Women with type 1 or type 2 diabetes should plan their pregnancies very carefully and should not start trying for a baby until they have gone through a pre-pregnancy care programme, due to the risks involved for mother and baby.
International studies show that women who engage in such programmes can reduce their chance of having a bad pregnancy outcome by 50 per cent, says Prof Fidelma Dunne, consultant endocrinologist at Galway University Hospitals (GUH) – yet Irish women with diabetes are very slow to take up the pre-pregnancy programmes available free of charge around the country.
Dunne stresses that pregnancy for a woman with diabetes is usually a very joyous occasion that results in a good outcome, but the risk of complications for mother and infant are significantly greater than for non-diabetic women.
She explains: “Firstly, any diabetes-related complication the woman may have can worsen during pregnancy. These women are more prone to develop high blood pressure or pre-eclamptic toxaemia as part of their pregnancy.
“They are more likely to develop excess fluid around the baby as the pregnancy progresses which can lead to early delivery of the baby and the necessity for neonatal care.
“Women with type 1 or type 2 diabetes are also more likely to have a Caesarean section than women without diabetes.”
And it’s not just the mothers who can develop complications as babies of diabetic mothers can also be adversely affected in the womb.
The miscarriage rate is higher in women with type 1 and type 2 diabetes and their babies are at an increased risk of congenital malformations.
“These babies are also at an increased risk of dying in the womb (stillbirth),” Dunne explains, particularly in cases where the mother’s control of her diabetes is not good.
While she certainly does not want to alarm women with diabetes about the implications of getting pregnant without planning, Dunne is anxious to raise awareness of the dangers involved for both mother and baby and of the importance and improvements in pregnancy outcome for women who engage in pre-pregnancy care.
Poor outcome
“We know from international studies and our own work in the west of Ireland that if these women with diabetes engage in pre-pregnancy care for three to six months before pregnancy, they can reduce the chance of a poor pregnancy outcome by 50 per cent.
“There are pre-pregnancy care programmes available to women with diabetes around the country but the uptake is only about 50 per cent,” she says.
Pre-pregnancy care programmes are available in the majority of larger hospitals where general diabetes care is delivered. Generally once women come forward, they are seen at their nearest pre-pregnancy care clinic within a week or two and continue to be seen at the same clinic every four weeks until all of their parameters are correct and in order for pregnancy.
“It can take three to six months to get all of the parameters in order before it is safe for a woman to become pregnant. Then once a positive pregnancy test is confirmed, the woman is transferred to the antenatal clinic where she will continue to see the same team she saw in the pre-pregnancy clinic, it’s a seamless transfer.
"It's very important that women with type 1 and type 2 diabetes are on contraception, that they plan pregnancies carefully and understand the implications of becoming pregnant with diabetes," Dunne says.
Pre-pregnancy care
"Without the clinic, I really don’t know if I would have had the successful outcome I had"
Galway woman Cliona Dempsey was halfway through her long journey to have a baby when out of the blue, she was diagnosed with type 1 diabetes at the age of 32.
She was referred to the pre-pregnancy care clinic at Galway University Hospital (GUH) and her attempts to have a baby had to be put on hold until she got her sugars under control.
She says: “At the time of diagnosis, my sugars were all over the place. There was no history of diabetes in my family, it was just one of those random things that appears. I had started trying to conceive when I was 30 and it was difficult to have to stop and wait for the go-ahead from the pre-pregnancy team, but my healthy baby boy, Brian, was born at the end of it all so it was well worth the wait.”
Dempsey attended the clinic once a month until her sugars and other parameters were at a level the team were happy with before she was able to start trying for a baby again.
“It can be very hard to keep your sugars under such tight control but in my circumstances, the knowledge that what I was doing would lead to a better outcome in pregnancy drove me to attend the clinic and work with the team.
“Without the clinic, I really don’t know if I would have had the successful outcome I had. They got me ready for a healthy pregnancy.”
Once Dempsey’s pregnancy was confirmed, she was transferred to the gestational diabetes clinic at GUH where her condition was more aggressively managed. She attended the clinic every two weeks throughout her pregnancy to have bloods taken and her blood pressure and sugar levels checked.
“The clinic nurse, Breda Kirwan called every three to four days to see how I was getting on and just to offer me any support I needed, she was just fantastic. It’s tough when you’re doing your best and you still can’t get your sugars under control but they were always there for me.
“Once my pregnancy was confirmed, I had to be more vigilant than ever about eating healthily and at the right times of the day, but I wanted a baby so badly and had thought it might never happen, so if they had told me to eat grass for nine months, I would have,” she laughs.
In Dempsey’s estimation, the standard of the pre-pregnancy and gestational diabetes clinics in Galway were world class. Being diabetic, she did not have the choice between going public and private but the service she got was “better than private”, she says.
