Diabetes should not be a deterrent to any woman who's planning her pregnancy. However, women with Diabetes Mellitus must take note that they would be less likely to breastfeed their babies, especially, if they were treated with Insulin injections during the pregnancy. A concerted team effort by the Gynaecologist and Endocrinologist is required for successful lactation. Exclusive breastfeeding is universally recommended for all women for the health and wellbeing of the baby. However, breastfeeding has benefits for the mother as well. Breastfeeding improves both Glucose and Lipid metabolism. During lactation, Insulin sensitivity is increased; blood sugar and lipid levels drop; and it also aids post-partum weight loss.
It is intuitive that women who had pregnancy associated diabetes (Gestational Diabetes) quickly normalise their blood sugar levels once lactation is established, without any medication. However, these women still face a high risk of developing Type 2 Diabetes Mellitus in future (50-90% of women with pregnancy associated diabetes may develop Type 2 Diabetes within 10 years of delivery). This risk is reduced by 40-60% with just 1-2 months of breastfeeding. In a study from Norway (the HUNT study), where women were evaluated at 50 years of age, women who had never breastfed had 2 times the risk of hypertension, 3 times risk of being overweight and 6 times the risk of Type 2 Diabetes Mellitus when compared with women who had breastfed their babies. So, even a few months of breastfeeding can have lasting impact on a woman's metabolic health.
(Also Read: Expert Tips To Increase Breast Milk Supply)
Given the huge burden of Type 2 Diabetes Mellitus in India, coupled with later ages of conception, more women than ever with Type 2 Diabetes Mellitus are planning pregnancy. Poorly controlled Diabetes Mellitus may have adverse consequences on the baby's heart, spine or brain. Thus, it is important to consult an Endocrinologist and bring the blood sugars as close to normal as possible before planning conception. Women who are consuming oral medications for their Diabetes may need to switch to Insulin. Any woman with Diabetes of any duration can plan pregnancy, provided we rule out any pre-existing complications of Diabetes that may worsen with pregnancy, and bring blood sugars to a safe level.
Most women are willing to use Insulin injections for treatment during pregnancy but during lactation, using Insulin becomes a challenge for the new mother, juggling the baby's feeding and sleeping schedule with her own needs. It not only involves frequent injections, but also regular sugar checks and risk of low sugars. During the postpartum period, women can safely use oral medications like Metformin and Glipizide/ Glibenclamide as they cross only minimally into the milk. Only 0.3% of the Metformin concentration and not more than 1.5% of Glibenclamide concentration in the mother's blood is reflected in the mother's milk. This means there is no risk of untoward side effects like low blood sugar for the baby. Taking tablets greatly simplifies a woman's life, ensures good glycemic control and a healthy mother and baby.
About Author - Dr Tejal Lathia is Consultant Endocrinologist at Hiranandani Hospital, Vashi- A Fortis Network Hospital
(This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.)