Imagine wanting to get pregnancy and bring discouraged from doing so. About 25 years ago, this was the case for many women with diabetes. Fortunately, with recent advances in diabetes management and careful planning, the chances of having a successful pregnancy are excellent!
If you have diabetes and are thinking about becoming pregnant, it is recommended that you start preparing about 6 months prior to conception. The most important thing to do before conception is to have your diabetes in good control and to learn how to continue managing your diabetes during pregnancy.
Once you’ve decided you want to become pregnant, you should make an appointment with your endocrinologist (a diabetes physician specialist) to review your health status and pregnancy plans. If you don’t have an endocrinologist, your primary care provider can refer you to one.
In addition to an endocrinologist, there are other who can help you during your pregnancy: an obstetrician, of course; but other members of your healthcare team my include a registered nurse and/or dietitian who focus on the management of diabetes and an ophthalmologist who will be sure your eyes stay healthy. While you will be the one in charge of your pregnancy, it is still necessary to have a medical team as well as loved ones to support you during this time.
You will need to meet with your obstetrician more frequently than a woman without diabetes. These visits may include ultrasounds to determine fetal growth and development and other laboratory tests. It is important to know that you will be scheduling a number of visits with your team during your pregnancy.
The Joslin-Beth Israel Deaconess Pregnancy Program recommends the following goals and medical assessments before pregnancy:
- Fasting and pre-meal blood glucose: 80-110 mg/dl
- Blood glucose one hour after meal: 100-155 mg/dl
- A1C, a blood test that measures average blood glucose over two to three months: less than 7 percent and as close to 6% as possible without hypoglycemia
- Blood pressure below 130/80 mm Hg (if you are taking medication for your blood pressure, the medicine is safe for use when pregnant)
- Review of diabetes and obstetrical history
- Eye evaluations to screen for and discuss risks of diabetic retinopathy
- Renal, thyroid, gynecological and sometimes cardiac evaluations
The critical stages of development for a baby begin within the first 8 weeks, which is often when a woman can’t even tell she is pregnant. Even so, during this time the baby’s spine and organs are forms. This is why is it important to keep your blood glucose levels in the target range prior to conception in order to help reduce the risk of harm to your baby. Checking your blood glucose daily and having an A1C test will help tell you if you’re staying on track. During your pregnancy, your A1C is typically checked every month.
If You Are Already Pregnant
More than half of all pregnancies are unplanned. If you fall into this category and discover that you are pregnant, it’s important that you schedule an appointment with your diabetes healthcare team and your obstetrician right way.
Glucose Management in Pregnancy
For the health of you and your baby, it’s important to achieve the best possible blood glucose control, while avoiding hypoglycemia. The table below depicts the recommended glucose goals during pregnancy.
Fasting and before meals
1 hour after meals
A1C – 1st Trimester
Below 7% and as close to 6% as possible
A1C – 2nd and 3rd Trimester
Women with type 1 diabetes must take insulin to manage their diabetes, and during pregnancy will find that the amount of insulin that they need will increase. Because diabetes pills have not been approved by the Food and Drug Administration (FDA) for use during pregnancy, woman with type 2 diabetes may also need to take insulin during their pregnancy, as well. As the pregnancy progresses, more insulin may be needed to compensate for the placental hormones that raise blood glucose. By the end of your pregnancy, you may need 2-3 times more insulin than you needed before pregnancy. Your healthcare team will work with you to find the insulin regimen that best meets your needs.
The food you eat during pregnancy not only helps your baby grow, but it also has an effect on your blood glucose levels and for this reason, a dietitian is an important member of your healthcare team. Part of a dietitian’s job is to provide you with a meal plan than takes into account you and your baby’s nutritional needs, your lifestyle, and the foods you like and dislike. A dietitian will also be able to tell you which foods are important to eat and which ones are best to omit during pregnancy in addition to helping you gain the appropriate amount of weight for each 3-month trimester of your pregnancy.
Exercise is an important part of managing diabetes, and is recommended as a safe therapy for managing diabetes in pregnancy. Women who are active for at least 5 days each week and who do aerobic and strength training exercises are more likely to have an easier pregnancy. Blood glucose is affected by exercise during pregnancy. Checking blood glucose around exercise is important to keep both you and your baby safe.
It’s okay to continue most activities during your pregnancy; however, it is best to check with your healthcare team, especially if the activity is strenuous such as skiing or hot yoga.
Gestational diabetes is the term used when diabetes is diagnosed during pregnancy. It usually develops between the 24th and 28th week of pregnancy and affects anywhere from 6-9 percent of all pregnancies. The treatment, blood glucose monitoring, scheduled office visits, meal planning, activity and medication are similar to the guidelines described above. Your healthcare team will help develop a specific care plan for you. It is very important that, once you deliver your baby, you schedule a follow-up appointment for laboratory testing and healthcare review with your team because women who have gestational diabetes are at risk for developing type 2 diabetes later on in life.
Postpartum (After Pregnancy)
With careful diabetes management, women can and do have successful pregnancies and healthy babies.
After your baby is born and you have seen your obstetrician for a follow-up visit, plan a healthcare check-up visit with your endocrinologist to review your blood glucose control, possible medication changes and weight management.