Hope Carried Me Through My Diabetic Pregnancy
For Loren Walters having her first child was easy, but nothing could prepare her for the ordeal she was going to face the second time around.
My son Jalon was born in 2010. I was not diabetic at the time and had no sign of gestational diabetes either (see our feature on page 36 for info on this condition). His birth weight was 3.2kg. In November 2013, after a few months of having severe nausea, loss of appetite and falling asleep at random (which was actually me slipping into and out of a diabetic coma), I was rushed to hospital. I was diagnosed with type one diabetes. (See table for the difference between type one and two).
My dad passed away at the young age of 42 after a long battle with this disease. I was shocked and in denial. I was put onto insulin and medication. This caused me to lose around 30kg.
DEALING WITH THE DIAGNOSIS
Four months after being diagnosed, I was still coming to grips with my condition, when I found out that I was 12 weeks pregnant. My body took a while to adjust to the diabetic medication and was not working well with the contraceptive that I was taking.
I thought that the irregular periods were due to the diabetes. There were also no signs or symptoms (as with my first pregnancy), which is why it took so long for me to realise that I was expecting.
HAVING FAITH AGAINST ALL ODDS
Upon finding out I was pregnant I was admitted to hospital. During this week in Groote Schuur Hospital, the professors did their rounds twice a week. On one occasion, the doctor did an HbA1c test to check my blood sugar at conception. She was not happy with the results.
She showed me lots of information and explained the risks for me and baby – birth defects, abnormalities and how babies of diabetic moms have difficulties in surviving. How, statistically, they do not make it past four months and that miscarriages are prevalent. I was given the option to abort, but had to decide straight away. I burst into tears. I had mixed emotions – anger at my dad and sadness because I was just starting to fall in love with my baby. I was shocked about the extreme risks involved, but I was also determined. I looked at her and said that I am not giving up this blessing. Shortly after that I phoned my husband. We were both devastated, but my husband also had unwavering faith that everything would be okay.
BATTLING TO CARRY ON NORMALLY
After the week in hospital, I was back at work. The changes in medication, diet and adjusting to the work environment was tough.
Taking insulin four times a day at work was so difficult. I had constant sugar lows at my desk. There were times when I did not pack enough food for the day, then there were the highs which left me tired and dizzy. I had to force myself to eat. The nausea made everything more difficult. I could barely get an apple in. I also struggled to concentrate.
I had to go to the hospital once a week and getting the day off from work was at times impossible. My tummy was becoming more uncomfortable. Eventually my boss and I reached an agreement that I would take unpaid leave days. The 32 week scan showed an abnormal increase in amniotic fluid. So not only was I carrying big, but I had too much amniotic fluid. I began to dread the weekly visits because any small thing (like glucose in urine) meant that I would have to be admitted.
A MACROSOMIC BABY
At 30 weeks I was told that I was carrying a macrosomic baby. A macrosomic baby simply means a big baby with a birth weight of over 4.5kg. Because the baby grows too large in utero, it can lead to birth complications for the mother and health complications for baby.
I felt like I could give birth there and then. I was extremely tired, but battled to sleep. I would sleep almost sitting up because I struggled to breathe. My back gave me problems. By 32 weeks Chloe weighed 2.8kg.
Right at the beginning of the pregnancy I was told that I would have to have a caesarean section. This really scared me, but the doctors advised me that natural birth was too risky. The c-section was scheduled for Monday, 20 October 2014. But by Sunday morning (19 October) at 7am I was already five centimetres dilated.
At 11am that morning I went through to the theatre and Chloe was born weighing five kilograms. The caesar was painless and without complications. After her birth Chloe was sent straight to the neonatal ICU and I was sent to recover in the ward. I was devastated to be separated from my baby early on but she needed medical attention.
A TOUGH WEEK FOR MOM AND BABY
Only 12 hours after the c-section, I was up and longing to see my baby. I eventually made it to the nursery and was shocked to see her in the NICU with so many wires attached to her. I was not allowed to breastfeed or even pick her up.
The doctors told me that she had a dangerous blood sugar reading of 1.3 at birth, and that she is very lucky to have survived. This was due to my high sugar levels. She had a drip through her navel and was monitored constantly until her body was able to maintain its own sugar levels.
I desperately wanted to be with her, but I had to be back at the ward for my medication and meals. On day three I was allowed to breastfeed and a week after giving birth we were finally sent home. After two weeks at home I was still crying about everything we had been through.
However today we are both doing really well and have gotten through it. My ordeal made me stronger. I cherish every single moment with my beautiful little girl and I live for my children. In the end I am so grateful for a perfect healthy little girl. YP
PREGNANCY WITH DIABETES
In pregnancy your insulin requirements can rise up to three times of your pre-pregnancy levels, so managing your blood sugar levels and your diabetes medication when expecting is vital for your own health and that of your baby.
Controlling your blood sugar becomes harder during pregnancy (normally during the second and third trimester) due to pregnancy hormones, but diabetic mothers can have healthy pregnancies with the correct monitoring, a healthy lifestyle and medication in place.
Meeting with your doctor or nurse before falling pregnant is crucial to ensure that you have a healthy pregnancy. It is vital to have controlled diabetes even before falling pregnant, because you might only find out you are pregnant by the time baby has already grown for two to four weeks. High blood sugar levels before 13 weeks of pregnancycan cause serious birth defects, the risk of miscarrying and other complications.You have to maintain ideal blood glucose levels (as explained by your doctor), eat the correct balanced diet, exercise and take the correct medication.
MANAGING DIABETES DURING PREGNANCY
If at all possible, women with pre-existing diabetes should self-monitor their blood glucose levels. This will have to be discussed with a healthcare practitioner, but should be in line with the pattern of testing and type of insulin that was used prior to the pregnancy. Your eyes should furthermore be examined in each trimester and your blood sugar should be monitored regularly.
Talk to your doctor about adjusting your diet to ensure that you and baby get enough kilojoules and to avoid sugar highs and lows. A suitable, safe form of exercise should also be discussed with your medical practitioner and included as part of your healthy lifestyle. You should be able to carry your baby to term without problems if your diabetes is well controlled. Your doctor will advise if an early delivery is necessary. If you took insulin during your pregnancy, then insulin might be given via injection or intravenously when labour begins. Insulin requirements often drop quickly right after giving birth.
THE EFFECTS OF DIABETES ON YOUR UNBORN BABY
Pregnant moms with diabetes often have babies with considerably larger bodies than other babies. The condition is called “macrosomia” and literally means “large body”. It happens because the baby receives too much sugar from mom’s placenta due to the mother’s high blood sugar levels. Baby’s pancreas subsequently produces more insulin to try and use up all the sugar. The extra sugar is converted to sugar which makes the baby fat. If the baby is too large for a vaginal birth, a c-section might be necessary.
High blood sugar levels during your pregnancy – and specifically the 24 hours before the delivery – may cause your baby to have dangerously low blood sugar right after the birth. The reason for this is that the baby’s body produces high levels of insulin to use up the extra sugars, and when the source of the sugar is taken away quickly, the baby’s blood sugar will drop instantly. If this is the case, then baby will be monitored closely and given glucose intravenously. Insufficient calcium and magnesium levels may also occur, but can also be rectified with medication.