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Could a woman who has had gestational diabetes do anything after delivery to check whether she had or has latent diabetes?
Yes, she could ask her doctor for the diagnostic test (GTT) to be performed, at least two months after delivery. A negative result means latent diabetes is very unlikely.
Is there increased risk of fetal malformations among those with gestational diabetes?
Classical diabetes and Pregnancy
I am an insulin-dependent diabetic and I am planning to conceive. Is there anything special I need to know?
Yes. Good diabetic control before conception is of utmost importance for your own and your baby's ultimate wellbeing. If you have decided to try for a baby, your doctor can arrange a simple blood test to determine how good your blood-sugar control has been.
If control is found to be unsatisfactory, it is best to put your plans on hold until the diabetes control has been optimized. Alteration in the insulin regime will be made until the blood sugar (glucose) level control is good and stable. This may take several weeks to achieve, but is well worth it.
There is no doubt that poor diabetes control at the time of conception is by far the leading cause of major fetal malformation among diabetic mothers. Where pre-conception control has been good, the rate of such malformations for diabetics is similar to the general average (about 3 per cent). However, in the case of poor pre-conception control, the rate of such malformation increases up to six times.
If I am insulin-dependent and I discovered that I was pregnant, even though this was unplanned, can I do anything in the early stages of the pregnancy to eliminate the increased risk of fetal malformations?
As stated before, if your blood-sugar control has been good, the risk of such malformation is not increased. On the other hand, if this has been unsatisfactory (you can have this verified by a simple blood test), it is in most cases too late to influence occurrence of malformations.
There is strong evidence that most malformations are already in place by eight weeks of gestation. Any intervention in correcting blood-sugar control has to be in place by five weeks of gestation, otherwise it is too late.
How and when will a mother know if her baby is affected?
The only reliable test to detect possible major malformation is an ultrasound scan ideally performed at about eighteen to twenty weeks of gestation. Detection is possible a few weeks earlier, but a negative result may not be as reliable. Most major malformations will be detected.
As an insulin-dependent diabetic, what changes should I expect when I become pregnant?
In the beginning (i.e. the first ten to twelve weeks), the tendency is for insulin requirements to decrease. This is because blood glucose is being transported from the mother's bloodstream to the fetus. This means she ends up with less blood glucose and is prone to low blood glucose (hypoglycaemia). Gradually, she develops insulin resistance and this means her insulin requirements will start going up again.
In summary, at the beginning, the tendency is to require less insulin and, about one third of the way through, the trend is towards more insulin. What all this means is, she should expect a few adjustments in the insulin regime during her pregnancy.