The Challenges of Pregnant Women living with Diabetes


#1

Women around the world are impacted by diabetes in many ways. Over half of the diabetes population are women, and many women (both with Type 1 and Type 2 diabetes) will have pregnancies during their disease exposure. The incidence of gestational diabetes (GDM) also continues to rise, hence it has been estimated that a sixth of all pregnancies around the globe are now affected by hyperglycaemia.

Such pregnancies bring multiple hazards for the women, the foetus and their offspring. In low and middle income countries, the effect of diabetes in pregnancy can be very challenging. Limited resources and screening process means that there is a failure to detect hyperglycaemia and even when it is detected there are inadequate resources to achieve an optimal level of glycaemic control. Clearly, there is a desperate need to identify effective strategies to help address this crisis.
In this discussion, we would love to hear from colleagues who may have developed innovative ways of working with women affected by diabetes in pregnancy in challenging circumstances. Sharing such experiences would provide important resources and ideas for others to try. It would also be helpful to hear of any innovations in relation to GDM and how we can reduce this burden on women. Moreover it can support us in identifying how we might also prevent them from going on to develop Type 2 diabetes.


#2

Psychological and psychiatric input are key elements in effectively managing pregnancy and diabetes. When a woman has diabetes, she has to take on the challenge of keeping her blood glucose levels as near to target as possible, for the health of the growing fetus. If a woman also has to deal with psychiatric disorders keeping within targets is much more difficult. Depression is the most common disorder and will have a huge impact on how well the woman can function. Kozhimannil (2009) from Harvard Medical School noted that pregnant women and new mothers had nearly twice the incidence of depression as non-diabetic women who were pregnant or had just given birth.

The same applies to other psychiatric conditions and diabetes. It is worth noting what research has uncovered in this regard.

While it is rare for women to experience first-onset psychoses during pregnancy, relapse rates are high for women previously diagnosed with some form of psychosis.

Those with Bipolar disorder and Schizophrenia appear to experience relief from symptoms during pregnancy, but the risk of relapse in the postpartum period is high.

Women who have pre-existing panic disorder will most likely continue to have symptoms during pregnancy.

Obsessive Compulsive Disorder (OCD): Several reports suggest that women may have an increased risk of the onset of OCD during pregnancy and the postpartum period. In one study of 109 women with diagnosed OCD, 39% of the participants reported that their OCD began during pregnancy. The prevalence of eating disorders in pregnant women is approximately 4.9%. Obesity and starvation (anorexia nervosa) have negative consequences for the mother and the baby and for the diabetes.

These psychiatric conditions are often under-diagnosed because they are thought of as mere hormonal changes and they are also undertreated because while there are safe medications to be had, doctors fear the potential harmful effects of medication on the growing fetus.