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• Heart disease: During pregnancy, there is increase in blood volume and blood flow,
and this causes the heart rate to go up. A normal heart handles this increased demand without any problems, but
it can be a problem in
women with heart disease. The risk of heart disease is higher in women with long-standing, poorly controlled type 2
diabetes who also have high lipid levels and high blood pressure; and in women with type 1 diabetes who have
multiple complications with autonomic neuropathy and kidney disease. If you have any of these risk factors for
heart disease, you should get an evaluation from a cardiologist before becoming pregnant.
• Lipid therapy: The FDA has not approved cholesterol-lowering medicines for use
during pregnancy, and if you are taking any of these drugs, you should discontinue them. Women with diabetes who
have high triglyceride levels can develop pancreatitis during pregnancy. Therefore, if you have high
triglycerides before you become pregnant, you should work with your nutritionist to take whatever measures are
necessary to lower the triglycerides.
• Thyroid disease: You should be screened for thyroid disease before becoming
pregnant. If you are hypothyroid, your thyroid hormone replacement medication will need dose adjustments during
pregnancy.
• Gastroparesis: In the first trimester, diabetic gastroparesis can
worsen the nausea and vomiting of pregnancy, and sometimes women will need to be admitted to a hospital for
intravenous fluids and nutrition because they
get dehydrated and malnourished. Occasionally this problem continues throughout the pregnancy.
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