Ian Blumer, MD, Charles H. Best Diabetes Centre
Denice Feig, MD, Mount Sinai Hospital
When Amber and her husband, Alex, began planning for their first child, they met with her health care team and learned what she needed to do to get her body ready for a healthy pregnancy. Over the next year, Amber worked hard to get her A1C down to 6.5% and to get her weight in a healthy range. Amber and Alex were excited when she reached her goals and even more elateda month later when Amber discovered she was pregnant. Throughout her pregnancy, they worked together to ensure a healthy pregnancy and a healthy baby. They knew they had succeeded when their beautiful daughter was born.
Most women with diabetes can have a safe pregnancy and delivery if they have tight blood sugar (glucose) control before becoming pregnant. If you have type 1 or type 2 diabetes, it is important to get good health care both before and throughout pregnancy. Women with gestational diabetes also need special care during pregnancy. This is a temporary type of diabetes that can occur during pregnancy.
This guide for patients comes from the Endocrine Society’s 2013 clinical practice guidelines for physicians about the care of pregnant women with diabetes: type 1, type 2, and gestational.
High blood sugar can affect you and your unborn baby. Pregnant women with high blood sugar are more likely to:
Tight blood sugar control can help you avoid these problems. A newborn of a woman with diabetes also may develop temporary low blood sugar (hypoglycemia) in the few days after birth.
If you have diabetes and want to have a baby, get a checkup before becoming pregnant. Ideally, your partner should join you, and you should see a team of health care providers that includes your diabetes specialist, a diabetes educator, a dietitian, and an obstetrician.
At this visit, the health care team will counsel you on what your target blood sugar range should be, as well as your hemoglobin A1C. Sometimes called A1C, this test shows your average blood sugar levels over the past few months. The care providers also will discuss whether you should change your diabetes treatment. If you receive insulin therapy, it is best to use an insulin pump or multiple daily injections of insulin. Pre-mixed insulin is less likely to help you maintain your target blood sugar range.
You also will learn what you should do before pregnancy to have the best chance for a healthy baby. Experts recommend the following:
Other health problems can affect you and your baby. Your doctor may want you to have tests to look for these problems.
If you have had gestational diabetes in a previous pregnancy, you should be tested for diabetes before becoming pregnant again. Women with a history of gestational diabetes have a 35 to 60 percent chance of developing diabetes in the next 10 to 20 years.
Blood glucose. While pregnant, you will probably need to check your blood sugar more often than before pregnancy. Check your blood sugar as often as your doctor recommends. You should probably test it before meals, one or two hours after a meal, at bedtime, and during the night.
Ask your doctor what your blood glucose numbers should be. Most pregnant women with diabetes should aim for these blood sugar levels as long as they do not cause low blood sugar:
Insulin. If you were already using an insulin pump before pregnancy, you should keep using it. You probably should not start using an insulin pump for the first time during pregnancy. But if other types of insulin treatment do not control your blood sugar, your doctor may want you to switch to an insulin pump.
Medical nutrition therapy. You should see a dietitian for nutrition therapy. This healthy eating plan, tailored to you, helps make sure you get the nutrients you need and gain the right amount of weight, while controlling your blood sugar. The dietitian may suggest you limit the amount of carbohydrates, or “carbs” (for instance, potatoes, bread, and fruit), that you eat. It is a good idea to eat three small meals and two to four snacks a day. Your dietitian also will advise how often to eat and how many calories to eat a day.
Vitamins. Your doctor likely will decrease the dose of folic acid you take once you finish your first trimester of pregnancy (week 12). Most often, the recommended dose of folic acid is 0.4 mg (400 micrograms) to 1 mg per day through the rest of pregnancy and until you stop breastfeeding. Ask your doctor what other prenatal vitamins you need.
Women with diabetes are encouraged to breastfeed their baby. Breastfeeding lowers your baby’s risk for childhood obesity and for type 2 diabetes later in life. Women with gestational diabetes have an increased risk of developing type 2 diabetes; breastfeeding seems to lower that risk. It also may help you lose the weight you gained during pregnancy!
Insulin is safe for breastfeeding women. If you take metformin or glyburide pills to treat type 2 diabetes, you can safely continue taking these medications while breastfeeding.
You can help ensure your baby’s health and your own health. Work with your obstetrician and your diabetes specialist to get proper medical care before, during, and after pregnancy. Take your diabetes medicine as prescribed and keep your blood sugar in control. Follow the healthy eating plan that you made with your health care team. Also, be physically active. Ask your doctor what type of activity is best for you.
The good news is that with careful planning, proper medical care, and good self-care, you can have a safe pregnancy and a healthy baby.