Pregnancy: Myths and truths about hormones and diabetes

Answers to four fundamental questions that concern every expectant mother about her own health and that of the fetus.

1) I shouldn't take a "thyroid pill" because it can harm the child

Thyroid drug treatments are categorized into thyroxine replacement therapy for hypothyroidism and antithyroid medications for hyperthyroidism. Both conditions can threaten fetal development and maternal health, requiring treatment when necessary.

Particularly in the more prevalent hypothyroidism during pregnancy, insufficient thyroxine for the developing fetus can result in spontaneous abortions and developmental issues in the brain and heart. The term "cretinism" used to describe the mental retardation in children of untreated hypothyroid women during pregnancy or children born with a genetic thyroid disorder.

2) Besides thyroid and sugar, there is no need for me to have anything else evaluated by an endocrinologist before and during pregnancy.

Aside from uncommon hormonal disorders that require ongoing monitoring by an endocrinologist, for which pregnant women typically receive guidance prior to pregnancy, calcium metabolism is a crucial aspect of monitoring during pregnancy. Sufficient levels of vitamin D and calcium are essential not only for the proper development of the fetus's skeleton but also for preserving the mother's bone mass. Pregnancy and breastfeeding are circumstances that, without adequate support, can result in a significant reduction in bone mass and early onset osteoporosis.

3) Gestational diabetes is rare and is controlled only with insulin

Besides women already diagnosed with Diabetes Mellitus who require special care during pregnancy, the occurrence of Diabetes during pregnancy is quite common. Depending on ethnicity, about 10 to 25% of pregnant women will develop gestational diabetes needing specialized management. Contrary to popular belief, gestational diabetes is not always associated with insulin. In fact, around 80% of pregnant women can manage their high blood sugar levels through special nutritional plans, guided by a diabetologist and nutritionist.

There are specific laboratory thresholds for diagnosing and monitoring gestational diabetes, and if a special diet does not yield the desired results, medication is advised. Insulin can often be restricted to a single daily injection, while oral medications like metformin have been approved in several countries, though insulin tends to be more effective. Managing gestational diabetes is crucial as it can result in macrosomia (overweight babies with delivery complications), preeclampsia (dangerous high blood pressure with organ damage), and neonatal hypoglycemia.

4) Post-childbirth, the hormonal and diabetic issues that arose are resolved.

Following delivery, it is essential to reassess and frequently adjust or discontinue the hormonal or anti-diabetic treatments used during pregnancy. Nevertheless, the risk of developing the conditions that necessitated these treatments persists, whether in future pregnancies or in general.

Moreover, certain hormonal issues can arise during the postpartum period, up to 12 months after pregnancy, which may sometimes be challenging to differentiate from postpartum depression, persistent tachycardia, and other common symptoms. The role of the attending gynecologist or even the pediatrician is crucial in directing the new mother to an endocrinologist if hormonal issues are suspected.