Ensure a healthy postpartum period with Meri Sehat's follow-up guide for pregnant diabetic women. Prioritize your well-being.

Postpartum Followup For Pregnant Diabetic Woman

As a mom-to-be, the first thing you should know is that each pregnancy is unique. From the number of appointments to scans and tests, your doctor will determine the kind of care you need depending on your condition to ensure a smooth process.

Introduction

As a mom-to-be, the first thing you should know is that each pregnancy is unique. From the number of appointments to scans and tests, your doctor will determine the kind of care you need depending on your condition to ensure a smooth process.

However, if you are diabetic and pregnant or have developed gestational diabetes during this pregnancy, you would have probably noticed the &lsquo;extra&rsquo; care showered at every stage &ndash; during pregnancy, labor, and then birth. But, as your diabetes team and the antenatal team must have told you, it doesn&rsquo;t end here. And you should be expecting a similar routine once the baby is born. 
&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/diabetes-gestational">Gestational diabetes</a> affects around 17 million pregnancies worldwide<a href="#accordion">[1]</a>.</li>
	<li>A majority of women with gestational diabetes develop transient hyperglycemia during pregnancy.</li>
	<li>It is a significant risk factor for permanent or future glucose intolerance or type 2 diabetes postpartum. Pregnant women with gestational diabetes are 50% more likely to develop diabetes within 5 years post-delivery<a href="#accordion">[2]</a>.</li>
	<li>Recommendations for postpartum follow-up visits include care continuing throughout the first year after delivery.</li>
	<li>Early diagnosis and intervention help reduce long-term complications, such as retinopathy, neuropathy, and cardiovascular disease. 
	&nbsp;</li>
</ul>

Understanding the importance of Postpartum Screening

<ul>
	<li>According to NICE guidelines, a woman with gestational diabetes should be screened for type 2 diabetes postpartum. This includes a fasting blood glucose test at 6-13 weeks postpartum. According to the American Diabetes Association, this recommendation is for 6-12 weeks postpartum<a href="#accordion">[3]</a>.</li>
	<li>If a woman was not screened in the first year postpartum or presented with a negative postpartum screening test result, they need to be screened at least every 3 years for a minimum of 10 years post-pregnancy<a href="#accordion">[4]</a>.</li>
	<li>If women present with a positive screening test result, they need to repeat the test at least 6 months postpartum to confirm the diagnosis of diabetes irrespective of the type of initial test (e.g., hemoglobin A1C, fasting plasma glucose, and oral glucose tolerance test)<a href="#accordion">[4]</a>.</li>
	<li>Repeat testing is also recommended if women were screened via hemoglobin A1c test during the first 6 months postpartum because the A1c test is not accurate during this time. Hemoglobin A1C is also less accurate in women with renal failure, anemia, certain hemoglobinopathies, and those who have recent transfusions<a href="#accordion">[4]</a>. 
	&nbsp;</li>
</ul>
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<ul>
	<li>Despite recommendations, one-third of affected women reportedly don&rsquo;t have postpartum screening<a href="#accordion">[5]</a>. Although attendance rates vary from country to country, it&rsquo;s generally poor.</li>
	<li>Women visiting hospital-based clinics are twice as likely than those visiting community clinics to go ahead with postpartum glucose testing<a href="#accordion">[5]</a>.</li>
	<li>Emotions, like feeling afraid or stressed out from adjusting to a new baby, or being diagnosed with diabetes also contribute to it.</li>
	<li>Studies in Australia and Canada found that postpartum reminders increased the screening rate to 50-60%<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>
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The comprehensive postpartum visit is usually scheduled between 4 and 6 weeks postpartum. Culturally, women and newborns are allowed 40 days post-delivery to recover and adjust to their bodies and environment.

In Pakistan, too, the tradition is to provide the new mother with relief from household work, supplemental food, and additional family support for 40 days. The period is also known as chilla. 
&nbsp;

A recent study found that this cost-effective, community-based practice is actually a sustainable intervention for maternal mental health with lower symptom severity among prenatally depressed women<a href="#accordion">[6]</a>.

While this timing should be individualized, today 23% of employed women go back to work within 10 days postpartum, with 22% more women resuming their roles between 10 and 40 days<a href="#accordion">[7]</a>. 
&nbsp;

In the case of gestational diabetes, your blood sugar levels are most likely to return to normal after labor. 90% of the time, it does. So, any diabetic medication you&rsquo;ve been prescribed by your doctor (including insulin) may be stopped at that time. 
&nbsp;

However, it may also be the case that you already had diabetes and were taking medications for it before your pregnancy. Or perhaps your pregnancy uncovered existing diabetes that you weren&rsquo;t aware of. Also, there&rsquo;s this increased risk of developing type 2 diabetes later in life or having gestational diabetes in future pregnancies if you have it now. The point is, diabetes continues after delivery in 2-3% of all women. If you fall into this category, you may be asked to carry on with your treatment.

Your blood sugar levels need to be checked regularly. However, studies indicate an average rate of &lt;50% completion of postpartum glucose screening to detect pre-diabetes or diabetes<a href="#accordion">[8]</a>. 
&nbsp;

Screening is important because:

<ul>
	<li>If you are pre-diabetic, screening allows you to adopt a targeted lifestyle and effectively reduce your risk of developing type 2 diabetes later on.</li>
	<li>If you&rsquo;re already diagnosed with type 2 diabetes, targeted intervention again can help reduce your risk of developing end-organ injury.</li>
	<li>Further, in case of future pregnancies, you can reduce your risk of complications, like hypertension, congenital malformations, preterm delivery, and neonatal morbidities, with optimized blood glucose levels. 
	&nbsp;</li>
</ul>

Regular appointments with your healthcare team are a sure thing. DO NOT skip them. In fact, do your preparations before an appointment to get the most out of this opportunity.

<ul>
	<li>Write down your worries and concerns that you need to discuss with your doctor or questions to get the desired information. Don&rsquo;t be shy to ask anything you don&rsquo;t understand.</li>
	<li>Make sure you have your list of medications and your blood sugar results with you.</li>
	<li>Your doctor may order more tests. They may modify your medications or advice you on some lifestyle changes. Take notes if you want to remember the instructions and what to anticipate next. 
	&nbsp;</li>
</ul>

Note: If you have a history of gestational diabetes, it&rsquo;s recommended to have a 2-hour glucose tolerance test at 6 weeks and then at least every 3 years after your baby is born. 
&nbsp;

Post-delivery, it&rsquo;s only natural that you prioritize taking care of your baby. However, this period is also one of the most important times to engage with your diabetes care team and manage the condition.

Your body has gone through so many changes, all of which impact your blood sugar. The delivery process, whether you have a c-section or vaginal delivery, will also affect your recovery period and, hence, your diabetes management. 
&nbsp;

Unlike common misconceptions, glucose targets are necessary to prevent hypoglycemia while regular screenings help monitor for diabetes complications after a pregnancy.

<ul>
	<li>Low Carbs are recommended for general diabetes management. However, according to the American Diabetes Association, you should consume at least 120 g of carbs daily while breastfeeding. This is because your glucose may drop to dangerously low levels while breastfeeding as milk production requires high levels of energy, including glucose. Make sure to have access to snacks.</li>
	<li>Half Of Your Plate should be filled with green vegetables.</li>
	<li>Choose Whole Grain&nbsp;Carbs, like oats, brown rice, wholewheat pasta, and high-fiber biscuits. They&rsquo;re also rich in vitamins.</li>
	<li>Opt For Beans and fish for your protein intake rather than red or processed meats.</li>
	<li>Reduce Fried and processed foods.</li>
	<li>Avoid Sweetened drinks and food items.</li>
	<li>Water Is Best for hydration. Cut down on your caffeine; stick to 300 mg or less per day.</li>
	<li>If you&rsquo;re getting enough calories, then breastfeeding is safe for you. While individual calorie intake depends on age, body size, how much you&rsquo;re breastfeeding, and your activity level, it&rsquo;s recommended to consume about 2300-2500 calories in a day.</li>
	<li>If your diabetes is well under control, your breast milk will be the same as someone without diabetes. 
	&nbsp;</li>
</ul>

The rapid fluctuations in your weight during and after pregnancy are normal. The problem starts when you are unable to shed those extra pounds. It puts you at risk of developing diabetes-related complications, including the risk of developing gestational diabetes in the next pregnancy and type 2 diabetes later in life.

Also, if you don&rsquo;t look or feel good due to weight, it may be an added stressor that can take a toll on your mental health. The CDC states that 1 in 8 American women experience postpartum depression, but nearly 30% of them were not even asked about the symptoms of depression during their postpartum visit<a href="#accordion">[9]</a>. 
&nbsp;

And diabetic people, specifically, are 2-3 times more likely to have depression and 20% more likely to have anxiety than those who are not diabetic<a href="#accordion">[9]</a>. (Note: Get screened for postpartum depression at each visit to get treatment as early as possible.)

Breastfeeding may help reduce excessive weight gain. However, the option is not available for all. Besides, an exercise routine to manage the weight after recovery from delivery allows slow, steady, and sustained weight loss. 
&nbsp;

Exercise not only promotes weight loss but also improves fitness and boosts energy levels as well. Further, it relieves stress, reduces symptoms of postpartum depression, and promotes better sleep. So, ask your doctor when it&rsquo;s safe to begin exercising again.

<ul>
	<li>A reduction of 0.5-1 kg per week or 7% of body weight in 6 months is considered a safe goal.</li>
	<li>Get at least 30 minutes of exercise every day.</li>
	<li>If you&rsquo;re breastfeeding, drink plenty of fluids throughout the day.</li>
	<li>Ditch the elevator; use stairs.</li>
	<li>Try yoga or Kegels. Go swimming. Join a dance class. 
	&nbsp;</li>
</ul>

You become extremely sensitive to insulin immediately after the placenta and baby are delivered. As such, your target blood glucose levels should be kept between 5 and 10 mmol/L to avoid the risk of hypo.

If your treatment before pregnancy was metformin, you&rsquo;ll probably be resuming it afterward. The same goes for insulin; if you were taking it before pregnancy, you will need to continue taking it but the type, dosage, and number of injections will have to be reviewed. 
&nbsp;

In some cases, insulin is started after pregnancy. If you need it, then these doses will be lower than what was being administered during pregnancy. Moreover, they have to be reviewed frequently, particularly during the first month after delivery.

If you&rsquo;re breastfeeding, insulin and metformin are usually the only diabetes medications that are suitable for use. Any other medication will be prescribed once this phase is over. 
&nbsp;

Your doctor may also need to adjust your medications to treat other diabetes-related issues, like cholesterol and high blood pressure.

In particular, blood pressure evaluation is recommended around 7-10 days postpartum for women with hypertensive disorders associated with pregnancy. For women with severe hypertension, it&rsquo;s important to consult a doctor within 72 hours; some experts suggest 3-5 days. This is important because more than 50% of postpartum strokes occur within 10 days of discharge<a href="#accordion">[7]</a>. 
&nbsp;

Birth control may also become part of the postpartum plan to prevent unplanned pregnancies in the future. This may include progesterone-only birth control pills since estrogen can affect milk production, a problem if you choose to breastfeed.

Besides, if you have had gestational diabetes and are planning future pregnancies, make sure you haven&rsquo;t developed diabetes since the last one. Also, take folic acid supplements daily for 3 months before trying to get pregnant. 
&nbsp;

Conclusion

Being a diabetic pregnant woman can be a scary notion. That is, managing diabetes in addition to navigating the changing hormones, fatigue, lack of sleep, lack of sexual desire, and other challenges. But, with a few precautions, you can definitely have a happy and healthy pregnancy. And with a little help from your family, friends, and healthcare providers, postpartum diabetes management is possible, too. Make sure you continue all your follow-up medical tests and doctor visits. Also, continue with a healthy and active lifestyle. 
&nbsp;

[1] Pregnancy as an opportunity to prevent type 2 ... - wiley online library.

[2] Gestational diabetes - after the birth. HSE.ie

[3] Á. Cronin a, a, c, et al. Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: A qualitative study.

[4] Diabetes after pregnancy recommendations. WPSI.

[5] Postpartum screening for diabetes in women diagnosed with gestational

[6] LeMasters K, Andrabi N, Zalla L, et al. Maternal depression in rural Pakistan: The protective associations with cultural postpartum practices - BMC public health. BioMed Central.

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