What to Know About Diabetes in Pregnancy
By Grateful Ogunjebe
Diabetes in pregnancy remains a significant public health concern, with implications for both maternal and child health if not properly managed.
Dr Daniel Afolabi explains the different types of diabetes that can affect women during pregnancy, associated risks, early warning signs, management strategies, and steps women can take to reduce their risk before and during pregnancy.
Experiences of patients
Mrs Lynda “As for me, I started my pregnancy journey eight months before she was diagnosed—an entire year and a half before my son was born. Living with type 2 diabetes, I already tried to live a healthy lifestyle, but I was nowhere near being prepared for pregnancy. As I got closer to my goal, I switched to insulin via multiple daily injections. Seven months later, my doctors, my husband, and I felt prepared for a healthy pregnancy.”
Another woman, who pleaded anonymity, said, “Diabetes can feel like a full-time job, but pregnancy and diabetes can feel like a full-time job with an excessive amount of unpaid overtime. Around the same time, I was getting increasingly ratty with everyone around me. I was having a tough time sleeping at night. I was always tired. Then I was diagnosed with postpartum thyroiditis, and all my symptoms fell into place. It meant my immune system had attacked my thyroid, and although it’s rare, it is very common in women with type 1 diabetes.
Funke, 25, “I had unusual fatigue and frequent urination, but I ignored it, thinking it was just pregnancy. The screening at my antenatal clinic caught gestational diabetes early. I followed the dietary and insulin plan, and my baby is perfectly healthy now.”
The key differentiator, Dr Daniel Afolabi said, is whether the woman had diabetes before pregnancy or developed it during pregnancy.
Women who develop diabetes during pregnancy are said to have gestational diabetes. This means the woman did not have diabetes before becoming pregnant, but her blood sugar levels became elevated during pregnancy due to hormonal changes that affect insulin action.
Gestational diabetes accounts for about 85–90 per cent of all cases of diabetes in pregnancy, making it the most common type, he noted.
On the other hand, some women enter pregnancy already living with diabetes. These cases fall into two categories: Type 1 diabetes and Type 2 diabetes. Type 1 diabetes is usually diagnosed earlier in life and requires lifelong insulin therapy, while Type 2 diabetes is more common and is often associated with obesity, sedentary lifestyle, and family history.
Management differs because women with pre-existing diabetes require tighter control even before conception, while gestational diabetes focuses on controlling blood sugar during pregnancy and monitoring after delivery, as blood sugar often returns to normal postpartum, Dr Daniel explained.
Poorly controlled diabetes in pregnancy can have serious consequences for both the mother and the baby, according to Dr Daniel Afolabi.
For the mother, diabetes increases the risk of high blood pressure, pre-eclampsia, excessive weight gain, prolonged or complicated labour, and caesarean section. There is also a higher likelihood of developing Type 2 diabetes later in life, especially in women who had gestational diabetes.
For the unborn baby, high maternal blood sugar can lead to excessive fetal growth, a condition known as macrosomia, which increases the risk of birth injuries during delivery. Babies may also be born prematurely, experience breathing difficulties, or develop low blood sugar (hypoglycaemia) shortly after birth.
If diabetes is poorly controlled throughout pregnancy, it can also increase the risk of stillbirth and long-term metabolic problems for the child, he warned.
Some women may experience symptoms such as excessive thirst, frequent urination, unusual fatigue, blurred vision, or recurrent infections, including urinary or vaginal infections. However, Dr Daniel Afolabi pointed out that many pregnant women with diabetes, especially gestational diabetes, may have no apparent symptoms at all.
This is why routine screening is crucial. Most women are screened for gestational diabetes between 24 and 28 weeks of pregnancy. Women who are at higher risk, such as those who are obese, above the age of 30, have polycystic ovarian syndrome (PCOS), hypertension, or a family history of diabetes, may need to be tested earlier.
Early testing allows for prompt diagnosis and intervention, which significantly improves outcomes, he added.
The goal of managing diabetes during pregnancy is to keep blood sugar levels within a safe range throughout the pregnancy, Dr Daniel said.
Management typically starts with dietary modification, focusing on balanced meals that control carbohydrate intake while ensuring adequate nutrition for both mother and baby. Regular, moderate physical activity, as advised by a healthcare provider, also plays an important role.
Women are encouraged to monitor their blood sugar levels regularly, as this helps both the patient and healthcare team assess how well the condition is being controlled.
When lifestyle measures alone are not sufficient, medications or insulin may be introduced. Insulin is safe in pregnancy and is often used when blood sugar targets cannot be achieved through diet and exercise alone, he explained.
Close follow-up through antenatal care is essential to adjust treatment as pregnancy progresses and insulin needs change.
While gestational diabetes cannot always be prevented, many women can significantly reduce their risk, Dr Daniel Afolabi noted.
Maintaining a healthy weight before pregnancy, eating a balanced diet, staying physically active, and managing existing conditions such as hypertension or PCOS can all help lower risk. Women are also encouraged to attend antenatal care early, where risk factors can be identified and screening arranged promptly.
For women with a family history of diabetes or previous gestational diabetes, pre-pregnancy counselling and early testing are especially important. Early detection and proper management remain the most effective ways to protect both mother and baby, he concluded.
