Pre-existing diabetes and pregnancy
If you have diabetes, it can affect your pregnancy, your health, and your baby's health. Keeping blood sugar (glucose) levels in a normal range all through your pregnancy can help prevent problems.
Diabetes - Animation
Diabetes is on the rise worldwide, and is a serious, lifelong disease that can lead to heart disease, stroke, and lasting nerve, eye and foot problems. Let's talk about diabetes and the difference between the three types of diabetes. So, what exactly is diabetes and where does it come from? An organ in your body called the pancreas produces insulin, a hormone that controls the levels of your blood sugar. When you have too little insulin in your body, or when insulin doesn't work right in your body, you can have diabetes, the condition where you have abnormally high glucose or sugar levels in your blood. Normally when you eat food, glucose enters your bloodstream. Glucose is your body's source of fuel. Your pancreas makes insulin to move glucose from your bloodstream into muscle, fat, and liver cells, where your body turns it into energy. People with diabetes have too much blood sugar because their body cannot move glucose into fat, liver, and muscle cells to be changed into and stored for energy. There are three major types of diabetes. Type 1 diabetes happens when the body makes little or no insulin. It usually is diagnosed in children, teens, or young adults. But about 80% of people with diabetes have what's called Type 2 diabetes. This disease often occurs in middle adulthood, but young adults, teens, and now even children are now being diagnosed with it linked to high obesity rates. In Type 2 diabetes, your fat, liver, and muscle cells do not respond to insulin appropriately. Another type of diabetes is called gestational diabetes. It's when high blood sugar develops during pregnancy in a woman who had not had diabetes beforehand. Gestational diabetes usually goes away after the baby is born. But, still pay attention. These women are at a higher risk of type 2 diabetes over the next 5 years without a change in lifestyle. If you doctor suspects you have diabetes, you will probably have a hemoglobin A1c test. This is an average of your blood sugar levels over 3 months. You have pre-diabetes if your A1c is 5.7% to 6.4%. Anything at 6.5% or higher indicates you have diabetes. Type 2 diabetes is a wake up call to focus on diet and exercise to try to control your blood sugar and prevent problems. If you do not control your blood sugar, you could develop eye problems, have problems with sores and infections in your feet, have high blood pressure and cholesterol problems, and have kidney, heart, and problems with other essential organs. People with Type 1 diabetes need to take insulin every day, usually injected under the skin using a needle. Some people may be able to use a pump that delivers insulin to their body all the time. People with Type 2 diabetes may be able to manage their blood sugar through diet and exercise. But if not, they will need to take one or more drugs to lower their blood sugar levels. The good news is, people with any type of diabetes, who maintain good control over their blood sugar, cholesterol, and blood pressure, have a lower risk of kidney disease, eye disease, nervous system problems, heart attack, and stroke, and can live, a long and healthy life.
This article is for women who already have diabetes and who want to become or are pregnant. Gestational diabetes is high blood sugar that starts or is first diagnosed during pregnancy.
How Diabetes Can Affect You and Your Baby
Women who have diabetes face certain risks during pregnancy. If diabetes is not well-controlled, the baby is exposed to high blood sugar levels in the womb. This can cause birth defects and other health problems in babies.
A fetus (baby) of a mother with diabetes may be exposed to high blood sugar (glucose) levels, and high levels of other nutrients, throughout the preg...Read Article Now Book Mark Article
The first 7 weeks of pregnancy are when a baby's organs develop. This is often before you may know you are pregnant. So it is vital to plan ahead by making sure your blood glucose levels are in the target range before you get pregnant.
While it is scary to think about, it's important to know what problems can occur during pregnancy. Both mom and baby are at risk for complications when diabetes is not well-controlled.
Risks for the baby include:
- Birth defects
- Early birth
- Loss of pregnancy (miscarriage) or stillbirth
A miscarriage is the spontaneous loss of a fetus before the 20th week of pregnancy. Pregnancy losses after the 20th week are called stillbirths. Mi...Read Article Now Book Mark Article
- Large baby (called macrosomia) causes increased risk of injury at the time of birth
- Low blood sugar after birth
- Breathing difficulty
- Obesity in childhood and adolescence
Risk for the mother include:
- An extra-large baby may lead to a difficult delivery or C-section
- High blood pressure with protein in urine (preeclampsia)
- Large baby can cause discomfort to the mother and increased risk of injury at the time of birth
- Worsening of diabetic eye or kidney problems
Diabetes can harm the eyes. It can damage the small blood vessels in the retina, the back part of your eye. This condition is called diabetic retin...Read Article Now Book Mark Article
Before You Get Pregnant
If you are planning a pregnancy, talk to your health care provider at least 6 months before getting pregnant. You should have good blood glucose control at least 3 to 6 months before you get pregnant and all during your pregnancy.
Talk with your provider about what your specific blood sugar goals should be before you get pregnant.
Before getting pregnant, you'll want to:
- Aim for an A1C level of less than 6.5%
- Make any changes needed to your diet and exercise habits to support your blood glucose and targets
- Maintain a healthy weight
- Schedule a pre-pregnancy exam with your provider and ask about pregnancy care
During your exam, your provider will:
- Check your hemoglobin A1C
- Check your thyroid level
- Take blood and urine samples
- Talk with you about any diabetes complications such as eye problems or kidney problems or other health problems such as high blood pressure
Your provider will talk with you about what medicines are safe to use and what are not safe to use during pregnancy. Often women with type 2 diabetes who take oral diabetes medicine will need to switch to insulin during pregnancy. Many diabetes medicines may not be safe for the baby. Also, pregnancy hormones can block insulin from working normally in the body (insulin resistance), so many diabetes medicines don't work as well.
You should also see your eye doctor and have a diabetic eye exam.
Pregnancy and Prenatal Care
During your pregnancy, you will work with a health care team to make sure you and your baby remain healthy. Because your pregnancy is considered high-risk, you will work with an obstetrician who specializes in high-risk pregnancies (maternal-fetal medicine specialist). This provider may do tests to check your baby's health. The tests may be done at any time while you are pregnant. You will also work with a diabetes educator and dietician.
Tests to check your baby's health
While you are pregnant, your health care provider may do tests to check your baby's health. The tests may be done at any time while you are pregnant...Read Article Now Book Mark Article
During pregnancy, as your body changes and your baby grows, your blood glucose levels will change. Being pregnant also makes it hard to notice symptoms of low blood sugar. So you will need to monitor your blood sugar as often as 8 times a day to make sure you stay in your target range. You may be asked to use continuous glucose monitoring (CGM) during this time.
Monitor your blood sugar
If you have diabetes, check your blood sugar level as often as instructed by your health care provider. Record the results. This will tell you how ...Read Article Now Book Mark Article
Here are common target blood sugar goals during pregnancy:
- Fasting: Less than 95 mg/dL
- One hour after a meal: less than 140 mg/dL, OR
- Two hours after a meal: less than 120 mg/dL
Ask your provider what your specific target range should be and how often to test your blood sugar.
You will need to work with your dietician to manage what you eat during pregnancy to help you avoid low or high blood sugar. Your dietician will also monitor your weight gain.
Pregnant women need about 300 extra calories a day. But where these calories come from matters. For a balanced diet, you need to eat a variety of healthy foods. In general, you should eat:
- Plenty of whole fruits and vegetables
- Moderate amounts of lean proteins and healthy fats
- Moderate amounts of whole grains, such as bread, cereal, pasta, and rice, plus starchy vegetables, such as corn and peas
- Fewer foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries
You should eat three small- to moderate-sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day. This can help you keep your blood sugar stable.
Your provider may also suggest a safe exercise plan. Walking is usually the easiest type of exercise, but swimming or other low-impact exercises can work just as well. Exercise can help you keep your blood sugar in control.
Labor and Delivery
Labor may start naturally or may be induced. Your provider may suggest a C-section if the baby is large. Your provider will check your blood sugar levels during and after delivery.
Inducing labor refers to different treatments used to start your labor. Treatments can also be used to augment your labor, which means to move it at...Read Article Now Book Mark Article
Your baby is more likely to have periods of low blood sugar (hypoglycemia) during the first few days of life and may need to be monitored in a neonatal intensive care unit (NICU) for a few days.
Low blood sugar is a condition that occurs when the body's blood sugar (glucose) decreases and is too low. Blood sugar below 70 mg/dL (3. 9 mmol/L) i...Read Article Now Book Mark Article
Once you arrive home, you will need to continue to closely watch your blood sugar levels. Lack of sleep, changing eating schedules, and breastfeeding can all affect blood sugar levels. So while you need to care for your baby, it's just as important to care for yourself.
When to Call the Doctor
If your pregnancy is unplanned, contact your provider right away.
Call your provider for the following diabetes-related problems:
- If you can't keep your blood sugar in the target range
- Your baby seems to be moving less in your belly
- You have blurred vision
- You are more thirsty than normal
- You have nausea and vomiting that won't go away
It's normal to feel stressed or down about being pregnant and having diabetes. But, if these emotions are overwhelming you, call your provider. Your health care team is there to help you.
Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
American Diabetes Association. 14. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S200-S210. PMID: 33298425 pubmed.ncbi.nlm.nih.gov/33298425/.
Centers for Disease Control and Prevention website. Type 1 or type 2 diabetes and pregnancy. www.cdc.gov/pregnancy/diabetes-types.html. Updated July 6, 2021. Accessed July 14, 2020.
Landon MB, Catalano PM, Gabbe SG. Diabetes mellitus complicating pregnancy. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 45.
The National Institute of Diabetes and Digestive and Kidney Diseases website. Pregnancy if you have diabetes. www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy. Updated January 2017. Accessed July 6, 2020.