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Living with Diabetes
Pre-pregnancy & Diabetes
The number of women who begin their pregnancies with diabetes has doubled since 1999. Whether a woman has type 1 or type 2 diabetes, pregnancy presents unique challenges. You may be concerned about the effect diabetes may have on your health and your baby's health. But there's much you can do to promote a healthy pregnancy.
Controlling blood glucose levels is the best way to prevent diabetes complications for your baby. Good blood glucose control reduces the risk of miscarriage and stillbirth, the primary concerns for pregnant women with diabetes. Blood glucose control during early pregnancy greatly decreases your baby's risk of birth defects, particularly those affecting the brain, spine and heart.
If you have high blood glucoses, the extra glucose can cross the placenta. This triggers your baby's pancreas to make extra insulin, which can cause your baby to grow too large. A large baby makes delivery difficult and puts the baby at risk of injury during birth. Sometimes babies of mothers who have diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high and they are no longer getting glucose from the mother. The good news is that pregnancies where blood glucose is well controlled have no higher risk of infant death than any other pregnancy.
Good blood glucose control also decreases the risk of high blood pressure and other potentially serious pregnancy complications for the mother. It can also keep existing diabetes complications, especially eye disease (retinopathy), from getting worse.
Your diabetes health care team likely includes a diabetes specialist, a diabetes educator, and a registered dietitian. As your pregnancy progresses, your health care team can help you manage your blood glucose level and adjust your diabetes treatment plan as needed. During pregnancy, you need to consult other specialists, including an obstetrician. Choose an obstetrician who handles high-risk pregnancies or has cared for other pregnant women who have diabetes. Your obstetrician will carefully monitor your health and your baby's health throughout the pregnancy. If you have retinopathy, an ophthalmologist should also be part of the care team.
What to do if you have diabetes and are thinking of becoming a mom:
- Discuss your plans to become pregnant with your health care provider and manage blood glucose tightly prior to becoming pregnant
- Talk to your health care provider about your options to monitor and control blood glucose during pregnancy
- Women with diabetes who have uncontrolled retinopathy, severe gastric complications, are in kidney failure or have certain heart conditions may be advised to avoid pregnancy
- If you are taking oral medications for diabetes, or medications for blood pressure or other medical conditions you need to discuss with your health care provider whether they should be discontinued prior to you becoming pregnant
Diabetes & Pregnancy
Pregnancy is a time of great anticipation, but combining diabetes with pregnancy can cause health concerns. The good news is that medical management can greatly reduce risks for both mother and baby. Women are encouraged to seek medical care at least three months before they plan to have a baby so their health care provider can help them control blood sugar and increase their intake of folic acid.
Pre-pregnancy diabetes is different from gestational diabetes. Gestational diabetes develops during pregnancy and usually goes away shortly after delivery. In the US, gestational diabetes affects 4% to 8% of pregnant women and this percent has not changed over time. In contrast, the number of women with pre-pregnancy diabetes has more than doubled in the last seven years. This is probably because the overall number of women with diabetes is growing.
If you have diabetes and are pregnant, tight glucose control throughout your pregnancy is an important goal. Expectant mothers who don’t control their diabetes have an increased risk of miscarriage, stillbirth, and birth defects. In addition, high blood glucoses during pregnancy may result in delivering a larger baby and a more difficult delivery. Increased monitoring and frequent check ups can provide reassurance that your pregnancy and delivery will proceed routinely for a healthy mother and baby.
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