Home' Trinidad and Tobago Guardian : December 4th 2016 Contents A8 | WOW MAGAZINE
Sunday Guardian guardian.co.tt Sunday, December 4, 2016
In last Sunday’s WOW and Wednesday’s
Health and Wellness magazine, we shed
light on sexual health issues women (and
men) with diabetes face. Fallon Lutch-
mansingh, Research Coordinator at the
Diabetes Education Research and Preven-
tion Institute (DERPi) joins us again to
look at how diabetes can affect pregnan-
What about hyperglycemia (high blood
glucose) in pregnancy?
Hyperglycemia in pregnancy can lead to
high rates of maternal and infant mortali-
ty and morbidity and fetal abnormality.
The high levels of glucose in the moth-
er bring extra glucose to the baby resulting
in a number of complications.
The chance of fetal abnormalities increase
by eight times and the chance of caesare-
an section can double. Further the mother
can develop pre-eclampsia and overt hyper-
tension, type 2 diabetes and even heart
Most women who have gestational dia-
betes develop type 2 diabetes within five
Children born to mothers with diabetes
have a greater risk of developing diabetes
in later life.
It is imperative to include a routine test
for diabetes in pregnancy. According to the
Pan American Health Organisation, one in
five women in the reproductive age group
15 to 44 years, in Trinidad and Tobago, are
diabetic. Therefore it is important for a
standard test for diabetes to be done.
How can a diabetic woman ensure she
has a healthy baby?
Prior to conception for women with dia-
betes there may be a few lifestyle changes
to be made.
• Stop smoking
• Get tested for glycated haemoglobin
A1c. This should be under 7 per cent.
Test often and review the results with
• Prevent birth defects - take 400 to 800
micrograms of folic acid daily
• Eat nutrient-rich foods
• Stop alcohol instead of wine, for exam-
ple, try a nonalcoholic alternatives.
• Avoid possibly unsafe foods such as off
raw meat, lunch meat, raw fish and
smoked seafood, soft cheeses like brie
and gorgonzola, fish with high mercu-
ry levels (like tuna), and unpasteurized
• Exercise regularly take a 30-minute
walk at lunchtime.
Pre-existing diabetes automatically makes
a pregnancy high risk even if it goes along
without any problems. A “preconception
visit” is recommended when possible before
a planned pregnancy especially in women
with diabetes. It allows the doctor to assess
general health and adjust any regimen
accordingly. In cases of poorly controlled
diabetes, it is recommend that women with
diabetes see a specialist such as an endo-
crinologist and an obstetrician gynecologist
at this point.
In addition to a higher chance of mis-
carriage, there are two major types of risks
that a mother with diabetes poses to a
developing baby. The first occurs in the
earlier part of the pregnancy, when organs
are beginning to grow and serious birth
defects can occur. The second concern
comes later in the pregnancy, mothers with
diabetes are at a higher risk being overweight
at birth (this is known as macrosomia). This
can create problems for delivery.
These complications are best prevented
primarily by maintaining good blood glucose
levels. This is why the glycated haemoglo-
bin A1C (average blood glucose over the
past two to three months) should be below
7 percent before conception. Some doctors
advise going lower, between 6 to 6.5 percent.
Before becoming pregnant, all women
will need certain routine tests. In Trinidad
and Tobago this includes:
1. Full blood count for anaemia
2. Blood type
4. VDRL – for syphilis
5. Sickle cell trait
The Health in Pregnancy in Trinidad
and Tobago (HIPTT) project is advocating
for the inclusion and routine testing of
diabetes in pregnancy.
Women with diabetes should also get a
comprehensive eye exam. Retinopathy is a
common complication of diabetes and preg-
nancy can stimulate the development of
eye disease. In cases of advanced retinop-
athy it can prevent a vaginal delivery because
pushing during labor can further damage
the eyes. Similarly women with diabetes
and kidney disease are at an increased risk
of further damaging the kidneys during
pregnancy and are recommended that they
not get pregnant.
During pregnancy, women with diabetes
should review their blood glucose records
on a regular basis with their doctor and get
an HbA1c test every few weeks. All pregnant
women should get an ultrasound around
week 18 to monitor the baby’s development.
For women with diabetes there are usually
additional ultrasound scans at other times
in the pregnancy. Sometime between weeks
20 and 22 a more detailed scan called a
fetal echocardiogram to make sure the fetal
heart is growing correctly will be done. If
you have retinopathy, it is recommended
that pregnant diabetic mothers get follow-up
eye exams every trimester.
Will the baby be born with diabetes
because the mother is diabetic?
No a baby is not born with diabetes if
the mother is diabetic. However the risk of
the baby developing diabetes later on in life
is twice as high compared to a baby born
to a mother without diabetes.
During pregnancy, women with
diabetes should review their blood
glucose records on a regular basis
with their doctor and get an
HbA1c test every few weeks.
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