10 Most Common Diabetes During Pregnancy Questions answered
1. I’m pregnant and have quite a few hypoglycemic reactions. Does that increase the risk of abnormalities in the child?
There’s no evidence that hypo’s increase the risk of congenital abnormalities. However, good blood sugar regulation is important. It’s not enough just to look at the HbA1c. The HbA1c is a kind of average representation of the blood sugar levels of the last 2 months. Because of this, the HbA1c can be good while there is often hyperglycemia, compensated by a lot of hypoglycemia. Besides measuring the HbA1c, it is therefore also important to measure day curves.
2. I not only have type 1 diabetes but also hypothyroidism. Is that a problem?
No, that’s not a problem. It’s common because they’re both so-called autoimmune diseases. These are diseases that are caused by (unwanted) defense of the body against its own organs, such as the thyroid or pancreas. It is important that the dose of the medicine you are given, levothyroxine, is immediately increased considerably, for example by 50 ug per day. This is because of the need for this hormone increases. The baby is also dependent on you in this respect.
3. How often should thyroid function be monitored during pregnancy?
If you have hypo- or hyperthyroidism, thyroid function should be checked every 6 to 8 weeks. If the dose of the thyroid hormone has been adjusted, it should be checked after 6 weeks. In general, it is advised to aim for high FT4 values (within the normal range). Also, check for antibodies against the TSH receptor. These antibodies can be transported to the baby via the placenta, which can cause hyperthyroidism (the thyroid working too fast) in the baby after birth.
4. I have heard that the thyroid gland can become disturbed after childbirth in patients with type 1 diabetes. Is that so?
Yes, that’s right. It is estimated that in 5 to 7% of cases patients with type 1 diabetes develop so-called postpartum thyroiditis. Therefore, thyroid function should be measured 3 months after childbirth. In addition, certain antibodies, the so-called TPO-antibodies, must be measured. If the antibodies are positive, while the thyroid function is (still) normal, the latter must be measured again after 6 and 9 months.
5. I am pregnant and have not only type 1 diabetes but also hyperthyroidism. Is that a problem?
No, in principle it doesn’t have to be a problem. However, the thyroid function must be closely monitored. If you are treated with tablets, it is important to know that you are not allowed to use a goitre during pregnancy. Strumazol can be replaced by propylthiouracil (PTU). This has the same effect, namely inhibiting the thyroid gland, but is less toxic for the baby.
6. I not only have type 1 diabetes, but also hyperthyroidism. I would like to become pregnant. Can you do that?
Yes, in principle, you can. The medications you’re taking can be adjusted. It would be even nicer if you didn’t have to take thyroid medication. That’s why young women with a pregnancy wish are often advised to be treated with radioactive iodine, which inhibits thyroid function. Often the patient will eventually develop hypothyroidism, which can, however, be treated well with thyroid hormone tablets that are not harmful to the baby.
7. What are the possibilities for prenatal diagnosis?
There are all kinds of options, and all tests have their good but certainly also their bad sides. In any case, it is good to realize in advance what you want to do with the results of a test if you want to undergo it. The options include a flake test, amniocentesis, ultrasound, combo test, triple test, and neck fold measurement. The ultrasound scan is regarded as the most valuable examination. In principle, a woman is also entitled to an amniocentesis if she is 16 weeks pregnant, but the question of whether the risk of an abortion outweighs the information provided by an amniocentesis has not crystallized properly.
8. I have diabetes and neuropathy. What is the influence of pregnancy on neuropathy?
As far as we know, unlike retinopathy and nephropathy, pregnancy has no effect on neuropathy.
9. In the first trimester of my pregnancy, the blood sugar level was checked, and it was too high. Am I diabetic now?
You probably have gestational diabetes. Because of the hormones produced in the placenta, which have an effect opposite to that of insulin, you have temporarily developed diabetes. That disappears again when the baby is born. In order to determine with certainty whether the blood sugar level is too high, this must be done in an official laboratory. The home monitors are not sufficiently reliable. However, you must be referred to the internist and gynaecologist. You are also eligible for an ultrasound scan at 18-20 weeks.
10. Is the existence of gestational diabetes harmful for the baby?
It is known that gestational diabetes can be accompanied by complications during pregnancy. In particular, premature birth and macrosomy (growing too big for age) are possible complications, which in turn can lead to shoulder dystocia and fractures of the collarbone during birth.
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