Pregnant women who have diabetes before becoming pregnant have special health concerns. In addition to the new demands that pregnancy puts on the body, women with diabetes must also carefully monitor and control their blood sugar levels and manage their diabetes medications.
If you have diabetes and would like to get pregnant, there are steps you can take to lessen the risks to you and your baby.
Diabetes Pregnancy Preparation
Meeting with your health care provider before becoming pregnant is very important to ensure a healthy pregnancy. Your health care provider can help you determine if your diabetes is controlled well enough for you to stop your birth control method. A blood test called the glycosylated hemoglobin test (HbA1c) can help evaluate how well your diabetes has been controlled over the past eight to 12 weeks.
Having other medical tests before you become pregnant can also help your diabetes health care provider monitor your health and prevent the development of diabetic complications during pregnancy. Your health care provider may recommend tests that include:
- A urinalysis to screen for diabetic kidney complications
- Cholesterol and triglyceride blood tests
- Eye exam to screen for diseases common in diabetics such as glaucoma, cataracts, and retinopathy
- Blood work for renal and liver function
- Diabetic foot exam
A pre-conception counseling appointment with your health care provider is another important step in preparing for pregnancy. Pre-conception counseling helps educate women so they can be physically and emotionally prepared — and healthy — for pregnancy.
Diabetes Pregnancy and the Importance of Blood Sugar Control
Good blood sugar control is important before becoming pregnant, because many women do not even know they are pregnant until the baby has been growing for two to four weeks. High blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects. They also can increase the risks of miscarriage and diabetes-related complications.
Good blood sugar control means keeping blood glucose levels within the ideal range (70 to 100 mg/dL before meals, less than 120 mg/dL two hours after eating, and 100-140 mg/dL before the bedtime snack), as well as balancing meals, exercise, and diabetes medications.
How Diabetes and Pregnancy May Affect Baby
A common problem among the babies of pregnant women with diabetes is a condition called “macrosomia,” which means “large body.” In other words, babies of diabetic women are apt to be considerably larger than others.
This occurs because many of these babies receive too much sugar via the placenta, because their mothers have high blood sugar levels. The baby’s pancreas senses the high sugar levels and it produces more insulin in an attempt to use up all the extra sugar. That extra sugar is converted to fat, making a large baby.
Sometimes, the baby becomes too large to be delivered vaginally, and a cesarean delivery becomes necessary. Your doctor will closely monitor your baby’s size and plan for the safest mode of delivery.
If you have high blood sugar levels consistently during pregnancy (especially in the 24 hours before delivery), your baby may develop dangerously low blood sugars right after delivery. This is because the baby has high levels of insulin to use up the extra sugars, and when that that source of sugar is suddenly taken away, his or her blood sugar levels drop quickly. Thus, many hospitals monitor babies of mothers with diabetes in the nursery for several hours after birth. If your baby’s blood sugar levels are low, the baby will be given glucose intravenously. Your baby may also have imbalances in calcium and magnesium levels, which can be replaced with medication.
Use of Diabetes Drugs During Pregnancy
If you take insulin to control your diabetes, your health care provider can tell you how to adjust your medication. Generally, your body will require more insulin during pregnancy, especially during the last three months.
If you take oral medications to control your diabetes, your health care provider may switch your medication to insulin during pregnancy, because the safety of using certain oral medications may not be known and/or better sugar control may be achieved with insulin.
Diabetes and Pregnancy Diet
During pregnancy, you and your health care provider should work together to adjust your diet. Changing your diabetes diet will help you avoid problems with low and high blood sugar levels. Your meal plan will also be adjusted to include more calories for your growing baby.
Diabetes and Pregnancy: Will I Be Able to Carry My Baby to Term?
Women with mild diabetes or who are very well controlled often carry their baby to term without any problems. However, many health care providers prefer to plan for an early delivery, usually around weeks 38-39.
Diabetes and Pregnancy, Controlling Blood Sugar During Labor and Delivery
Blood sugar control remains important even during labor, which can be a stressful time for the mother and the baby. If you have been taking insulin during your pregnancy, you may be given insulin by injection or intravenously when labor begins. Insulin requirements often drop rapidly immediately after delivery.
This information is provided by WebMD.