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Managing Diabetes During Pregnancy: What You Should Know?

From the Joslin Diabetes Center, an affiliate of Beth Israel Deaconess Medical Center

Q. If I have diabetes, are there issues to consider before becoming pregnant?

The most important thing is recognition of the need to plan your pregnancy and establish preconception diabetes treatment goals. There are a number of steps you can take many months before pregnancy that have an impact for the whole pregnancy. If you haven't taken care of yourself beforehand and you haven't gotten your blood sugars under control before conception, the risk of miscarriage and birth defects is much greater. Your doctor will also check to see if you have any complications of diabetes such as eye or kidney disease that could impact your health and the health of your baby. That's why it's important to make an appointment with your physician before you get pregnant and develop a plan to be the healthiest you can be.

Not only should women who have diabetes talk to their doctors prior to becoming pregnant, but women who are at high risk of developing diabetes - who have a family member who has diabetes - should talk to their primary care physician before getting pregnant. Part of this discussion should be a fasting blood glucose test to make sure the level is not high and then ensure the person doesn't have diabetes that had gone undiagnosed.

Q. How does diabetes impact pregnancy?

Diabetes has great impact on pregnancy outcomes - making it a high-risk pregnancy. Patients really do need much more specialized care because their glucose needs to be controlled. Preterm delivery and hypertensive diseases of pregnancy are more common in pregnancies complicated by diabetes and the delivery may be complicated with a bigger baby. Still birth may occur when blood glucoses are very poorly controlled.

In the first trimester, if blood sugars are very high, birth defects can develop. The higher the blood sugar levels, the higher the risk of birth defects. Women who have very high blood sugar levels can have a 30 to 40 percent chance of birth defects. For women who have blood sugars that are well-controlled, the risk of birth defects decreases to about 2 percent, which is what we see in the general population.

Q. Does pregnancy affect the management of diabetes?

Changes in blood glucoses and insulin requirements occur throughout pregnancy. In the first few weeks of pregnancy, blood glucoses and insulin requirements may increase. This is followed by a decrease in blood glucoses and insulin requirements by approximately nine weeks of pregnancy.
Then, as the pregnancy progresses and the placenta begins to grow, it makes hormones that raise the blood sugar. Beginning around 16 to 20 weeks, we begin to see a rise in blood sugars. In order to prevent blood sugars from getting too high and out of control, we monitor the blood sugars and make frequent adjustments to the patient's insulin doses. If you have diabetes, the amount of insulin you need may double or triple by the end of pregnancy. It is also common for you to experience low blood glucoses because the "tighter" control of blood glucoses needed for pregnancy.

It is important to eat healthy food during pregnancy to avoid excessive weight gain. Excessive weight gain can also increase the risk of adverse pregnancy outcomes. Talk to your health care provider about the "plate method." To get a mental picture of what you should be eating, divide your dinner plate into one half and two quarters. You should put veggies and fruit on half of your plate and a lean meat and a whole grain on each of the quarters of your plate. You should also know how many carbohydrates to eat with meals. Avoid eating low-fiber processed carbohydrates, which can spike your blood glucoses.

During your pregnancy, you will also likely need more frequent eye exams to make sure that pregnancy does not cause changes in the back of your eye.

Q. Can unmanaged diabetes during pregnancy have a long-term impact on the baby?

High blood sugars during pregnancy lead to uncontrolled fetal growth, so babies are born large for their gestational age. Large birth-weight babies are more likely to be obese and can sometimes have impaired glucose metabolism as children. The prevalence of pre-existing diabetes in pregnancy is increasing and this relates to the rise in obesity of our population.

Q. What is gestational diabetes and how does it differ from Type 1 and Type 2 diabetes?

Gestational diabetes occurs because of the temporary insulin resistant state of pregnancy. It usually happens between the 26th and 30th week of pregnancy. There are some risk factors for gestational diabetes. If you are overweight or obese or had a baby that weighed more than nine pounds, or you have a family history of Type 2 diabetes or are 40 years of age and older, you have a much greater risk of gestational diabetes. Certain ethnic/racial groups are also more likely to develop gestational diabetes.

Unlike Type 1 or Type 2 diabetes, most women who are diagnosed with gestational diabetes during pregnancy will not have diabetes after they deliver, but their long term risk (of developing Type 2 diabetes) is very high - up to 50 percent in the first five to seven years after delivery. If you had gestational diabetes, it's important to continue good nutrition and maintain a regular exercise program, try to achieve normal weight or BMI, and see your physician regularly post-delivery.

Q. What would be the best advice for a woman with diabetes who is considering pregnancy?

The best advice is to make sure your blood sugars are under control before getting pregnant. You should try to lose weight by following a healthy diet and getting regular exercise, if you are overweight or obese, before pregnancy. Remember, it is important to monitor your blood glucoses and make careful insulin adjustments during pregnancy. It is common that women with preexisting diabetes tend to have large birth weight babies but overall, the outcomes are usually very good.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Updated September 2012

Contact Information

Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus
330 Brookline Avenue
Boston, MA 02215