Diabetes



If you have diabetes you will need special care before and during pregnancy to be sure that your blood sugar is well controlled. The goals for your blood sugar values are 90-100mg dl for your fasting blood sugar and less than 120mgl dl 2 hours after meals. As long as you are rigorous about this, you have a very good chance of a healthy pregnancy and a healthy baby. If you have long standing diabetes. you are more likely to develop pregnancy complications, especially preeclampsia. Any eye problems related to the diabetes may also worsen. High blood sugar levels at the time of conception can damage the developing baby so it is important to control blood sugar before you try to conceive miscarriage is more likely as are major birth defects such as neural tube defects or congenital heart disease. High blood sugar levels during pregnancy slows fetal lung development so the baby may have breathing problems at birth.

During your pregnancy it is important that you are screened early for neural tube defects, with a blood test or an ultrasound scan. If you are taking pills for diabetes, it is usually safest if you switch to insulin before conception because it doesn't cross in to the placenta. It is essential to continue to control your blood sugar. A first trimester evaluation of your vision and of your kidney function is also important. At about 32 weeks your doctor is likely to start non stress tests to check the baby's well being. Your doctor may also order a third trimester ultrasound to check your baby's weight.

Systemic Lupus Erythematosus

Women with this disorder can have healthy pregnancies, but it is best if conception occurs when the condition is controlled. Most SLE medications are safe during pregnancy active SLE is much more dangerous to your baby than the drugs used for treatment. SLE increases your risk of miscarriage or of having a smaller baby. Your doctor is likely to start nonstress tests at around 32 weeks to check your baby's well being. You win also have ultrasound scans to check the baby's growth. Your blood will be checked for signs of antiphospholipid antibody syndrome. This condition increases the risk of blood clots developing, as well as causing problems with the baby. If you are found to have this syndrome, you will be treated with blood thinning injections during pregnancy to prevent a blood clot. Other antibodies cause heart rhythm problems in about 1 in 80 babies.

Epilepsy

Most antiepileptic agents are linked with an increased risk of birth defects. To minimize this risk to need to consult your neurologist to reduce the number of medications you are taking and the dose to the lowest levels possible that still control your epilepsy. If you are taking antiseizure agents you should have screening for neural tube defects at 15 weeks and a level 11 ultrasound at 17-19 weeks .