Is there a connection between pregnancy, diabetes and diabetic retinopathy?

- Shveta Garg, Pune, India

Diabetes refers to a condition in which the body cannot adequately use the sugars and starches (carbohydrates) it takes in as food to make energy. The body either makes too little insulin in the pancreas, or the insulin it makes is not sufficient to change those sugars and starches into energy. As a result, the body collects extra sugar in the blood. This extra sugar, if allowed to collect in the body for too long, can damage organs such as the heart, eyes and kidneys.

Three types of diabetes are known: Type 1, Type 2, and Gestational (pregnancy-related). Type 1 is due to lack of insulin in the body, while resistance to action of insulin leads to Type 2. This article discusses the connection between pregnancy and diabetes.

Diabetes is often detected in women during their childbearing years and can affect the health of both the mother and her unborn child. Diabetes and fertility are also related. Young women with diabetes, either Type 1 or 2, tend to start their periods a little bit later in life than women without diabetes. On the other end of the spectrum, women with diabetes tend to go through menopause slightly earlier, so this provides a slightly smaller window of fertility for them. In addition, many women with Type 2 diabetes have an underlying syndrome called 'polycystic ovarian disease, in short referred to PCOD. Because of the effects of PCOD on the ovaries, women with Type 2 diabetes and PCOD may take longer to conceive than women without diabetes.

Now, if a woman has diabetes, and wants to get pregnant, it is critically important for her to be in good control of her blood glucose levels before she goes off any contraceptive agents, and starts trying to get pregnant. It is a good idea to be in good blood glucose control three to six months before she conceives. Also, the blood glucose levels should be kept under control during pregnancy and, of course, after as well.

The early weeks of pregnancy are important for the baby. Since most women do not know of their pregnancy until the baby has been growing for about two to four weeks, one needs to really plan the pregnancy. Also, a treatment plan has to be put in place to balance meals, exercise & intake of insulin. This plan will, of course, change as the pregnancy progresses as per the recommendations of your doctor and a dietician. You will also need to check your blood glucose often, and keep a record of your results. With your blood glucose in the target range and good medical care, the chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes

Pregnancy in women with pre-existing diabetes is generally considered to be high-risk. It does not necessarily mean problems, but your doctor may have to work with other specialists to help you have a healthy pregnancy and baby.

Gestational diabetes is a type of diabetes that is first diagnosed in a pregnant woman. It can often be controlled by a proper diet and regular exercise regimen alone, but sometimes a woman with gestational diabetes may need to take medications. In most cases, this condition goes away after pregnancy. Many women who have had gestational diabetes have an increased chance of developing Type 2 diabetes later, but with healthy diet, regular exercise and weight control, it can be delayed or prevented completely.

If a woman has medical conditions caused by her diabetes, pregnancy can make these conditions worse. Miscarriage and stillbirth are more common in pregnant women with diabetes. Hence the need to be cautious.

After delivery, it is as important to keep check on blood glucose level as it was during pregnancy. Some new mothers have better blood glucose control in the first few weeks after delivery, while for most, it is a period of fluctuating blood glucose level. During the first few weeks at home with the baby, most mothers are tired and stressed from lack of sleep, and with odd sleep patterns, the chances of napping at mealtime or snack time increase, which can potentially cause a dangerous lowering of blood glucose. It is important to check your blood glucose level often during this time, to avoid blood glucose reactions that may not be good for the baby or the mother. Breastfeeding is equally good for women with diabetes, but it may make your blood glucose a little harder to predict. To help prevent low blood glucose levels during breastfeeding, it is a good idea to have a snack, water or a caffeine-free drink at frequent intervals.

Diabetic retinopathy is referred to retinal damage caused by complications of diabetes mellitus, which may eventually lead to blindness. Diabetic retinopathy is one of the major causes of preventable blindness around the world in those aged between 24 and 64 years. For a significant number of diabetic women, the first half of this period coincides with peak fertility and childbearing years. Diabetic eye disease may develop for the first time during pregnancy, and visual loss at this stage can have serious implications for both the patient and her family.

Several studies on the progression of diabetic retinopathy in women have tried to explain if it is the natural tendency of the disease, or some unique factors that operate during pregnancy, which cause deterioration. That retinopathy worsens during pregnancy is now undisputed, although the mechanism by which progression occurs depend on a variety of factors. The major factors influencing progression of retinopathy during pregnancy include; the state of pregnancy itself, duration of diabetes prior to the pregnancy, degree of retinopathy at time of conception, metabolic control before and during pregnancy, as well as the presence of coexisting hypertension.

There are certain recommendations that are widely accepted for the management of diabetic patients with retinopathy who are planning pregnancy or are already pregnant. Since the risk of progression of retinopathy during pregnancy is greater in women who have had diabetes for longer periods of time, it is beneficial to counsel women in their childbearing years about planning their pregnancies early if possible.

When planning pregnancy, women with preexisting diabetes should have a comprehensive eye examination and should be aware of the risk of development and/or progression of diabetic retinopathy. Women with diabetes who become pregnant should have the eye examination in the first trimester, and close follow-up throughout life.

Pregnancy in a diabetic woman brings about many changes that can lead to the development of diabetic retinopathy or worsening of pre-existing disease. In some patients this may develop into sight threatening disease which, if not treated adequately, can cause devastating visual impairment.

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