pregnancy may be less able to form early memories than children whose mothers had normal pregnancies, a US researcher said on Friday.

The study, presented at the annual meeting of the American Association for the Advancement of Science in San Francisco, suggests that babies deprived of oxygen and iron before birth are not as able to develop early memories.

The need for iron doubles during pregnancy because it is used to make blood cells for the fetus. In pregnant mothers with diabetes, fluctuating glucose levels can result in iron deficiency, which can reduce the blood’s capacity to carry oxygen.

“When oxygen and iron deficiencies occur prenatally, they alter the development of memory,” said Tracy DeBoer of the University of California Davis.

DeBoer studied infants of diabetic mothers at 12 months and again at age 3 1/2. Her study suggested that memory deficits that appeared at one year persisted into early childhood.

She did not specify which type of diabetes the mothers had, but type-1, type-2 and gestational diabetes all affect blood sugar levels.

In the older group, the babies were shown a series of nine objects in three levels of difficulty. In the highest level of difficulty, babies whose mothers had been diabetic during pregnancy on average could recall two fewer objects than those whose mothers had a normal pregnancy.

The finding was consistent with the deficits measured in a simpler test of infants at 12 months, she said.

The notion that babies could recall anything at all in the first two years of life is relatively new.

Researchers have long thought that childhood amnesia - the inability to remember early life - was because babies could not form memories, but researchers at the meeting said new studies suggested infants could recall things as early as four months of age.

Duke University researcher Patricia Bauer told the meeting new studies suggest that infants do form memories by late in the first year that are similar to adults, but “the rate of forgetting is faster than in adults.”

Memories from early childhood that survive this process of forgetting tend to be particularly meaningful, she added.

Stem cells could be harvested to treat child

Cells passed from mother to child during pregnancy could be used to treat insulin-dependent diabetes, new research suggests.

Scientists found they can develop into functioning islet beta cells which produce insulin in the pancreas.

They think in some cases the maternal cells may protect against the kind of damage that leads to type 1 diabetes.

The discovery opens up the future possibility of a mother’s stem cells being harvested and used to treat her diabetic child.

Essential hormone

Type 1 diabetes is an autoimmune disorder which destroys insulin-producing pancreatic cells.

Insulin is the essential hormone used by the body to regulate the uptake of glucose for energy production.

Around 350,000 people in the UK suffer from type 1 diabetes and have to give themselves regular insulin injections.

The new findings suggest an unusual and beneficial form of “microchimerism”, the harbouring of cells or DNA that originate from another genetically distinct individual.

Originally, the research was carried out to investigate whether cells passing from mother to child in the womb were in some way responsible for type 1 diabetes.

Maternal cells

Scientists studied 172 individuals and took pancreatic tissue from four deceased males.

They found small numbers of female islet beta cells in the pancreatic samples that were capable of producing insulin.

There was no evidence that the mother’s cells were causing damage or becoming the target of an immune response.

However the researchers found more maternal DNA in the blood of children and young adults with type 1 diabetes than in healthy individuals.

Although the disease was not prevented, it looked as if the mother’s cells were trying to undertake repairs.

Regenerating tissue

“We think the maternal cells may be helping to regenerate tissue in the pancreas,” said Dr Lee Nelson, one of the investigators from the Fred Hutchinson Cancer Research Center in Seattle, US.

“The child is probably tolerant to the mother’s half-matched cells because the child acquired the cells during its life as a foetus while its immune system was still developing.”

Maternal microchimerism was first recognised in children with severe immunodeficiency in the 1970s.

In 1999, Dr Nelson showed that microchimerism can persist into adulthood in people with normal immune systems.

Writing in the journal Proceedings of the National Academy of Sciences, the researchers said they believed the new findings were the first to describe a maternal contribution to hormone function.

They added: “Our findings also raise the possibility that naturally acquired microchimerism might be exploited to therapeutic benefit.”

 The vast majority of all medical complications during pregnancy fall into one of the following three categories: hypertension, diabetes, and premature labor. Let’s take a closer look at each one of these. 1. Gestational Hypertension: When Normal Is Too HighEven as you progress well into your pregnancy, every obstetrical visit will still include a measure of your blood pressure. Blood pressure is the force of the blood pushing against the walls of your arteries, which are the blood vessels that carry oxygen-rich blood away from the heart to all parts of your body. When the pressure on the arteries becomes too high, it’s called hypertension.About 5 percent of women have hypertension before they become pregnant. This is called chronic hypertension. Another 5 percent or so develop hypertension during pregnancy. This is called gestational hypertension. Oddly enough, a normal blood pressure reading may actually signal hypertension during pregnancy. Why? Because all the natural hormones your body pumps out during pregnancy end up dilating your blood vessels, which should produce a blood pressure at the low end of the normal range.

So, if yours is at the upper end of the normal range, your blood pressure is, relatively speaking, too high.
Dangerously HighExcessively high blood pressure during pregnancy can cause many problems. One is a condition called placental abruption. This is a premature separation of the placenta from the uterine wall, a condition that would typically cause vaginal bleeding and uterine contractions. If the abruption jeopardizes your health or your baby’s health, you’ll need to have an immediate delivery.Another high blood pressure problem is a rare but life-threatening condition called preclampsia. This occurs when high blood pressure is accompanied by protein in the urine. The mechanisms leading to precalmpsia are not clear, but this condition can quickly worsen and jeopardize the life of both mother and baby. If the fetus is less than 34 weeks old, a drug called a corticosteroid may be administered to help speed up the maturity of the fetal lungs. On the other hand, if it occurs after the 37th week, the physician may recommend inducing delivery.The only real cure for preclampsia is delivery. Receiving regular prenatal care allows your doctor to deal with the problems that might arise from hypertension early on.Most reasons for hypertension during pregnancy are unknown. Certainly, if you have a history of hypertension, pregnancy could just exacerbate the condition. But obesity and stress can also have a compound effect on your blood pressure during pregnancy.Hypertension is a particularly worrisome issue during pregnancy because it can constrict the blood vessels in the uterus, which supply the fetus with the necessary oxygen and nutrients. This can slow the fetal growth and result in a low birth weight. Hypertension also increases the risk of a preterm delivery, that is, a delivery that occurs before your 37th week. Both low birth weight and prematurity not only increase the risk of health problems for newborns but may result in learning problems and the delayed development of motor skills later on.The treatment for hypertension during pregnancy is limited. A doctor will generally recommend that a pregnant woman with early or mild hypertension cut back on her activities and avoid strenuous exercise, while more serious cases require hospitalization.2. Gestational Diabetes: Not So SweetWhen you’re pregnant, it’s breakfast, lunch, and dinner for two every day for nine months. Your body provides your baby with its only source of nourishment. And that source of nourishment is also your own body’s source of nourishment—the glucose that results from the breakdown of carbohydrates in your body. This glucose is delivered from your bloodstream to the muscles and other cells that need this fuel through a hormone called insulin. When your body fails to produce enough insulin, the glucose builds up in your body, which can possibly result in diabetes. There is never a good time to have diabetes, but there is no worse time than during pregnancy, as it puts two of you at risk.During pregnancy, your body delivers glucose to the baby through the placenta, a temporary organ that also provides the baby with oxygen and serves to pass out the baby’s waste. (After birth the placenta is called the afterbirth.) For its limited existence, this organ has a tremendous workload, including producing hormones that assist in the baby’s development.Trouble is, the natural hormones of pregnancy, which are designed to break down your fat cells into glucose, may create more glucose in your system than your body can adequately metabolize. The result is gestational diabetes. If, on top of that, your diet is high in sugar by-products—in other words, if you are taking in large amounts of carbohydrates and sugar through candies and cakes—this second source of glucose coming in from the outside may put you over the threshold.Pregnancy affects the blood glucose levels in all women, so at 28 weeks you’re going to be screened for diabetes. Diabetes is a very common problem in pregnancy and some women who are nearly diabetic when they get pregnant will go right over the edge and experience this glucose intolerance, and the inability to process all the glucose in their system.The problem with diabetes in pregnancy is that it often leads to the birth of large babies, because the excess glucose goes to the baby directly. In other words, if mommy has high sugar, the baby has high sugar. And it affects you as an individual—by frequent urination, weight gain, and restricted movements—the same way it affects the baby in utero. The baby gets excessively large and urinates frequently, changing the composition of the fetal fluid, which may even put the baby at risk of death.The other problem with large babies is that they tend to suffer more trauma during vaginal delivery—broken collarbones, for instance, or injury to the nerves in the neck called the brachial plexus. Large babies also have a very difficult time as newborns because they’re so overweight that they may suffer from a variety of metabolic disorders.To test for diabetes, the physician will administer a challenge test. You’ll be asked to drink a glucose solution in a soda-style liquid. After an hour, your glucose level will be measured. If the reading is too high, which occurs about 20 percent of the time, your doctor will have you come back for a glucose tolerance test.The good news is that most women whose challenge test comes back high don’t turn out to have gestational diabetes after this follow-up test. But if your blood sugar level is still high, the doctor will put you on a diabetic diet based on complex carbohydrates, proteins, and vegetables. You will then need to monitor your sugar on a daily basis. If it continues to be elevated after a week or two, then you might need to start taking medication, such as insulin or oral hypoglycemic agents. The aim, whether by diet or medication, is to bring down your blood sugar to a level that will hopefully not interfere with your pregnancy.3. Premature Birth: Ready or NotEvery day one in eight babies born in the United States arrives sooner than expected. Premature birth is another common problem of pregnancy, and it can happen to anyone. By definition, a premature birth is one that occurs before the thirty-seventh week of pregnancy. The average size of a baby at 37 weeks is about five pounds.However, since the field of neonatology has improved dramatically in the last couple of decades, a baby born healthy at 35 weeks has an overwhelmingly good prognosis for long-term survival. So more and more these days the definition of preterm labor has to do with how early in the pregnancy it occurs relative to the health of the baby. Prematurity can grossly compromise a child’s quality of life and put the child at risk for deafness, cerebral palsy, and blindness.Just what causes premature birth, no one knows for certain. Some research suggests that one of the main contributing factors to preterm labor is infection. Though such infections must be occurring quietly, without showing any symptoms, the bacteria in the cervix must be causing an inflammation, and the by-products of that inflammation are chemicals that can induce preterm labor.In other cases, women who have no infection may have a relatively weak uterus, or their cervix just doesn’t have the integrity to hold the pregnancy as the baby gets bigger, thus allowing the cervix to open up early on. Still other women may have anatomical deformities of the uterus that again may put them at risk for preterm labor. Another probable cause of premature birth is stress. And as everyone knows who has been through it, stress is certainly a big factor in pregnancy.The typical signs of premature labor are lower back pain, vaginal bleeding, excessive vaginal discharge, and premature contractions. Preterm labor is treated by such medications as magnesium sulfate, terbutaline sulfate, and antibiotics—all of which aim, though with limited results, to stop those contractions.Women in premature labor are often given steroids. Steroids? Yes, not all steroids are bad for you. When used appropriately in the right circumstances and under a doctor’s supervision, steroids are a wonder. They are given to women experiencing premature labor in order to literally pump the baby up. Like turning up the heat on the stove to boil the potatoes a little quicker, the steroids help mature the baby’s physiology more quickly so that he or she—however small—has a better chance of survival at birth.Five Illnesses to Avoid During PregnancyIf the mother-to-be is exposed to any of the following, see your doctor immediately.–Fifth disease is caused by the parovirus and can cause anemia in your baby. If you get fifth disease early in your pregnancy, you could have a miscarriage.–Chickenpox is caused by the varicella virus and can cause birth defects.–Rubella, or German measles, is now rare, but it used to be a common cause of birth defects. Pregnant women should be tested to see if they’re immune to rubella.–Cytomegalovirus (CMV) is a common infection that can be passed from the mother to the baby, and it can cause birth defects. It doesn’t produce symptoms, and there is no way to treat it. Those most at risk are those who work in day-care or health-care settings. Wash your hands after handling diapers and avoid nuzzling the babies.–Toxoplasmosis is an infection caused by parasites from raw or uncooked infected meat or from contact with the feces of a cat. It can result in stillbirth, or death shortly after birth, and can cause mental or motor-developmental delays, cerebral palsy, epilepsy and visual impairments, including sometimes blindness.Cook meats well, wash or peel fruits and vegetables, wear gloves while gardening, and have others change the kitty litter.