Pre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Article contributed by Ms Yong Lai Mee

The prevalence of Type 2 Diabetes Mellitus (T2DM) among women in childbearing age is increasing. Pre-existing T2DM in pregnancy increased the risk of maternal and neonatal complications such as macrosomia big baby), miscarriage, stillbirth, eclampsia (high blood pressure and its complications), and preterm labour. The American College of Obstetricians and Gynaecologists and the American Diabetes Association emphasized the importance of achieving optimum diabetes control for promoting the well-being of maternal and reduced prenatal fetus and baby adverse outcomes. Below are some tips to achieve optimum pre pregnancy diabetes care.

Blood Glucose Control

  • Keep pre pregnancy HbA1C < 6.5% to avoid complications during pregnancy.
  • Fetal mortality rate increased 4 folds in those with HbA1C >6.6%.
  • Poorly controlled pre pregnancy diabetes increases congenital heart diseases by 3 folds, neural tube defects increase by 4 folds and spontaneous miscarriages in 30-60% of all pregnancies.
  • Plan 4-6 months before pregnancy to ensure diabetes control is within target range.

Read morePre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Contraception – Male condom

The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects, so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb / uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Read moreContraception – Male condom

Contraception – Hormonal implant (Implanon)

The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb/uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Hormone implant currently available is Implanon NXT®. It consists of a single plastic rod measuring 4 cm and contain a progestogen hormone called etonogestrel. Implanon is inserted surgically, just under the skin of the upper arm. The implant will release a minute amount of this hormone every day for 3 years. It works by preventing the monthly ovulation (the release of an egg from the ovary) during your menstrual cycle. It also thickens the vaginal mucus to prevent sperm from reaching the egg (fertilization). Continuous effect of the hormone will thin out the lining of the uterus (womb) to prevent attachment of a fertilized egg. Implanon does not contain any oestrogen.

Read moreContraception – Hormonal implant (Implanon)

Heartburn during pregnancy

Heartburn is a term used to describe a burning pain or discomfort in the chest and upper abdomen. The actual medical term for it is gastro-esophageal reflux disease (GERD). It is quite common for pregnant women to experience the symptoms of heartburn, which usually come and go until delivery. It can start anytime during the pregnancy period and may worsen as the pregnancy progresses (second or third trimester). While it can be uncomfortable or painful, heartburn by itself will not harm the baby.

Symptoms and signs

  • Burning pain in the center of the chest and the upper abdomen, frequently accompanied by an unpleasant taste in the mouth.
  • Belching (burping).
  • Nausea with or without vomiting.
  • Persistent throat irritation, with or without irritating dry cough.

Read moreHeartburn during pregnancy

Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

Read moreAnaesthesia and Analgesia in Obstetrics and Gynaecology

Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

Read moreSuction evacuation for miscarriage

Vaccination and Pregnancy

It is important to ensure that you are adequately protected against certain infectious diseases during your pregnancy. In the community, people are protected against infectious disease because they have had the infections before and developed immunity to it. Some are protected against chickenpox, for example, because they had it when they were kids, causing their immune systems to make antibodies to the chickenpox virus. However, over time the antibody level may decline to a very low levels and the person may lose the protection against that particular infectious agent.

Alternatively, many in the community have been vaccinated and developed antibodies to that specific infectious agent contained in the vaccine. Many countries now have an immunization schedule that tries to cover as many infectious disease as possible, hoping to reduce the disease burden to the community and the health care system.

Read moreVaccination and Pregnancy