News on diabetes during pregnancy and birth defects

It's natural for pregnant women to worry about the health of their developing baby.  Fortunately we're learning more about what causes birth defects and how to prevent them. For example, a recent study showed that birth defects are much more likely if the mother is diabetic.

A study recently published in the American Journal of Obstetrics and Gynecology looked at birth records for 10 states. Researchers looked at 13,000 births involving a birth defect. They were compared with 5,000 healthy births. Birth defects were three to four times more common if the mother had diabetes before pregnancy. Nearly 40 types of birth defects were involved. Prior research had not linked this many types to diabetes.

Women with diabetes who get pregnant have bigger babies and a higher risk of problems with the birth. So do women who develop diabetes during pregnancy (called gestational diabetes).

With very tight control of blood sugar, a woman can help decrease the risk of some of these difficulties. They include problems for her and the baby during the pregnancy and at the time of delivery.

Studies of animals show that exposure to high blood sugar levels in the womb can damage a fetus's developing organs. But the problems for pregnant women and their babies are not just about blood sugar levels. Even if blood sugar control is excellent, women who have diabetes before conception are at increased risk of having a baby with one or more birth defects.

Since this study demonstrated that diabetes is associated with many different types of birth defects, it is likely that the harm occurs to the tissues in the fetus very early on. It could be in the first few weeks of pregnancy.

While you can't prevent type 1 diabetes, you can markedly decrease your risk of developing type 2 diabetes. And type 2 diabetes is much more common. It is becoming more prevalent along with the rise in overweight and obesity rates.

Here is what you can do to help decrease your risk of diabetes. This applies to everyone, men and women, not just to women who are planning on future pregnancy.

First, learn about your family's medical history. Does one of your parents or a brother or sister have type 2 diabetes? If so, your risk is already more than double that of someone who does not have such a family history. If two or more members of your immediate family have diabetes, then your risk of developing it is extremely high.

Even if your risk is high, you can do a lot to prevent diabetes from ever affecting you. Ideally, you should strive to:

·         Maintain a normal body weight for your height. This means keeping your BMI below 25.

·         Exercising for 45 to 60 minutes daily. In addition to devoted exercise time, stay physically active throughout the day.

Family history is not the only factor that increases the risk of type 2 diabetes. Excess body fat, especially around the belly, and lack of exercise also put you at higher risk for type 2 diabetes.

It's going to take many years to sort out the exact relationship between diabetes in the mother and the many potential types of birth defects. But you don't need to know these details to take action now. For women planning pregnancy, this study adds one more very good reason to exercise more and keep calories in check.

What are you doing to prevent diabetes?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Diabetes
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