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Complications of
Diabetes
Two aspects of diabetes
complications need to be considered when a woman is contemplating pregnancy. First, there is the impact of the
pregnancy on diabetic com-plications and maternal health, and second, the effects of diabetic complications on
fetal health.
• Diabetic retinopathy: New diabetic retinopathy can suddenly appear during
pregnancy, and retinopathy that is already present can get worse. There are two possible reasons for the
deterioration: First, if your diabetes control has been poor and you suddenly tighten it over a short period of
time (such as getting ready for pregnancy), the rapid improvement itself can cause a flare-up of the retinopathy.
Second, the hormonal and circulatory changes that occur in pregnancy may worsen the retinopathy. If you have
significant retinopathy before you become pregnant, you might require treatment during the pregnancy. Therefore,
you will need to see an ophthalmologist before and during the pregnancy. The retinopathy usually improves after
the pregnancy.
• Diabetic kidney disease: If you have kidney disease secondary to your diabetes,
pregnancy can make the kidney disease worse. Often the kidney disease will recover after delivery, but it may
not if the prepregnancy kidney failure is more severe. Women with diabetic kidney disease who are contemplating
pregnancy should therefore consider getting an opinion from a nephrologist (kidney doctor).
• Preeclampsia: Preeclampsia is a serious condition where there is severe elevation
in blood pressure, fluid retention, and protein loss. It occurs more often in women with diabetes. About 15 to 45
percent of women with diabetes who have microalbuminuria develop preeclampsia. Hospitalization and early
delivery may be necessary.
• Blood pressure medications: If you are taking ACE inhibitors to control your blood
pressure, your doctor will switch you to other blood pressure medicines because ACE inhibitors cannot be taken
during pregnancy.
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