Diabetes Effect on Pregnancy
Common Health Issues

Diabetes Effect on Pregnancy

It’s not impossible to have a healthy pregnancy and a healthy baby if you have diabetes. But careful planning and establishing healthy habits and good blood glucose control are essential before you become pregnant. All your baby’s major organs are formed during the first 8 weeks of pregnancy. That’s before many women even know they are pregnant. If your blood glucose levels are out of control during this period, your baby could be seriously affected. That is why it is so important to have a full physical and an evaluation of your blood glucose control before you even begin trying to conceive.

DIABETES EFFECTS ON PREGNANCY

 

Risk

If you have diabetes, both you and your baby face additional risks compared to a woman who does not have diabetes and her baby. But those risks are not insurmountable.

 

In rare cases, serious diabetes-related problems can pose a significant risk to you or your baby. If you have severe cardiovascular disease, kidney failure, or crippling gastrointestinal neuropathy, think through your decision very carefully. Pregnancy can make these conditions worse, or it can lead to life-threatening conditions such as a stroke or heart attack.

 

Certain medication can risk the health of your baby. If you take sulfonylurea drugs, for example, you will have to discontinue them because of the potential for causing birth defects. Your doctor may suggest switching to insulin. Also, certain medications, such as ACE inhibitors, that you may be taking for other conditions will have to be switched to safer medications because of the potential danger for your baby.

 

 

The greatest risk to your baby is unstable blood glucose levels. This is especially critical during the first 3 months when all the baby’s organs are developing.

 

What You Should Do

Before You Conceive

First, schedule a pre-pregnancy visit with your primary care doctor, obstetrician, diabetes educator and other members of your health care team. You will want to discuss any specific risks you need to be aware of, any concerns you may have about the risks to your baby, and how to achieve and sustain good blood glucose control both before and during your pregnancy.

 

Your doctor should complete a thorough physical examination before you become pregnant. You will be evaluated for evidence of high blood pressure, heart disease, kidney disease, nerve disease and eye disease. If you have any of these problems, they should be treated before you consider pregnancy. Your doctor will probably take a blood sample and measure your glycated hemoglobin. This will tell how good your blood glucose control has been over time. If you have type 1 diabetes, your thyroid function should be evaluated. If you have had diabetes for more than 10 years or have any signs of heart disease, such as chest pain on exertion, your doctor may suggest an electrocardiogram.

 

Your doctor will also look for signs of neuropathy. Neuropathy can affect how your heart and blood pressure will respond to the physical demands of pregnancy. It can also affect how well your body nourishes both you and your baby, so make sure your doctor knows if you have any signs of neuropathy. Your doctor will also examine your kidney function. If you have a history of kidney problems or poor blood glucose control, your kidney function can worsen during pregnancy.

 

Problems with your kidneys can put you at risk for a difficult pregnancy, including edema and high blood pressure. Also visit your ophthalmologist for a thorough eye examination. Untreated diabetic retinopathy can also worsen during pregnancy.

 

You and your doctor will want to discuss the possibility of practicing tight blood glucose control before you get pregnant. Before you commit to the awesome burden of pregnancy, you want to make sure you can achieve blood glucose levels that are as close to normal as possible. If you plan on waiting until you are pregnant, it may be too late. Your baby’s organs will begin to develop before you even know you ae pregnant.

 

Talk to your doctor about whether tight control will work for you. In one study, women who practiced tight control reduced the risk of birth defect to only 1%, compared to 10% for those who began intensive therapy after the pregnancy had begun. You should begin your intensive management well before becoming pregnant. If you have type 1 diabetes, this means adhering to a program of several insulin injections per day and testing your blood glucose level six to eight times per day. If you have type 2 diabetes, you may need to begin insulin therapy and may need to test your blood glucose level two to three times each day. If you have never used insulin before, the best time to develop your program is before you become pregnant. Your doctor will evaluate how well you are controlling your blood glucose levels by measuring your glycated hemoglobin. When your day-to-day blood glucose measurements and your long-term glycated hemoglobin measurements indicate that your blood glucose levels are under control, your doctor will probably advise you and your partner to stop using birth control and try to get pregnant

 

Once You Are Pregnant

One of the most important aspects of your pregnancy care is to maintain good blood glucose control. You and your doctor should set reasonable blood glucose goals that you can follow. During the first 3 months, maintaining good blood glucose control will ensure the proper development of your baby’s organs. During the last 6 months, your good blood glucose control will prevent your baby from growing too large, a condition known as macrosomia. 

 

Having a big baby may seem like a good thing, but it can cause complications during birth. Women with diabetes often have larger-than-normal babies because of all the extra glucose in their blood. However, this is not a big a problem as it was in the past, because today more women practice tighter blood glucose control. If your baby is too large, there is a greater risk of having a Caesarian section to avoid the danger of trying to push a large baby through a small birth canal. This could result in shoulder damage to the baby or respiratory distress. To avoid this risk to your baby and the possibility of a Caesarian section (C-section), keep your blood glucose levels close to normal throughout the entire pregnancy.

 

If you are not using insulin, you may have to do for the first time to maintain good blood glucose control. If you are already using insulin, be prepared to make adjustments in the timing, dose and type of insulin you may be used to using.

 

Good nutritional habits are essential during pregnancy for anyone, but even more so for a woman with diabetes. This can be especially challenging during the first trimester if you are experiencing any kind of nausea or vomiting. You should schedule a visit to your dietitian even before you become pregnant, and then continue visits on a regular basis. Your dietitian will devise a plan for you based on your weight, your weight gain during pregnancy, and your blood glucose goals. Your dietitian may suggest eating five or six small meals a day to keep your blood glucose levels stable and to prevent nausea.

If you do develop nausea, eat dry crackers or toast before rising and eat small meals every 2.5 to 3 hours. Avoid caffeine, fatty foods and salty foods. Drink fluids between meals, not with meals. Take prenatal vitamins after dinner or at bedtime, and always carry a fast-acting carbohydrate snack with you.

 

It is important to remain physically active during your pregnancy. This will not only help you better control your blood glucose levels, but also help you handle the physical demands of labor and speed your recovery once your baby is born. Talk to your doctor about what types of exercise are safe and appropriate. Of course, the best time to begin an exercise program is before you become pregnant.

 

Your doctor will probably encourage you to monitor your blood glucose levels several times a day. If you take insulin, you may start out testing only before meals during the first trimester and add after-meal testing during the second and third trimesters. Suggested times for testing may be once before each meal, 1 hour after each meal, at bedtime, during the middle of the night (around 2AM) and before any exercise or physical activity, including sex.

 

If you have type 2 or gestational diabetes and you are controlling your blood glucose levels through diet alone, you may not have to monitor quite as often. Instead, your doctor may suggest that you monitor before each meal, 1 hour after each meal, and before you go to bed. Always test before you exercise.

In addition to your regular doctor’s visits, you will need to visit your obstetrician more often than most women, perhaps on a weekly basis. Your obstetrician may suggest aminocentesis, screening for neural tube defects, regular ultrasounds, and fetal heart rate monitoring.

Giving Birth

If you have practiced good blood glucose control throughout your pregnancy, are in good general health, and your baby is not too large, there is no reason you can’t have a normal vaginal delivery. However, even with good blood glucose control, your baby may still be too big for your birth canal. Many women without diabetes face this dilemma. 

 

You and your doctor will have to evaluate whether a vaginal delivery or C-section is safer. Much will depend on the size of your baby at birth, the size of your birth canal, the state of your placenta, and your overall general health. If you have any complications that could endanger your life or that of your baby, your doctor will recommend a C-section.

Your doctor will also be on the lookout for other complications that may arise during pregnancy. Your blood pressure will be checked at every visit. Sometimes during pregnancy, a serious condition known as preeclampsia occurs. This condition is marked by high blood pressure and tends to occur more often in women with diabetes than in those without diabetes. Preeclampsia can threaten the life of both mother and baby. If you show any signs of preeclampsia, your doctor may recommend an early delivery, probably by C-section.

 

Labor is hard work, but it can be especially trick for someone with diabetes. You will not be allowed to eat during labor because of the possibility of eventual C-section. This can be difficult if your labor is prolonged, because you need the energy to get you through labor and delivery. Some hospitals allow women to drink juice during labor, but others allow only water. Your blood glucose levels need to stay close to normal throughout the whole process, preferably below 120mg/dl. Your blood glucose levels will be monitored frequently throughout labor to ensure this. You will most likely have an intravenous catheter inserted so that fluids or calories can be given as needed. You can be given insulin as injections or through an IV, but most women don’t need insulin during active labor.

 

Being hooked up to monitors and IV lines can tie you down during labor. Most obstetricians and midwives believe that walking around during labor is good for you and the baby. Lying flat on the bed may be the last thing you want to do. If you are having a vaginal delivery, you want to let gravity help in the process of moving the baby down the birth canal. 

 

Also, the more active you are in labor, the better chance that you can use active muscles to contract and push the baby out. Many women find that moving around helps to deal with the pain of labor. Talk to your doctor in advance about what to expect in labor. Will you be strapped to a bed the whole time or will you be allowed some mobility?

 

Make sure your doctor understands what is important to you. However, if your doctor feels that you will need more monitoring and restriction during labor, it is best to discuss this in advance. Make sure you have a clear understanding of what to expect during labor before you go to the hospital. Also discuss the possibility of C-section even if you are attempting a vaginal delivery and know what to be prepared for.

 

Once your baby is born, he will be watched closely for certain conditions. Your baby is at high risk for hypoglycemia and will be monitored for blood glucose in the first 4 to 6 hours after delivery. Jaundice is also common in newborn babies, and your baby may be treated with light therapy to overcome this condition. If your baby was delivered too early or is much larger than is normal for his or her age, your pediatrician will be on the lookout for any respiratory problem.

After Delivery

If you have type 1 or type 2 diabetes, your blood glucose levels will be monitored regularly in the hospital. Your insulin requirements will depend on whether you begin eating regular meals right away or are limited to liquids and IV feedings. If your blood glucose levels are low, you may be given a snack right away or will be given glucose intravenously. If you are not yet eating solid food, you will need less insulin. You may very well need less insulin during the first 3 to 4 weeks. After 1 to 2 months, you will probably be able to go back to the same diabetes management plan that you followed before becoming pregnant.

 

In the meantime, your insulin and dietary needs will depend on whether or not you are breastfeeding, how quickly you get back to eating regular meals, and how quickly you resume your normal activities. You have just been through a very stressful, physically challenging ordeal. During this period your blood glucose levels may swing wildly. The hormones in your body and your whole body metabolism are undergoing a great change. While you are in the hospital, you will be given food and insulin as required and will be monitored carefully. But going home may be a scary project.

 

Make sure that before you go home, you meet with your doctor and go over a diabetes management plan to follow in the immediate post-partum period. Ask your doctor the best way to make adjustments for swings in blood glucose levels. This plan should take into account whether or not you will be breastfeeding. 

 

Also, meet with your dietitian, who should devise a meal plan for you that will take into account our caloric needs, especially if you are breastfeeding. With a new baby, you will have to be especially careful about hypoglycemia. During this period, it is especially important to test your blood glucose levels frequently. This is true even if you have type 2 diabetes and are not taking insulin. If you feel hypoglycemia coming on, test right away and treat it if necessary. If you can’t test, you may want to eat a carbohydrate snack anyhow. Keep plenty of fast-acting carbohydrate snacks close at hand.

 

You should schedule a follow-up visit with your diabetes care doctor soon after leaving the hospital to assess how well you are adjusting to your new schedule. This is an emotionally joyous, yet stressful, period and you will need all the help you can get. You may also consider arranging for visits from a home health care nurse in the first few weeks, while you make the adjustments to your new life.

Breastfeeding

Breastfeeding may seem like a bother, especially if you are trying to deal with your own changing needs. But in many ways, breastfeeding is more convenient than bottle-feeding. You can feed on the spot with no preparation. And breast milk is the ideal food for your baby. Babies who are fed breast milk for at least 3 months are less likely to develop diabetes themselves. Your body uses up a lot of energy and this can cause your blood glucose levels to fluctuate. 

However, some women find that breastfeeding makes blood glucose control a little easier. You may be able to eat a little more and require less insulin without having your blood glucose levels rise too high. Make sure to pay attention to the possibility of low blood glucose. Test your blood glucose level frequently, even if you are not taking insulin, and keep fast-acting carbohydrate snacks close at hand. When you nurse your baby during the day or in the middle of the night, have a snack and glass of water or milk handy. You can have your snack as the baby feeds.

 

Make sure to schedule a follow-up visit with your dietitian soon after you come home from the hospital. Your dietary needs will change if you are breastfeeding, and your dietitian can help you make the necessary adjustments. You will want a plan that provides you and your baby with adequate nutrition, but at the same time helps you lose any weight you put on during pregnancy. All this, while you maintain normal blood glucose levels.

Breastfeeding may seem challenging for any woman, but it can be especially so if you have diabetes. But as many women with and without diabetes can attest, the convenience, personal satisfaction, and benefits to your baby far outweigh these minor challenges.

 

GESTATIONAL DIABETES

Even if you don’t have diabetes at the beginning of your pregnancy, there is a slight chance that you will develop insulin resistance about halfway through your pregnancy. Usually, sometime between the 24th and 28th week of pregnancy, your doctor will give you an oral glucose tolerance test. You will be asked to drink a glass of a high-glucose fluid, and your blood glucose levels will be monitored at 1-hour intervals for 1 hour or 3 hours. If your blood glucose levels do not come down as quickly as someone without diabetes, your doctor may determine you have gestational diabetes.

Approximately 2% to 3% of all pregnant women develop gestational diabetes. You may have it for one pregnancy, but not for another pregnancy. For some reasons, your body develops a resistance to insulin. It may be due to the high levels of hormones circulating in your body, or the additional stress placed on your body during pregnancy, or a combination of factors. Whatever the reason, you have developed a temporary resistance to insulin that will most likely go away once the baby is born.

Risks

If you have gestational diabetes, the greatest risk is to the growth and development of your baby. Fortunately, by the time gestational diabetes develops, all your baby’s organs and systems have formed. But if you do not control your blood glucose levels, your baby may grow too large, and a condition known as macrosomia occurs. If your baby is larger than normal and/or your birth canal is too narrow, your baby could be at risk for damage to the shoulder or respiratory distress during delivery.

 

If you develop gestational diabetes, you are at increased risk of developing diabetes later. You have an almost 70% chance of developing gestational diabetes during another pregnancy. You also have a 40% to 60% chance of developing type 2 diabetes in 5 to 15 years, compared with a 15% risk for someone who has not had gestational diabetes. If you are obese and have had gestational diabetes, your chances of developing type 2 diabetes can be as high as 75%. You can reduce your risk of diabetes to 25% by keeping your body weight within healthy limits and getting plenty of exercise.

 

What You Should Do

If your doctor determines that you have gestational diabetes, you should see a dietitian or nutritional counselor right away. Your doctor can recommend someone to you. Gestational diabetes can usually be controlled by adhering to a meal plan aimed at keeping blood glucose levels close to normal while providing for the nutritional needs of you and your baby. Your meal plan will probably recommend that you avoid refined sugar, maintain a suitable calorie intake and eat a higher amount of protein. You should continue your regular prenatal vitamins.

 

You and your doctor will discuss a blood glucose monitoring plan that works for you. Some doctors may advise monitoring your blood glucose level 4 to 6 times per day, much like a person with type 1 or type 2 diabetes would do. Other doctors find that measuring your fasting and 2-hour postmeal blood glucose level is consistently under 105mg/dl and your 2-hour postmeal level is less than 120mg/dl, then following your diet plan and keeping close tabs on your baby’s development is probably sufficient.

 

If your fasting and 2-hour postmeal blood glucose levels are too high, then your doctor may advise that you begin insulin treatment. If your fasting blood glucose levels are greater than 105mg/dl, you will probably be asked to take a bedtime dose of intermediate-acting insulin, usually no more than 10 units initially. If your postmeal blood glucose levels are above 120mg/dl, you will probably be advised to take a mixture of intermediate and short-acting insulins in a 2:1 ration. 

 

Typically, you might take 30 units of such a mixture before breakfast. Although it is rare for gestational diabetes, you should be aware of the signs of hypoglycemia. If you believe you are going through a low blood glucose reaction, test your blood glucose and eat 10g to 15g of a carbohydrate snack. If you are unable to test, have the snack anyhow and call your doctor.

 

As your pregnancy proceeds, your obstetrician will see you on a weekly basis. You will probably be asked to monitor fetal movement yourself. Your doctor will also monitor the baby’s growth by periodic ultrasounds and will also conduct fetal heart-rate monitoring from time to time.

 

If you stick to your diet, exercise moderately, and keep good blood glucose control throughout the rest of your pregnancy, there is no reasons that you should not have a normal delivery. Talk to your doctor about any special concerns you might have as your delivery date approaches.

 

After delivery, your blood glucose levels should return to normal. You should be tested for diabetes on a regular basis. The best way to prevent type 2 diabetes from developing is to keep your weight down, exercise frequently, and eat a well-balanced, low-fat diet.

 

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Management of Preexisting Diabetes in Pregnancy: A Review by Rachel Blair, Anne Peters and Anastasia Alexopoulos

Diabetes in Pregnancy by T Linn and R G Bretzel

Gestational Diabetes mellitus by Donald Coustan

author

Rich Health Editorial Team

Health Research

Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner