Managing Diabetes During Pregnancy: What You Should Know
By Julia Cruz
Beth Israel Deaconess Medical Center correspondent
Pregnant moms want healthy babies. That should go without saying. But when it comes to either pre-existing diabetes or gestational diabetes, mothers-to-be need to focus on their own health to protect the health of their unborn child.
What Is Gestational Diabetes?
Gestational diabetes is defined as hyperglycemia, or high blood sugar, that is less severe than overt diabetes and first appears in pregnancy. We all need glucose, or blood sugar to live. Glucose is the main source of energy for our bodies. Our glucose levels are associated with the foods we eat (mainly carbohydrates) and controlled by the pancreas, which produces insulin to help manage glucose levels.
But women with gestational diabetes aren't able to produce enough insulin to keep those glucose levels in check. In addition, they are more likely to have insulin resistance, which means that insulin does not work as well in their bodies. Women who are overweight or obese are more likely to have insulin resistance and have a higher risk of developing gestational diabetes.
"Women who are diagnosed with gestational diabetes need to monitor their blood sugar, watch what carbohydrates they eat, and in some cases take insulin to maintain proper glucose levels," says Dr. Florence Brown, Co-Director of the Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program.
What Is Pre-existing Diabetes?
Pre-existing diabetes refers to diabetes that is diagnosed before pregnancy. Type 1 diabetes usually occurs in children and young adults, while Type 2 diabetes generally develops during adulthood. Type 1 diabetes develops when the immune system attacks the body's own cells that make insulin. Type 2 diabetes occurs when the insulin does not work well because it is "resistant" to insulin and also does not make enough insulin to control blood glucoses. Women with both Type 1 and Type 2 diabetes need insulin to control blood glucoses usually starting before pregnancy. .
"The reason why diabetes can develop during pregnancy is because the placenta produces hormones that increase insulin resistance in women," says Dr. Karen O'Brien, a high-risk pregnancy specialist in the Division of Maternal-Fetal Medicine at Beth Israel Deaconess Medical Center.
Risks For Mother And Baby
Pre-existing diabetes and gestational diabetes can put an expectant mother at risk for preeclampsia. They can also lead to problems for the baby including jaundice, respiratory distress syndrome, low blood sugar (hypoglycemia), low calcium levels, and a condition called macrosomia, or big baby syndrome, where the baby weighs more than 8 pounds, 13 ounces.
"The concern about big babies is that they may become overweight or obese as children," says Dr. Brown. "Big babies also increase the risk of complications related to vaginal birth and potential need for a cesarean delivery."
In addition, women with gestational diabetes have a 50 percent risk of developing Type 2 diabetes within seven to 10 years of their pregnancy. Nevertheless, a healthy diet and regular exercise after pregnancy and mild weight loss after pregnancy can reduce this risk.
Additional Risks for Women with Pre-Existing Diabetes
There is an increased risk of birth defects in infants of mothers with preexisting diabetes, especially if the diabetes is not well controlled. Women who have already been diagnosed with diabetes before becoming pregnant will likely be well accustomed to keeping track of their blood sugar levels, taking insulin and watching their carbohydrate intake.
"It is very important that they closely monitor blood glucose levels before pregnancy, as high blood sugar levels can be harmful, especially in the first few weeks of pregnancy when the baby's heart, lungs, brain and kidneys are developing," notes Dr. Brown.
Your primary care physician will likely recommend a preconception consultation to address any potential pregnancy issues and get a baseline glucose tolerance level.
"That's often the case even for women who don't have pre-existing diabetes, but who are at higher risk of developing it," says Dr. O'Brien.
Pregnant women with pre-existing diabetes also face additional health risks, including eye diseases such as macular edema and proliferative retinopathy.
"Women with pre-existing diabetes need to be watched closely with dilated eye exams in each trimester during pregnancy," recommends Dr. Brown.
Severe low blood glucose is also very common in the pregnancies of women with preexisting diabetes because normal glucose levels are being targeted and there is a fine line between blood glucoses that are normal and too low.
Best Practices for Healthy Mom and Baby
While the risks may seem frightening, staying healthy and having a healthy baby if you're diabetic or develop gestational diabetes is absolutely possible. Beth Israel Deaconess Medical Center and the Joslin Diabetes Center have teamed up to bring the best medical care and diabetes monitoring to expectant mothers.
"Diet and exercise are the first lines of treatment for gestational diabetes," says Dr. Brown.
At the Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program, expectant moms are coached on healthy eating practices like counting carbs and the "plate method" (filling half your plate with veggies, one quarter lean meat and one quarter whole grains).
Women who don't have diabetes but are overweight and at risk for developing it are also encouraged to lose weight before they become pregnant.
"Reducing your overall weight by even five percent can dramatically decrease your risk for developing diabetes," notes Dr. O'Brien.
Exercise should be limited to activities you were already doing before you became pregnant and in some cases, low impact versions of those activities. Be sure to check with your obstetrician or primary care physician for the best exercises for you.
"Even just walking 10 to 15 minutes right after eating a meal will improve the blood sugar control at one hour after a meal," suggests Dr. Brown. "You don't have to jog. Just walk."
Most importantly, keep checking your blood glucose levels throughout the day as recommended by your physician. Dr. Brown recommends women with gestational diabetes test before breakfast and one hour after each meal. The experts at the Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program work together with expectant moms to monitor levels and adjust insulin as needed.
"It's a team approach to diabetes care and everybody participates," says Dr. Brown. "We see the patients here but we also have them contact us regularly through e-mail or fax. They send in their blood sugars weekly so we can review them and try to control their blood sugars by small frequent insulin adjustments."
"It's really a partnership between our two hospitals and the mom. We all work together to monitor and manage blood sugar levels and be vigilant about exercise and diet," says Dr. O'Brien. "In most cases, diabetes is not a reason not to conceive. As long as we can control glucose levels, all the risks can be minimized."
Above content provided by Beth Israel Deaconess Medical Center in partnership with the Joslin Diabetes Center. For advice about your medical care, consult your doctor.
Posted November 2012