Diabetes and Pregnancy

Pregnant women who have diabetes before getting pregnant have special health concerns, such as keeping blood glucose (sugar) levels in good control, managing diabetes medicines, adjusting meal plans, and exercising regularly.

Preparing for pregnancy

Meeting with your health care provider before becoming pregnant is very important to ensuring a healthy pregnancy. Your diabetes 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 your health care provider evaluate how well your diabetes has been controlled over the past 6 to 12 weeks. This test is used along with home glucose monitoring to make treatment adjustments.

Having other medical tests before you become pregnant can help your diabetes health care provider monitor your health and prevent the development of diabetes-related complications during pregnancy. Some of the tests your health care provider might order include:

• A urinalysis to screen for diabetes-related kidney complications
• Cholesterol and triglyceride blood tests
• Eye exam to screen for glaucoma, cataracts, and retinopathy

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. A pre-conception appointment usually includes:

1. An evaluation of your weight: Your healthcare provider will tell you to try to reach your ideal body weight before becoming pregnant. This means losing weight if you are overweight to reduce your risk of high blood pressure complications, or gaining weight if you are underweight to reduce the risk of delivering a low birth-weight baby.
2. A discussion of your lifestyle: Smoking and drinking alcohol are two habits that must be stopped in order for you to have a healthy pregnancy.

   Smoking during pregnancy affects you and your baby's health before, during, and after your baby is born. The nicotine (the addictive substance in cigarettes), carbon monoxide, and numerous other poisons you inhale from a cigarette are carried through your bloodstream and go directly to your baby. Smoking while pregnant will:

   • Lower the amount of oxygen available to you and your growing baby.
   • Increase your baby's heart rate.
   • Increase the chances of miscarriage and stillbirth.
   • Increase the risk that your baby is born prematurely and/or born with low birth weight.
   • Increase your baby's risk of developing respiratory problems.

   Smoking may increase the risk of having an ectopic pregnancy placental problems (placenta previa or placenta abruption) and vaginal bleeding. Second and third hand smoke exposure can also be harmful. During pregnancy, drinking alcohol can cause miscarriage, preterm birth and stillbirth. Stop drinking if you suspect you are pregnant. Excessive drinking can lead to fetal alcohol syndrome, a pattern of birth defects that includes mental retardation, as well as cardiovascular, skeletal, and facial abnormalities.

3. An evaluation of your diet and a discussion of prenatal vitamins ” Before considering pregnancy, you should begin taking a daily vitamin that contains folic acid. Folic acid has been shown to decrease the risk of having a baby with a neural tube defect, such as spina bifida a serious condition in which the brain and spinal cord do not form normally. The March of Dimes Birth Defects Foundation recommends taking 400 micrograms of folic acid daily before conception and in early pregnancy. Many pharmacies sell over-the-counter prenatal vitamins that do not require a prescription.

Controlling blood glucose

Good blood glucose control means keeping blood glucose levels within the ideal range 70 - 100 mg/dl (3.9 5.6 mmol/L) before meals, less than 140 mg/dl (7.8 mmol/L) two hours after eating, and 100-140 mg/dl (5.6 7.8 mmol/L) before bedtime snack), as well as balancing meals, exercise, and diabetes medicines.

Good blood glucose 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 glucose levels early in the pregnancy (before 13 weeks) can cause birth defects.

Good blood glucose control is just as important during pregnancy because high blood glucose levels can increase the risk of miscarriage and can increase your risk of developing diabetes complications.

Medicine management

If you take insulin to control your diabetes, your health care provider can tell you how to adjust your medicine. Generally, your body will require more insulin during pregnancy, especially during the last three months of pregnancy.

If you take oral medicines to control your diabetes, your health care provider might switch your medicine to insulin during pregnancy, since certain oral medicines could harm the developing baby.

Meal planning

During pregnancy, you and your healthcare provider should work together to adjust your meal plan. Changing your meal plan will help you avoid problems with low and high blood glucose levels. Your meal plan will also be adjusted to include more calories for your growing baby.