The Diabetologist #10

to seek medical care after they have discovered they are
pregnant. In the Maine study, in which health care providers
in a state-wide network were trained in preconception
care and attempts were made to contact diabetic women
before pregnancy, only one-third of the diabetic pregnancies
occurred in women who had received preconception
counselling.7
Lower income, unemployment, less education and unmarried
status are known factors to have a major impact on
whether or not women seek preconception care.8
Large individual differences may be observed in how diabetic
women and their partners cope with the need for ‘preconception
watchfulness’ and pregnancy planning. While
some women or couples may be ‘unrealistically’ optimistic
regarding the health risks involved, others may react overanxiously,
and develop a phobia of hyperglycemia, leading
to excessive blood glucose monitoring and very frequent
consultations of the diabetes health care team.
Unplanned pregnancy may cause emotional stress and
Diabetes mellitus in pregnancy is associated with an increased
risk of preeclampsia, spontaneous abortions, foe-
In a recent study, it was found that women who felt their
fears of criticism.
tal malformations, stillbirths, macrosomia and related neonatal
morbidity. In the last decades, it has become clear an unplanned pregnancy than women who had been
doctor discouraged pregnancy were more likely to have
that poor glycemic control is an important determinant of reassured they could have a healthy baby.9 This finding
these problems.1,2 Achieving and maintaining optimum underscores the importance of the doctor-patient relationship.10
glucose regulation is considered of high relevance in minimizing
the risk of these complications.
Social support appears to play a significant role as well.
Unfortunately, diabetic women with good glycemic control In the same study, women with unplanned pregnancies
before and during pregnancy generally should not expect reported to be less satisfied with their partner relationship
a normal rate of perinatal complications. In a prospective than those who planned their pregnancies. Most of the
cohort study of 323 Dutch women with type 1 diabetes women with unplanned pregnancies felt that their partners
and overall good glycemic control (HbA1c less than 7%), were not well informed about the possible risks or were
it was noticed that the rates of congenital malformations, not able to understand the amount of effort required to
macrosomia and perinatal death were still increased 3.5- achieve a good diabetes control.9
to 4.5-fold as compared with national data.3
Next and related to medical problems, important psychological
issues may arise and need to be addressed as part For a woman with diabetes the ‘developmental tasks’
3.3 Pregnancy
of a multidisciplinary team approach.
related to pregnancy are essentially the same as for any
This chapter will highlight some of the psychological issues
involved in diabetes care throughout different stages for separation and adopting a realistic relationship with the
woman, i.e. developing attachment to the fetus, preparing
of pregnancy, from planning conception to delivery and newborn. 11,12
beyond.
It is thought, however, that women with diabetes have a
different mood profile compared with non-diabetic women.
3.2 Prepregnancy
In a study of pregnant women with preexisting diabetes
In general, maternal and perinatal complication rates are mellitus and non-diabetic controls, maternal characteristics
and test results on the Profile of Mood States-Bipolar
lower in diabetic women with lower HbA1c levels.1–3 In
this respect, it is considered important to counsel diabetic form were reported. Women with diabetes displayed a
women who are planning to become pregnant about the greater anxiety and hostility in comparison with nondiabetic
women with no association to their level of glycemic
reduction in complications that may be achieved by (further)
improvement of glycemic control.4–6 Fertile women control. Their psychological profile was not associated
with diabetes should be strongly encouraged to use effective
contraception until optimal glycemic control has been tes classification.13
with the severity of the disease as reflected by the diabe-
established.
By contrast, in a prospective longitudinal study using
Research suggests that most women with diabetes tend Mental Health Inventory (MHI-5) forms and the Spiel-
02 issue 10 < APRIL 2012