When motherhood is oh so sweet
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The thought of having a baby when you have type 1 diabetes is scary, but don’t be afraid to go for it, says Bridget McNulty, now the doting mom of 4-month-old Arthur.
It is no walk in the park, however, and you need careful blood glucose control and a good medical team to ensure the well-being of both mom and baby.
“A lot of information online is frightening and makes it seem virtually impossible, but most of that is from sites that over-emphasise the dangers,” says Bridget, 32, who was diagnosed with type 1 diabetes in 2007.
“If you’re healthy, have good blood glucose control and your doctor gives you the thumbs-up, there’s no reason not to have a baby.”
A former Durban journalist, now based in Cape Town, Bridget is editor of Sweet Life, a diabetes lifestyle magazine and online community.
Having lived with diabetes for seven years, she knew pregnancy would mean a lot of hard work and even tighter glucose control than usual, so she waited until she was 100 percent ready before she and husband, Mark Peddle, tried for a baby.
“I knew there were significant complications to the baby if the mom’s blood sugar was uncontrolled – and that poor control could result in stillbirth or miscarriage – so it wasn’t a decision to be taken lightly.
“When Mark and I were ready, we spent a whole afternoon googling diabetes and pregnancy, and read everything we could find. It was scary, but I felt prepared, and I knew how important it was to take it seriously.”
As it turned out, the pregnancy went well. She was in the best diabetic control of her life, and she felt healthy until the end. People with diabetes are advised to aim for an HbA1c (three-month blood glucose average) of 7.0, but during pregnancy it has to be below 6.0 – she achieved this every month except the last when it crept up to 6.4.
“I didn’t think it was possible to have such good control before I fell pregnant – a baby is amazing motivation!”
Bridget advises moms-to-be with diabetes to have an endocrinologist (diabetes specialist) on the team, as it’s a high-risk pregnancy. Her endocrinologist helped keep her blood sugar in control.
Eating for two was out of the question and she had to change the way she normally ate to minimise spikes in blood sugar, with Durban dietitian, Genevieve Jardine, explaining how to do this.
“One of the hardest things about diabetes and pregnancy is that hormones have such an effect on blood sugar and while you’re pregnant your hormones are going crazy – all the time. It could get frustrating when I was doing everything ‘right’ and my blood sugar would spike or drop from something out of my control.”
Babies born to moms who have diabetes, have to be born at 38 weeks (via C-section or induction) and, because of rising blood pressure and water retention, Arthur’s birth was brought forward by two days.
She describes seeing her son for the first time as “breathtaking”.
“I’ve never felt such an instant connection in my life.
“Arthur had to have his blood sugar checked every few hours instead of only once (as he would have if he had been born to a mom without diabetes). His heels were covered with marks from where they had to take his blood for the tests, and he wailed every time.
“The hospital stay was quite stressful, in retrospect, and would have been much easier had I known what to expect. Because my insulin was still in Arthur’s system for three days after he was born, his blood sugar kept dropping and he had to be given formula top-up feeds to keep it up. Once we were discharged he was totally fine, though, and he’s been 100 percent healthy and thriving ever since.
“I didn’t anticipate how tricky it would be to juggle a newborn and diabetes – both require a lot of attention and don’t take well to being ignored. The hormones since the birth have been difficult to anticipate with regards to how they affect my blood sugar, and breast-feeding has also been a curveball – it drops your blood sugar. Waking up a few times a night also had an effect, and so did rushed meals. Luckily, all that has stabilised now that Arthur is older.”
Bridget will be writing about her pregnancy in the first issue of Sweet Life magazine next year – you can find out more information on www.sweetlifemag.co.za or on the Facebook page Diabetic South Africans.
“I’m very happy to chat to anyone who has specific questions about diabetes and pregnancy – I know what it feels like to be on the other side!”
* For information on diabetes, visit www.diabetessa.co.za or call 0861 222 717.
Three main types of diabetes
Type 1: occurs when the person’s immune system damages the insulin-producing cells so they no longer produce the pancreas’ insulin the body needs. The actual cause is not fully understood. Although it may occur at any age, it most commonly begins in childhood or adolescence. People with this type have to be treated with insulin, without which they will die.
Type 2: about 90 percent of people with diabetes have type 2, a form of the disease that develops later in life and which is primarily, but not always, associated with unhealthy behaviours and being overweight. It is a disease of lifestyle, and risk factors include poor diet, being overweight, physical inactivity and stress.
Gestational diabetes: occurs when women who develop a resistance to insulin and subsequent high blood glucose during pregnancy. It occurs around the 24th week of pregnancy and when uncontrolled, it can have serious consequences for the mother and her baby.
Poor blood sugar control
Having a baby when you have pre-existing diabetes takes planning, from long before conception and throughout the pregnancy.
A woman should discuss it with her diabetes care team, and her blood glucose level should be optimal for at least six months prior to falling pregnant, says Dr Stanley Landau, a senior physician at the Centre for Diabetes and Endocrinology in Johannesburg.
“Insulin or oral diabetes medication may need to be switched and non-diabetes treatments may need to be stopped or amended before conception,” he says.
“Thorough evaluation of the eyes and kidneys is also a must.”
Regular assessment and reassessment should be undertaken to ensure blood glucose targets are being met and the timelines are still appropriate.
“These women are typically highly motivated around the time of their pregnancies and it usually makes for an enjoyable experience, in spite of having to juggle pregnancy needs and those of the diabetes simultaneously.”
Poor blood sugar control at the time of conception and throughout the pregnancy can be harmful to the unborn child, causing congenital abnormalities, which are usually the result of poor diabetes control within the first few weeks of the pregnancy. Cardiac and bone abnormalities typify poor diabetes control in the second half of the pregnancy.
With good and sustained glucose control, these complications need not develop. The adverse effects of diabetes on a pregnancy are identical for types 1 and 2 diabetes, says Landau.