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By Melissa Tennen, HealthAtoZ writer
If you have diabetes and plan to become pregnant, take your multivitamins along with controlling your glucose levels.
The chance for your child being born with certain birth defects can be four times higher if you are not getting proper nutrition, says a study from the Centers for Disease Control and Prevention.
"If a woman is taking proper nutrients before and in the early stages of development when the organs are being developed, the risk of the baby born with birth defects is no higher than a woman without diabetes," says Adolfo Correa, M.D., Ph.D., lead author of the study and supervisory medical officer of the National Center on Birth Defects and Developmental Disabilities.
Data on more than 6,000 infants were examined with half being born to mothers with diabetes. The study did not separate type 1, type 2 and gestational diabetes or the severity. And it did not look at how individual vitamins worked and how they actually prevented birth defects among children born to mothers with diabetes.
"We don't really know how multivitamins work with any woman who is pregnant," Correa says. "Taking multivitamins early in pregnancy may provide essential micronutrients for fetal development, but it may also reflect other aspects of good prenatal care, including good control of diabetes and nutrition, that are also essential for a healthy pregnancy outcome. More research is needed to help us understand whether the beneficial effects we have observed with multivitamins are due to the multivitamins or to some other aspects of prenatal care."
This information adds to what is already known from previous studies: Women with poorly controlled preexisting diabetes in the early weeks of pregnancy are two to four times more likely to have babies with a serious problem, such as a heart defect or neural tube defect, which affects the brain or spinal cord. The risk of miscarriage and stillbirth also is higher.
"It's nice that we have something to offer women with diabetes," says Siobhan Dolan, M.D., assistant medical director for the March of Dimes and assistant professor of Obstetrics and Gynecology and Women's Health at Albert Einstein College of Medicine in New York. "We have always encouraged women with diabetes to get their sugar under control, but beyond that there was not much more we could do and that's a very difficult message to give. Now we have something to offer so we can have healthy mothers and healthy babies."
About one in every 100 women of childbearing age has diabetes before pregnancy (preexisting diabetes). Another 3 percent to 5 percent develop diabetes during pregnancy (gestational diabetes).
Women with poorly controlled diabetes (gestational or preexisting) are at increased risk of having a large baby weighing 10 pounds or more. The extra sugar in the mother's blood causes the baby to grow too big and fat, particularly in the shoulders and trunk. Vaginal delivery is harder on the baby and mother. Also, because of the extra sugar that the baby is getting, the baby's pancreas is making extra insulin. After birth, the baby may have a tough time stopping the extra insulin production. These newborns are at higher risk of breathing difficulties, low blood sugar levels and jaundice.
"It's even more important for women with diabetes pre-conceptually be in optimal health," says Francine Kaufman, M.D., past president of the American Diabetes Association. "Women should do this even if they aren't pregnant and not planning to be. They need these vitamins and good glucose control during the early weeks when there is the major formation of fetal development."
More than half of all pregnancies, regardless of diabetes, are unplanned. So, be sure to take at least 400 mcg of folic acid every day, starting a month before conception and lasting through the first few months of the pregnancy to decrease the risk of neural tube defects. Folate is in beans, green leafy vegetables, liver, citrus fruits and juices, and whole-wheat bread. However, the folic acid in fortified foods and supplements is almost twice as well absorbed as the dietary form.
"Chromium helps to maintain glucose uptake into the cells," she says. "It goes into the cell and helps the transport of glucose into the cell and thereby helps to regulate the blood sugar. Good food sources are egg yolk, bran, mushrooms and nuts. You should get between 50 to 200 micrograms a day."
Be careful to not to take too many vitamins, Dolan says. Overdoses of vitamin A are particularly dangerous and can cause birth defects.
"Birth defects are an elusive and complicated process," she says. "This study helps us learn more about how to prevent them."
This article was reviewed and updated June 2007.
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