Q: Why is my obstetrician screening me for diabetes?
A: Pregnancy puts all women at risk for developing insulin resistance. Insulin, which allows the body to process carbohydrates (sugars), is a hormone produced by the placenta that makes a pregnant woman more resistant to her own insulin.
About 6 to 7 percent of women in the U.S. will develop diabetes during pregnancy. In the United States, the risk is higher for African American, Hispanic, Native American, Pacific Islander and Southeast or East Asian women than for white women.
Diabetes can increase risks for other complications in pregnancy, including preeclampsia, an infant that is large for its gestational age, maternal and infant birth trauma, and neonatal respiratory distress.
Risk factors for gestational diabetes include:
- Personal history of impaired glucose tolerance or gestational diabetes in a previous pregnancy.
- Mother who is a member of an ethnic group with an increased risk for type 2 diabetes.
- Family history of diabetes.
- Pre-pregnancy weight greater than 110 percent of ideal body weight, BMI higher than 30, significant weight gain in early adulthood and between pregnancies, or excessive weight gain during pregnancy.
- Previous delivery of a baby weighing 9 pounds or more.
In overweight and obese women, weight loss before pregnancy can reduce the risk of developing gestational diabetes. In a 2015 study of more than 3,000 women, those who exercised during pregnancy reduced their risk of developing gestational diabetes.
If you are diagnosed with diabetes, it is imperative to keep your blood glucose controlled to improve pregnancy outcomes for yourself and your baby.
Q: I am considering bariatric surgery for weight loss. Is it safe to get pregnant after the surgery?
A: More than 80 percent of bariatric procedures are performed in women, and approximately half of these are performed in reproductive-aged women.
Both nonsurgical and surgical weight loss can improve fertility. This was illustrated in a study in which 15 of 32 women who were unsuccessful in their attempts to conceive prior to bariatric surgery became pregnant following surgery.
Women are generally advised to delay pregnancy for 12 to 18 months following bariatric surgery. This will optimize weight loss and reduce the potentially adverse effect of post-bariatric surgical nutritional deficiencies.
Obesity is associated with numerous adverse pregnancy outcomes, including miscarriage, preeclampsia, gestational diabetes, cesarean delivery, stillbirth and congenital birth defects.
After bariatric surgery, the frequencies of many of these adverse outcomes are reduced.
Please note that bariatric surgery is not recommended as a treatment for infertility; however, fertility may be increased. Talk to your obstetrician and bariatric surgeon about your options.
Dr. Joanne Price Williamson is an obstetrician/gynecologist at Memorial Health University Physicians – Provident OB/GYN Associates in Okatie.