Sugar Matters
August 6, 2013

Diabetes and pregnancy Part 5: what happens after delivery?

One of the most common mistakes I see women with gestational diabetes make is forgetting about this diagnosis after they deliver their babies. The women who had diabetes BEFORE they became pregnant tend to be much more vigilant, because they know they will almost 100 per cent likely need to continue taking some medication after they deliver – it’s just the types or maybe doses that will change. This week,let’s discuss both groups of women.{{more}}

Those who had diabetes before pregnancy (Type 1 or Type 2): All women with Type 1 diabetes and likely the vast majority of those with Type 2 diabetes will continue taking medications after they deliver their babies. The trick is knowing how to adjust your medications after delivery, because they will have to be adjusted. For those of you with Type 2 diabetes, you may have been switched from pills to insulin during your pregnancy, and there will be a good chance that you will return to pills after you deliver. Some pregnant women can be treated with diabetes pills, but the dose will need to change.

For those of you with Type 1 diabetes, your insulin doses will also need to change after delivery. Why? There are many changes that happen after you deliver your baby, many of which directly affect how much diabetes medication (including insulin) you will need. Changes like weight loss are obvious, but there are others like loss of hormones related to the baby’s placenta, as well as maternal hormone changes that make your insulin needs and insulin sensitivity quite different right after delivery and more changes within the first few weeks following.

You need to be sure to discuss with your doctor what changes you will need to your doses or types of medication after you deliver, because it is almost 100 per cent likely you will NOT require the same doses afterwards.

Those who have gestational diabetes, i.e. diagnosed only during pregnancy: There is a widely held assumption that gestational diabetes goes away for good after a women delivers her baby. NOT SO!!! This assumption leads to some major issues, because women and their doctors do not keep up with monitoring. While it is true that most women with gestational diabetes will not need to continue medication after their deliveries, there is a subgroup that WILL. Plus, there is strong research data showing that about 50 PER CENT of women with gestational diabetes will develop Type 2 diabetes within five years of their pregnancy. PLUS, any woman who has gestational diabetes with one pregnancy has an even higher risk of having it with subsequent pregnancies. For all of these reasons, it is imperative that women with gestational diabetes have regular follow-up lab work with their doctors after they deliver.

Most recently, a strong recommendation from the major diabetes associations was that all women with gestational diabetes should have a follow-up two-hour oral glucose tolerance test at between 8-12 weeks after delivery. PLUS you should have an ongoing follow-up even if that test is negative, because your risk stays high for five years after you deliver.

The main lesson here is that even after you deliver it is not the end of the story, even if your diagnosis was gestational diabetes during pregnancy and not before. Many women have stopped paying attention and had bad surprises later on when they had diabetes doing damage to their bodies, undiagnosed and untreated.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD

Medical Director Endocrine Care Group

Tel: 843-798-4227