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So, diabetes is dangerous for a pregnant woman because
it can affect many organ systems. So, typically if
you're diabetic you think, "Okay, if my sugar is fine, I'm okay," but sadly
it can be affecting
the heart, okay, so it can cause ischemia within the heart
and during pregnancy it's a normal physiological change for the heart to
really increase its work.
The blood volume increases by about 50 percent so the
amount of blood circulating through your body increases and that heart has to
tolerate that and moves it forward to feed the placenta
which feeds the fetus. So if you have underlying cardiac disease,
don't know about it, get pregnant... pregnancy I always say is like a stress
test for life
and so something will come out.
So, that's just an example for diabetes for the heart, diabetes with the kidneys...
diabetes can affect the kidneys if you don't know about it, um,
it doesn't really typically have any signs per se.
We know glucose does a lot of things. One of the things we know it can do is
it can act as growth hormone, can cause the baby to grow very big
and that can lend itself to a difficult delivery vaginally
or even needing a c-section with all the complications that can go along with c-sections.
We also know glucose also has a impact on just the
tissues throughout our body. We haven't worked that out, we as a field of medicine,
have not worked out
all the pathways of how that happens, but we certainly know that
with diabetes those fetuses are at an increased risk of having structural problems
especially the spine
and the cardiovascular system. We think something's going on with the glucose
and how it attacks the tissues, how it works for the tissues in
terms of forming
and so again diabetes can be dangerous in that way because
again, you think your blood sugar is okay well-controlled, and you're feeling okay
but you also have a fetus on the other side of that placenta.
I think it's also important for patients to understand that if diabetes
when taken care of appropriately, doesn't mean that you can't have a
good pregnancy outcome.
I think the key is making sure that we maintain what is called euglycemia,
making sure your blood sugar is in good control and making sure that we've
assessed for these other signs of what
we call end-organ damage and they're not there or if they are there, optimizing that.
It's important for patients to understand that
under appropriate care you can have a good outcome with diabetes.
I mean it's definitely a partnership between the patient,
their general obstetrician, the maternal fetal medicine specialist, maybe an
endocrinologist. I think with a multi-disciplinary team
we certainly can have a good outcome with diabetes, so I don't want patients to
believe that if they have diabetes they cannot have a good outcome, but it is
important for them to understand that
it's crucial to come pre-conceptually for a consultation to understand
you know, what it means to be pregnant with diabetes, number one, and two,
to allow us to take care of them and knowing
their kinda overall health status.
So, if a woman has gestational diabetes during her pregnancy, at some point in her
lifetime she'll have about a 40 percent chance of having diabetes.
That doesn't mean it's going to happen right away, but at some point in their lifetime.
So, the reason why that's an important statistic for women to know is that
you know, obesity is increasing in our population so
obesity and gestational diabetes, they're kind of increasing linearly
together and so it's important for patients know when they come back
for their postpartum visit
they should have a screen to see whether they have diabetes and if that's
normal they also should
know that throughout their lifetime when they're not pregnant anymore,
they're going to see the primary care physician, it's important to know I should
be screened for diabetes regularly throughout my life.