Diabetes leads to reduced fertility rates in women and increased risk of abortion

 Women with diabetes and high sugar levels not only have significantly reduced fertility rates, they also face increased risk of abortion and congenital fetal defects.

Said Dr. Vidya V Bhat, who is a leading Obstetrician and Gynaecologist, Laparoscopic Surgeon, and IVF Specialist in Bengaluru: “Diabetes, if not managed well, is bad news for women trying to conceive. It leads to hormonal disruption, resulting in delayed or failed implantation. It also increases chances of genito-urinary infection, menstrual disturbances, egg not releasing from the ovary during the menstrual cycle (anovulation), PCOS, auto-immune reaction to eggs, and premature ovarian failure. All this makes conceiving very difficult.”

Women with type 1/type 2 diabetes with high blood sugar levels around the time of conception also have higher risk of abortion, congenital fetal defects, risk of delivering preterm, high blood pressure disorder (pre-eclampsia), build-up of acids in the blood (diabetic ketoacidosis), stillbirth, the baby in the womb growing much smaller (IUGR) or much larger (macroscopic) than expected, and increased risk of surgical intervention, according to the doctor.

Added Dr. Vidya V Bhat: “Diabetes in mothers is a risk for the baby growing in the womb too. Uncontrolled blood sugar levels can cause malformations in the embryo, congenital cardiac defects, central nervous abnormalities, spinal and limb defects, and renal and skeletal deformities. After delivery, the baby may suffer from birth asphyxia and respiratory distress.”

Diabetic women can take many precautions during pregnancy to minimize the risk to themselves and their developing baby. Said Dr. Vidya V Bhat: “They should continue insulin and medical nutrition therapy during pregnancy. They should monitor FBS and PPBS twice in a week and maintain normal blood glucose levels of FBS<95mg/dl and PPBS<140mg/dl. It is important to prevent elevation in glucose levels while providing adequate nutrients to the woman. This can be done by taking total calories through three meals and three snacks in a day. Diabetic women should also be counselled to avoid build-up of acid in blood due to starvation (ketoacidosis). They should also do regular aerobic exercises, as this increases insulin sensitivity.”

Dr. Vidya Bhat said that pregnant diabetic women should be provided with good antenatal care, timely check-ups and regular fetal growth monitoring, as well as early detection and treatment of medical and obstetrical complications. Patient should also be counselled about daily fetal movement count. Planning of timing and mode of delivery is important and ensuring provision for good neonatal care.

Said Dr. Vidya Bhat: “Diabetic women can plan to get pregnant if their pre-conceptional HBA1C levels are normal (5-7%). They should also undergo urine microscopy and renal function tests, peripheral neuropathy evaluation and an eye exam. There is a 6-10% higher incidence of anomalies in infants of diabetic mothers due to diabetes-related abnormalities as well as chances of increased mortality of the baby immediately before or after birth.”

By Dr. Vidya V Bhat, Medical Director, RadhaKrishna Multispecialty Hospital, Bengaluru.