Diabetes and Pregnancy
If you have diabetes, pregnancy presents special challenges that most women never need to worry about. Pregnancy can cause such drastic fluctuations in blood sugar that even women who do not have diabetes can acquire it temporarily while they are pregnant, a condition known as gestational diabetes. If you already have diabetes, it is important to begin managing your condition as early as possible, ideally before you become pregnant. In this article we will discuss the management of diabetes and pregnancy.
Your Pregnancy Diabetes Healthcare Team
It is important to see an ob-gyn regularly during pregnancy, but if you have pre-gestational diabetes, your regular doctor may also want you to see an endocrinologist or a maternal fetal medicine specialist. Your doctor may also want you to see an eye specialist, as diabetes during pregnancy can cause damage to the small blood vessels in your eyes. It may also be helpful for you to see a registered dietician.
Risks of Pregnancy Diabetes
If your blood glucose levels get too high while you are pregnant, you are likely to experience a worsening of existing long-term problems related to your diabetes, such as heart and kidney disease, foot problems, and eye problems. You and your baby will also be at increased risk for:
- Macrosomia—this is when a baby is unusually large (over nine pounds) at birth. Risk for this condition rises with diabetes and pregnancy. If you have poor control over your blood sugar, the excess glucose can cause your baby’s pancreas to manufacture an excess of insulin, which can cause him or her to grow too large while still in the womb. This can cause problems during childbirth, and may lead to a C-section delivery.
- Breathing difficulties for the newborn
- Infant hypoglycemia, a condition that results in chronic low blood sugar after the baby is born
- Birth defects—a particular concern if your pregnancy is unexpected. The baby’s organs are forming during the first eight weeks of pregnancy, and out-of-control blood sugar can do the most harm during this time, especially to the formation of the heart, spine, and brain.
- Preeclampsia, a potentially life-threatening condition that involves high blood pressure and excess protein in the urine during pregnancy
- Baby developing obesity or diabetes later in life
- Depression during your pregnancy
- Miscarriage or stillbirth
Fortunately, studies have shown that women who properly manage their diabetes and pregnancy are at no greater risk for most of these problems than women who do not have pregnancy diabetes. Again, high blood glucose levels present the greatest danger to the baby during the first eight weeks of pregnancy, so it is important to get control of your blood sugar as early as possible. Good blood sugar control during pregnancy also helps to prevent neonatal jaundice.
Blood Sugar Control
If you have diabetes, you probably already know what your blood glucose levels should be and why it’s important to monitor them. Your doctor will be able to tell you how these numbers can be expected to change during pregnancy, and how your routine may need to change while you are pregnant.
A great many variables will combine to make your pregnancy unique with respect to your diabetes—for example, the degree to which you experience morning sickness. Some medications for diabetes are not recommended for pregnant women, and pregnancy affects blood sugar and insulin levels differently at different stages (during the third trimester, for example, hormones manufactured by the placenta can block the effect of insulin in your body, requiring you to take a higher dosage). Accordingly, your doctor may want to change the dosage of any diabetes medication you are taking, or possibly even change medications.
As a general rule of thumb, your Target Blood Glucose Numbers (mg/dL) should be less than 90 upon waking up, and less than 120 two hours after you have eaten. While you are pregnant, you will need to check your blood glucose several times each day, usually first thing in the morning (before you have eaten breakfast) and two hours after each meal.
Pregnancy Diabetes Management
The timing of delivery is important in patients with gestational or pre-gestational diabetes. Usually your doctor will recommend delivery at 39 weeks. If you are not on medication and your sugars are well controlled, some may recommend 40 weeks. You can also expect to have a special test for your baby called a non-stress test. This is usually done twice a week to ensure your baby’s well being. Ultrasounds are also used to monitor your babies growth.
In general, many of the best ways to manage diabetes and pregnancy are good health habits for anyone: exercise regularly and eat a balanced diet consisting of plenty of vegetables, fruits, and whole grains (see Pregnancycorner’s article about proper nutrition during pregnancy). Make sure to take whatever prenatal vitamins your doctor recommends, and be sure to remember that folic acid is especially important during pregnancy. If you remember to take your insulin or other medication on time and as directed, and if you see your doctor for regular check-ups before and during your pregnancy, diabetes should cause no serious problems for you or your baby.