Managing diabetes takes time and effort, a constant awareness of how your body is doing.
Add in a pregnancy and all the changes that causes in a body and the female diabetic can have an even harder time controlling her disease.
That's why it's important for women with diabetes to tell their physician immediately after finding out they're pregnant so that the doctor can begin monitoring the mother-to-be's health closely.
"Women who have diabetes and get pregnant, they're at a higher risk for all kinds of problems," said Dr. William Vereen of Siouxland Women's Health Care, 1000 Jackson St.
Among those risks: larger babies that are at higher risk for birth trauma, birth defects affecting the heart, miscarriage and still birth.
It's best for the female diabetic to plan her pregnancy, Vereen said, but that's obviously not always going to happen. His advice to women is to maintain control over the disease at all times so that once they're expecting, there will be fewer unexpected complications.
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"If they're in poor control when they get pregnant, there's a higher risk for birth defects and miscarriages. It's important to get good, tight control before you get pregnant," Vereen said. "Most people who are diabetic know what they need to do."
In an exam early in the pregnancy, a physician or obstetrician can perform tests on the woman's kidneys, heart and eyes - all organs that can be affected adversely by poorly controlled diabetes - to get a baseline measurement of their functions to compare with tests that will be done later in the pregnancy to make sure they're operating at healthy levels.
Pregnant diabetics are more likely to have blood pressure problems. Their insulin and other medication levels may also need to be adjusted to keep up with the body's changes. Vereen said he routinely schedules diabetics for more frequent checkups so that the diabetes can be closely monitored. More ultrasound exams of the fetus also will be done to watch for any birth defects or other diabetes-related problems.
"You're at a higher risk and need more intensive management by yourself and your doctor," Vereen said.
In many cases, the disease can be easily controlled by the patient. She may just need to check her sugar levels more often or change her eating habits.
"Sometimes all it takes is your diet" to make sure everything goes OK, Vereen said.
Pregnant women also are subject to developing gestational diabetes, a form of diabetes that sets in with pregnancy. It happens when all the body's changes associated with pregnancy overwhelm the pancreas, which produces insulin.
"The stress and strain of pregnancy is too much for the pancreas to keep up with," Vereen said.
Vereen said his clinic screens all its patients at 28 weeks to check for diabetes. Many women aren't aware they've developed the disease because many of the same symptoms - frequent thirst, hunger and urinating - are common to pregnant women, diabetic or not.
"Sometimes diabetics aren't diagnosed until they're pregnant," Vereen said. "That's one thing about diabetes is you don't always feel bad."
Most of the time, the mother will see her sugar levels return to normal by her six-week post-birth checkup. Though the diabetes is gone, she should inform her family doctor about having had gestational diabetes.
"If you get gestational diabetes, you're at a higher risk to develop adult-onset diabetes later in life," Vereen said.
No matter if the diabetes was present before pregnancy or during it, most women can reduce their chances of a high-risk pregnancy simply by following their doctors' orders and managing their disease properly.
