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Women suffering from diabetes require special care during pregnancy and earlier – when planning the birth of a child.
Next Sunday, January 8, the jubilee XX Final of the Great Orchestra of Christmas Charity. The orchestra will once again play for the youngest patients and their mothers. The collected money will allow the purchase of the most modern devices to save the lives of premature babies and insulin pumps for pregnant women with diabetes. Onet – as every year – plays together with the Great Orchestra of Christmas Charity!
The story of Bożena Kołodziejczyk
From the age of 11, she struggled with diabetes, and then – as an adult woman – she could not decide to get pregnant for a long time for fear of the consequences of her illness. However, fate decided for her and one day she had to take up this challenge. 3 years ago, she described her experiences for the “Diabetes and pregnancy” seminar.
– We thought about the baby (me and my husband), but only theoretically. I have never been able to organize myself to balance my diabetes perfectly, and if you want to get pregnant, you need to be as balanced as possible to protect your baby from malformations. (…) And then suddenly I was faced with an accomplished fact. I’m pregnant!!! Somehow it didn’t get to me. Shock and cry, what will it be ???
I went to the diabetes clinic for pregnant women. The best solution for a baby to develop well was an insulin pump. The company that makes this equipment lent me one of its pumps for free. 9 months with the pump! Revelation! (…) You live like a healthy person. I did not have to think about each injection, and the skin has rested from the injections. I set the units, calculated what I ate, and the pump worked by itself. My sugars were normal, no changes in my eyes, which is a risk in pregnancy with diabetes. The day of birth has finally come. God! How I was scared. I was in the pregnancy pathology ward, because of my other medical conditions I had a cesarean. I was connected to the pump all the time. On August 24, 2007 at 8 am our longed-for Oliwka was born – she weighed 3670 kg, which is normal, not like large diabetic children.
Expert opinion on diabetes in pregnancy
Prof. dr hab. n. med. Jacek Sieradzki from the Department and Clinic of Metabolic Diseases Collegium Medicum of the Jagiellonian University
– What conditions should be met for a safe pregnancy of a diabetic woman and the birth of a healthy child?
– We have to distinguish between two situations: when a woman who already has diabetes becomes pregnant and when diabetes becomes apparent during pregnancy. The risk in both of these cases is different, certainly greater in the case of pre-pregnancy diabetes. The degree of this risk depends on the health of the future mother, because untreated or poorly managed diabetes causes serious complications in the kidneys, eyesight and other organs. In this situation, the condition of the patient who becomes pregnant may worsen. Therefore, pregnancy of a diabetic woman should be planned a few months before conception. Before it begins, the sugar level in the body must be perfectly balanced. Unfortunately, our statistics show that no more than 20 percent of young women with diabetes are planning a pregnancy, and all of them should do so. The first weeks of pregnancy are crucial for the development of some fetal defects. Therefore, a sugar level unbalance at the very beginning of pregnancy carries a high risk.
– Why does pregnancy promote the development of diabetes in some women who have not had the disease before?
– Because it puts an extra burden on the woman’s body. The secretory capacity of the pancreas may have been sufficient for the woman before pregnancy, while the burden on the other organism – the baby developing in the womb – may turn out to be excessive. Gestational diabetes, the mechanism of which resembles type 2 diabetes, affects 5-7 percent of all pregnancies and usually develops at the turn of the second and third trimesters. Its essence is the resistance of cells to insulin caused by substances secreted by the placenta. Gestational diabetes develops mainly in women who have a genetic predisposition to the disease. Other risk factors for this type of diabetes include overweight or obesity, age 35 and over, hypertension, and diabetes in a previous pregnancy.
– How is gestational diabetes detected?
– According to the recommendations of the Polish Diabetes Association, every woman diagnosed with pregnancy, regardless of what week, should have a blood sugar test. Then, between the 24th and 28th week of pregnancy, obligatory screening tests are performed, referring pregnant women to a glucose load test. If this test is used to diagnose diabetes, your doctor will initiate diabetes therapy. We start with dietary treatment (for the time being there is no procedure allowing for the administration of pills during pregnancy). If sugar control is not achieved after one week of dieting, insulin treatment is started. We must not allow the high level of sugar in the mother’s body to remain high for a long time, because it causes abnormal, apparently accelerated development of the baby. The child’s weight increases (so-called macrosomia), and at the same time his body remains immature. The high weight of the child heralds problems in childbirth, and the immaturity of the newborn’s organism means that it is not fully prepared for independent life outside the mother’s womb. At birth, a diabetic baby may develop respiratory distress, jaundice, and other health abnormalities that compromise his chances of good health and even survival. Paradoxically, a child may suffer from hypoglycaemia, i.e. a sudden drop in sugar levels after delivery, and this may end up damaging the central nervous system.
Why does gestational diabetes regress after pregnancy in some women and persist in others?
– Diabetes that occurs during pregnancy should be cyclical, ie disappear after delivery and appear in the next pregnancy. But it is not uncommon for this gestational diabetes to turn out to be permanent type 2 diabetes. It depends on how efficient the cells in the pancreatic cells that produce insulin are in each individual woman. Diabetes disappears with more efficient cells, but persists with less efficient cells. Nevertheless, all women who have had diabetes during pregnancy are at risk of developing type 2 diabetes later in life.
The story of Ola Sobotkowska
– I am a mother of three children – says Ola. – I was diagnosed with diabetes in the second trimester of the first pregnancy during screening in the 20th week of pregnancy. It was 2005. I felt fine, but the result left no doubt – the sugar level was 4 times above the norm. From then on, I was under the care of a gynecologist and diabetologist. I used a pen for short-acting insulin 3 times a day before main meals and once a day in the evening with long-acting insulin. After pregnancy, my diabetes did not regress. After two years, I had a planned second pregnancy, but the baby was still born due to diabetes. I was referred to a specialist gynecology and obstetrics clinic at the Bródno Hospital in Warsaw. Thanks to this medical care, I gave birth to two healthy children. In my third pregnancy, I was still applying insulin with a pen, in the fourth I was rented an insulin pump. However, after the baby was born, I had to give her back. Then I made a decision that I would buy an insulin pump permanently. It is not cheap – PLN 12, but I think it is worth it. The comfort of living with a pen and pump is incomparable – one injection for 3 days instead of four a day.
An expert voice on insulin pumps
– Personal insulin pumps are used primarily in those patients who had diabetes before pregnancy – informs prof. Jacek Sieradzki. – There is an organized system of renting pumps for pregnant women in Poland. They can also keep them for several months after giving birth. Recently, we extended this project to include the period of preparation for pregnancy. A woman gets a pump for a year, rented by one of a dozen or so centers in Poland, prepares for pregnancy, becomes pregnant, uses it during pregnancy and puerperium, and then returns. The pump facilitates both preparation for pregnancy and sugar control during pregnancy and the puerperium.
We should strive to create diabetes and obstetrics centers that lend pumps to diabetic women of reproductive age in each voivodeship. However, this involves appointing a special diabetes and obstetrics team, which guides patients from the preparatory period to pregnancy until delivery. It is not easy, because such a procedure does not exist in the NFZ billing system. However, such centers already operate in 12 voivodships, with two in Warsaw and Łódź. More would be nice, because we expect more insulin pumps after the final of the Great Orchestra of Christmas Charity in January.
Help of the Great Orchestra of Christmas Charity Foundation for diabetics
For several years, the Foundation has been dealing with pregnant women suffering from diabetes and implements programs helping diabetics. One of them is the care program for pregnant women with diabetes. The coordinator of this program is prof. Jacek Sieradzki. It is the WOŚP Foundation that equips centers specializing in the management of pregnant women suffering from diabetes with insulin pumps. In 2005-2011, the Great Orchestra of Christmas Charity purchased 290 pumps for the project. In 2011, for the first time, the foundation purchased equipment enabling continuous monitoring of glucose levels in mothers during pregnancy and childbirth. The WOŚP Foundation wants to continue this program and purchase new pumps to meet the needs of future mothers in 100%.
– After long consultations with doctors and specialists, we decided to choose, as one of the goals of the upcoming finals, the purchase of insulin pumps for pregnant women. We have been implementing this program for several years. But we can see that the needs are great. In the future, we would like women with diabetes who want to give birth to healthy children to come to the care center in each voivodeship city and stay under its wings throughout the entire period of planning, pregnancy and puerperium. The possibility of using insulin pumps (…) helps to prevent complications that are dangerous to health, both for the mother and the child. But for the program to do its job, it is important to reach out to women with diabetes, either preparing for motherhood or already pregnant. Especially those who cannot afford to buy their own pump – explains Jurek Owsiak.
Addresses of insulin pump rental centers can be found at: www.cukrzycaiciaza.wosp.org.pl
Text: Barbara Skrzypińska