Diabetes and Pregnancy

Pregnant woman eating fresh fruitsWomen who know they are diabetic should get themselves into the best shape possible, even before trying to get pregnant. They should be under the care of someone who understands the needs of diabetics during their child-bearing years. A “preconception checkup” is essential. There is a lot of research showing that poorly-controlled diabetes before pregnancy is associated with a higher risk of congenital abnormalities, as well as the death of the baby soon after birth. If diabetes is controlled before and during your pregnancy, the risks will go down significantly, but are still higher than in women without diabetes.

In addition to finding out how well-controlled a woman’s diabetes is, the preconception checkup, which includes laboratory tests, let the doctor know whether or not she has other diseases associated with diabetes, such as heart disease. Some conditions, such as high blood pressure, may need to be treated before pregnancy, and will continue to be treated during pregnancy. Other conditions will be monitored closely, including any damage to the kidneys or the back of the eyes.

Ideally, pregnant diabetic women should be followed by a team specializing in their care. This would include an obstetrician experienced in managing high-risk pregnancies. Other team members might include a doctor specializing in the care of diabetics, a dietitian, and a nurse.

Both type 1 and type 2 diabetics must have their sugars controlled. Type 1, or insulin-dependent diabetes, is due to a lack of insulin and is treated with insulin. Type 2 diabetes is caused by insensitivity to insulin, as well as a relative lack of insulin. It is usually managed by diet and oral medications, but is often treated with insulin during pregnancy.

There is another group of women who only have diabetes during pregnancy, called gestational diabetes. This is discovered by doing an oral glucose tolerance test during the middle of the pregnancy. Whether or not, and when, to do this test depends on the woman’s weight and her personal and family history, which might point to a risk of diabetes. Some doctors screen all their pregnant patients for gestational diabetes. Those who have it may be able to control their blood sugars with diet and exercise. Those who still have elevated blood sugars may need insulin or an oral agent.

If you are pregnant and have diabetes, your insulin dosage must be carefully adjusted and your blood sugars monitored. Elevated blood sugars are risky for both the mother and the baby. If blood sugars are near normal when pregnancy begins, and this continues throughout the first three months, the risks to mother and baby are the lowest possible. Very high blood sugar early in pregnancy significantly increases the risk of a miscarriage, as well as congenital abnormalities.

Low blood sugar is also very dangerous. For this reason, blood sugar control should be good, but the ideal sugars should not be quite as low as in women who are not pregnant. Insulin will be given by multiple daily injections in order to adjust to the dose as needed. An insulin pump may also be used.

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Patients with type 2 diabetes may be told to stop their oral medicine and start insulin before getting pregnant, or if they are already-pregnant and on oral medicine, they are often switched to insulin. (One oral medication that can be continued is metformin.) Some of the other oral medications used to treat type 2 diabetes may cause damage to the fetus. There are studies going on to discover if any of them are safe. It is harder to adjust dosages of oral medication than insulin, which is another reason insulin may be used.

To best control blood sugar, as well as manage weight gain, pregnant women need the help of a dietician. Eating the right amount and types of food and getting appropriate exercise are very important.

The size of the growing fetus will be watched carefully. Because babies born to diabetic mothers can be abnormally large, delivery is usually suggested at 38 weeks of pregnancy. This may be by induced labor or C-section. Blood sugars must be monitored and insulin used as necessary during labor, delivery, and afterward.

The most important thing for women with diabetes to remember is that getting their blood sugars under control before they try to conceive will greatly affect the outcome of their pregnancy.

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Diabetes and Pregnancy

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11 comments

  1. Yamileth says:

    Don’t feel bad I had 2 miscarriages my self and this is my 4 pregnancy i have 1 baby that is 7 years now and my pregnancy is going well just fallow the doctor directions and you see that everything is going to go well. and good luck to you!!

  2. Yamileth says:

    I did had gestational diabetes at my first pregnancy, and it went away
    but it came bake 2 years later as a DIABETES 2.
    Now I"M pregnant again. I am 10 weeks 2 days..
    I HAVE A QUESTION ABOUT THE INDUCE LABOR OR C-SECTION
    Do I have to have these 2 options or i can deliver as a regular woman do?

  3. Bebe+Emmys says:

    Oh and now I have to get tested around 6 weeks after birth because once you have gestational diabetes you have an increased risk of it turning into regular diabetes.

  4. Bebe+Emmys says:

    I had Gestational diabetes. It’s not as easy as they make it sound! Trust me! You feel so off when your levels are not right. Having to poke your finger up to 6 times (sometimes more) a day, I was up to 3 insulin shots a day. And they also don’t mention that it can make your placenta deteriorate faster… My little girl only gained 2oz in the last 2 weeks of my pregnancy because of this. She also came out smaller rather then bigger. My son was bigger then her and I didn’t have it with him. Now that I’ve had it, my specialist said I’ll probably have it with any pregnancy after.

  5. Wow! I learned a lot!

  6. Mom2Be2013 says:

    I have type 2 diabetes. This is my second pregnancy. First was a miscarriage. So, I am super nervous, super scared and praying harder then ever that this time everything works out well. I have waited 11 years for this.

  7. Niek says:

    I think it’s really nice that they websites u can lern from

  8. Niek says:

    I don’t really know any other people that has had diabetes prior to being pregnant

  9. Niek says:

    I have had diabetes for 8 yrs. now. So this being my first pregnancy I’m nerves scaredand praying hard that everything goes ok. So far I’m 21 weeks & things are going fine.

  10. Sasoo says:

    My sis had it b/c she was very ill throughout and could only stomach plain/starchy foods. I’m trying to stay away and very conscious of the possibility.

  11. McKenzie says:

    I had gestational diabetes with my second child hopeing I will not get it with my third one.

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