01 Mar 2011
Ms Han Yoke Leng’s second pregnancy was a pleasant surprise, but the 36 weeks that followed were filled with many anxious moments.
Diagnosed with type 1 diabetes mellitus at 19, Ms Han has to control her blood sugar levels through daily insulin injections. When she became pregnant, the hormonal changes began to interfere with the action of the insulin, leading to insulin resistance and a build-up of blood sugar levels.
“In an unplanned pregnancy for a patient whose blood sugar level is not adequately controlled, we need to get the level of blood sugar under control quickly, within a few weeks, if possible, to reduce the risk of a miscarriage or birth defects,” said Dr Abel Soh, Associate Consultant, Department of Endocrinology, Singapore General Hospital (SGH).
Apart from high blood sugar levels, the 30-year-old office administrator in a multinational corporation also had to worry about low blood sugar levels which can occur when waiting too long
between meals, doing too much exercise, or if too much insulin is taken. Frequent or prolonged instances of low blood sugar levels can have serious consequences: The baby’s growth may be retarded, and/or the mother may experience a seizure.
Right nutrition is critical
Eating properly – getting enough nutrients without overloading on the calories – can be tricky too. “When I was not pregnant, I could control my carbohydrate intake. But during pregnancy, it became difficult because I had to ensure the baby was getting the right nutrients and that I also gained the right amount of weight,” said Ms Han.
People with diabetes do not produce enough insulin, which is involved in the metabolism of carbohydrates, proteins and fat. Without insulin injections or tablets, their blood sugar levels escalate, especially after a meal, said Dr Soh.
Like Ms Han, Ms Jamilah Abdul Latiff, 41, had to be careful about her food intake during her fourth pregnancy. But unlike Ms Han, Ms Jamilah only developed diabetes during pregnancy. The body is sometimes unable to produce enough insulin to counter the insulin resistance caused by hormonal changes during pregnancy, resulting in a form of the disease known as gestational diabetes. It usually goes away after the baby is born, but for some, the diabetes becomes chronic.
Although controlling her diet helped
Ms Jamilah maintain good blood sugar control at first, she had to start insulin injections in her seventh month to deal with rising blood sugar levels.
Teamwork for success
Because of the complications that come with diabetes, women like Ms Han and Ms Jamilah are seen by a team at SGH’s Diabetes Centre that includes an obstetrician, an endocrinologist, a nurse and a dietitian.
It is essential that all are present to understand the patient’s overall condition, and to decide on a treatment that takes into consideration different aspects of the patient’s needs.
For instance, the dietitian advised Ms Han to eat frequent small meals to minimise sugar spikes that occur after each meal. The endocrinologist checked Ms Han’s sugar profiles regularly, and adjusted her insulin doses according to changes in her blood sugar levels.
Underscoring the difficulties that can occur with such pregnancies, Ms Han’s baby grew unusually large – a potential problem among women with diabetes.
“Unfortunately, despite our best efforts to control her blood sugar levels, the baby continued to grow. The team decided to deliver the baby earlier,” said Dr Soh.
Overly large babies are hard to deliver naturally, and may suffer injuries during delivery. They are also prone to diabetes later. Ms Han’s son weighed 4.07kg when he was delivered in December 2010.
Ms Han’s first child, a girl, was smaller and weighed 3.5kg at birth. Her first pregnancy, which was planned, was smoother.
Before she even became pregnant, Ms Han and her husband made sure her blood sugar levels were under control.
“However, many women with pre-existing type 1 or 2 diabetes do not plan their pregnancies, despite being told the risks of having a baby when their blood sugar control is suboptimal,” said Dr Soh.
“We are working on improving our pre-pregnancy counselling, so the risks of miscarriage and congenital abnormalities are reduced in early pregnancy for these women,” said Dr Soh.
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