Up to 1% of pregnant women have diabetes before pregnancy, and up to 12% may develop it during pregnancy. Diabetes during pregnancy poses a risk for both the mother and the baby.
Diabetic pregnant women may have infections, hypertension, premature birth, and more incredible difficulty in controlling blood sugar despite treatment and a higher incidence of complications of the disease.
The baby may grow more slowly, be born prematurely, or grow excessively, making delivery difficult, resulting in a cesarean section. The newborn may also have problems breathing or regulating temperature or blood sugar levels.
The strict control of the pregnant woman is essential to avoid complications.
Diabetes that is already present before pregnancy can be of 2 types:
Type 2 diabetes: appears in people over 30 years of age and is initially controlled with diet, although, over time, it may require treatment with medication and even insulin.
Type 1 diabetes, diagnosed before the age of 30, always requires treatment with insulin and the diet.
Gestational diabetes appears during pregnancy. To detect it, a test is done on all pregnant women between weeks 24 and 28—the O’Sullivan test. Blood glucose is determined 1 hour after taking 50 g of glucose. If this test is positive (glycemia is equal to or greater than 140 mg/dl), the diagnosis must be confirmed with a glucose curve. A fasting blood glucose determination is made after 1, 2, and 3 hours of taking 100 g of glucose. It is considered positive if the values are altered in 2 resolutions.
Mothers who had diabetes before becoming pregnant may be treated with diet alone, pills (oral anti-diabetics), or insulin. During pregnancy, oral antidiabetics are contraindicated, so most pregnant women will be treated with diet and, if necessary, also with insulin.
Gestational diabetes is usually well controlled with diet, but sometimes insulin is also required.
How diabetes affects breastfeeding (or breastfeeding diabetes)
Gestational diabetes generally disappears entirely as soon as the child is born. It is a risk factor for that mother to develop diabetes in the future and for the child to have diabetes, obesity, or metabolic syndrome (a cardiovascular risk factor that includes hypertension, diabetes, and increased cholesterol and triglycerides)
Breastfeeding is known to protect the mother from breast and ovarian cancer. But also the risk of developing diabetes, metabolic syndrome, and cardiovascular disease such as myocardial infarction. If the mother also has diabetes (pregestational or gestational), the protective effect of breastfeeding is more significant.
Breastfed babies also have a lower risk of diabetes, obesity, and metabolic disease. But if your mom had diabetes during pregnancy, the protective effect of breastfeeding is even more significant.
In the case of diabetic mothers, it is even more important to take all precautions to ensure the success of breastfeeding. The increase in cesarean sections, the separation of the baby from its mother “for observation,” or the use of bottles of artificial milk is the optimal breeding ground to make it challenging to start breastfeeding. Suppose we add that a slight delay in the rise of milk is expected in diabetic mothers. In that case, failure is guaranteed if care is not taken to promote skin-to-skin contact, breastfeeding on demand during the first hours of life, and the use of supplements with a relocator or syringe when necessary.
Treatment of diabetes during lactation
Gestational diabetes usually resolves entirely after delivery, and the mother does not require further treatment.
Insulin is a large molecule and does not pass into the milk. It does not pose any risk to the baby.
Before pregnancy, women taking oral antidiabetics that had to switch to insulin can continue insulin while breastfeeding. Some authors recommend this option since not all oral antidiabetics are compatible with breastfeeding. The specialist who treats the mother will choose one compatible, and it is always possible to resort to the page e-lactancia.org.
The diet will be the same that the mother previously had to control her diabetes, taking into account that the needs increase by about 300 kcal per day for the first six months and then by about 400 kcal per day until the end of lactation. But it is not necessary to count calories. The sensation of hunger warns when it is needed to eat more.
- Breastfeeding is the best, we already know that, and it has added value for diabetic mothers and their children, even if it means overcoming some more difficulties.