When you have diabetes — either type 1 or type 2 — pregnancy presents unique challenges. Naturally, you're concerned about the effect diabetes might have on your health and your baby's health. There's much you can do to promote a healthy pregnancy, however. Here's what you need to know about pregnancy and diabetes — and delivering a healthy baby.
Pregnancy and diabetes: Your health care team
Your diabetes health care team likely includes an endocrinologist or other diabetes specialist, a diabetes educator, and a registered dietitian. As your pregnancy progresses, your health care team can help you manage your blood sugar level and adjust your diabetes treatment plan as needed.
During pregnancy, your health care team should include the following:
- An obstetrician. Your obstetrician will discuss with you the expectations of managing diabetes in pregnancy, potential complications to watch out for, and special laboratory tests and consults that are recommended for managing your pregnancy.
- An eye specialist. Your obstetrician or health care provider might recommend an eye appointment, especially if you have not had one recently. An eye specialist can monitor diabetes-related damage to the small blood vessels in your eyes, which can progress during pregnancy.
- A pediatrician. You might also want to establish a relationship with the doctor who will care for your baby after he or she is born.
The goal: Tight blood sugar control
Controlling your blood sugar level before and during pregnancy is the best way to prevent diabetes complications. Good blood sugar control during pregnancy can:
- Reduce the risk of miscarriage and stillbirth. Good blood sugar control reduces the risk of miscarriage and stillbirth — primary concerns for pregnancy and diabetes, as patients with uncontrolled diabetes have a higher risk of miscarriage and stillbirth.
- Reduce the risk of premature birth. The better your blood sugar control, the less likely you are to go into preterm labor.
- Reduce the risk of birth defects. Good blood sugar control before and during early pregnancy greatly reduces your baby's risk of birth defects, particularly those affecting the brain, spine and heart.
- Reduce the risk of excess fetal growth. If you have poor blood sugar control, extra glucose can cross the placenta, resulting in your baby growing too large (macrosomia). A large baby makes vaginal delivery difficult, increases the risk of a cesarean delivery and puts the baby at risk of injury during birth.
- Prevent complications for mom. Good blood sugar control reduces your risk of urinary tract infections and yeast infections. It can also help avoid diabetic complications such as diabetic ketoacidosis. With diabetic ketoacidosis, your blood sugar is so high that your body fails to make enough insulin, resulting in a buildup of chemicals called ketones in your blood, and requiring hospitalization for management.
Prevent complications for baby. Sometimes babies of mothers who have diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is too high. Good blood sugar control can help promote a healthy blood sugar level for your baby, as well as healthy levels of calcium and magnesium in the blood.
Good blood sugar control also helps prevent a yellowish discoloration of the skin and eyes (jaundice) after birth, and decreases the risk of developing too much amniotic fluid around the baby — a condition known as polyhydramnios.
The action plan
Your diabetes health care team will help you establish your target blood sugar range. Then it's up to you to make healthy lifestyle choices and follow your diabetes treatment plan.
Remember the basics:
- Check your blood sugar level often. Frequent blood sugar monitoring can help you prevent low blood sugar and high blood sugar (hyperglycemia). Remember, controlling your blood sugar level is the best way to promote a healthy pregnancy and prevent diabetes complications.
- Take diabetic medications as directed. Your health care provider will discuss the best diabetic medication to take in pregnancy. While some oral diabetic medications are safe to use in pregnancy, others have not been well-studied. Discuss all medications with your health care provider, before stopping or continuing to take them. If you also have hypertension, some medications — such as angiotensin-converting enzyme (ACE) inhibitors — should not be taken during pregnancy. Again, talk to your health care provider about all your medications.
- Be flexible. You'll need to adjust your medication dosage depending on your blood sugar level, what you eat, whether you're vomiting and various other factors. Your stage of pregnancy matters, too. During the last three months of pregnancy, for example, hormones made by the placenta to help the baby grow can block the effect of insulin in your body. As a result, you might need more medication than usual to counteract that resistance.
- Eat a healthy diet. Your diabetes diet probably includes plenty of fruits, vegetables and whole grains. Although you can eat the same foods during pregnancy, your health care provider or registered dietitian might suggest changes to your meal plan to help you avoid problems with low blood sugar or high blood sugar. It's also important to take prenatal vitamins containing folic acid.
- Include physical activity in your daily routine. Get your health care provider's OK to exercise, then choose activities you enjoy. Aim for at least 30 minutes of moderate aerobic activity three times a week. If you haven't been active for a while, start slowly. Check your blood sugar level before and after any activity, especially if you take insulin. You might need to eat a snack. Or have your health care provider adjust your medication before exercising to help prevent low blood sugar.
- Schedule regular prenatal checkups. Your health care provider might recommend extra clinic appointments and prenatal screening tests to monitor your baby's growth and development.
Remember, your health care team is there to help you manage your blood sugar level and prevent complications. If you have questions or concerns, don't hesitate to ask for help.
Labor and delivery: What to expect
Your health care team will help you determine the best time and safest way to deliver your baby. Sometimes labor is allowed to begin naturally. In other cases, labor may need to be induced to reduce the risk of complications.
During labor, your health care team will closely monitor your blood sugar level and adjust your medication dosage accordingly. If your baby is too large, an induction isn't successful or you develop complications, you might need a C-section.
After delivery, your attention will turn to your baby — but it's still important to take care of yourself. Continue to check your blood sugar level often, especially if you're breast-feeding. Keeping yourself healthy is the best thing you can do for your baby.