Diabetes and Pregnancy
Today, with improved health care, women with diabetes can expect to deliver a healthy baby. If you have your diabetes in good control before you get pregnant, and take special care of your diabetes during pregnancy, you have a much better chance of having a healthy baby. You also lower your risk of getting other health problems from diabetes while you are pregnant.
If you have Type 1 or Type 2 diabetes and have it in good control, you have the same chance as other women to get pregnant. But when you have diabetes, you and your partner have other things to consider. It is important to plan for your pregnancy. Both your health and your baby’s health depend on good planning.
Steps you must take include a healthy diet, exercise, and very careful control of your blood glucose (sugar). The most important step is to see your doctor early. If possible, see your doctor before you get pregnant. For more information about diabetes, see Diabetes: Basic Facts and Diabetes: Your Management Plan.
Close Control of Diabetes
Close control of your blood glucose is very important before you become pregnant and during the first several weeks that you are pregnant. A1c (A-one-C) levels should be as near to normal as possible (6 %). Close control during these times may lower the risk of birth defects and miscarriage. Most women with diabetes can have a normal, healthy pregnancy when the blood glucose goals are met. Check with your doctor what your specific blood glucose goals are for fasting and after meals.
While you are pregnant, your body’s need for insulin changes. To control your diabetes, you and your doctor may need to make constant adjustments. You will need to work closely with your diabetes health care team.
Some women get diabetes only while pregnant. The name for this kind of diabetes is gestational (jess-TAY-shun-ul). Pregnancy hormones increase your body’s need for insulin. Sometimes, your body cannot make enough insulin to meet the increased need. Other times, your body may not properly use the insulin it makes.
Some people may have had diabetes prior to becoming pregnant, but only discovered it during the pregnancy. Your doctor may test you for pre-existing type 2 diabetes at the first prenatal visit if you are at high risk for having type 2 diabetes.
How do you know if you have gestational diabetes?
A blood test called a glucose tolerance test is how to learn if you have gestational diabetes. This test is done between the 24-26 weeks of pregnancy. This should be done in the morning after an overnight fast (no food or fluid with calories) of at least 8 hours. You will be asked to drink a glucose (sugar) solution. A series of three blood samples will be taken and tested (prior to drinking the glucose solution, at 1 hour, and at 2 hours after).
The test results are based on the 3 blood glucose levels listed below:
- 92 before drinking the glucose solution
- 180 one hour after drinking the glucose
- 153 two hours after drinking the glucose
If your blood glucose level is equal to or higher than any one of these levels, you have gestational diabetes. Talk to your doctor about your results.
What happens after pregnancy?
Gestational diabetes usually goes away after pregnancy. You may get gestational diabetes in future pregnancies. Some women with gestational diabetes get Type 2 diabetes years later. To reduce risk for Type 2 diabetes later in life, do the following:
- Keep your weight normal.
- Eat healthy foods.
- Exercise regularly.
Are you at risk for diabetes?
You are at risk for diabetes if one of the following describes you:
- Pregnant and over 25-years old
- Overweight before getting pregnant
- Family history of diabetes
- African American, Hispanic, Asian, Pacific Islander, or Native American
If you have Type 1, Type 2, or gestational diabetes, you will receive medical care from a health care team. Members of the team have special training in different fields:
- Your obstetrician (OB-steh-TRISH-un) is a doctor specially trained to care for pregnant women. He or she watches your health and your baby’s health. Your doctor visits are like those for other pregnant women. With diabetes, however, you must see your doctor more often.
- A maternal-fetal (FEE-tal) medicine doctor has skills in treating complications in pregnancy. Complications are other health problems, like diabetes, that can occur or get worse when you are pregnant. This doctor helps both you and your baby when you have diabetes.
- An internist (in-TER-nist) is a doctor trained to detect and give medical care for certain diseases in adults, like diabetes.
- An endocrinologist (EN-doh-crin-OLoh-jist) is a doctor specially trained to treat diabetes.
- A dietitian (DIE-eh-TISH-en) specializes in nutrition. He or she tells you how you must change your diet during pregnancy. What you eat affects the way your baby grows and develops before birth. Your dietitian will create a meal plan for your special needs.
- A diabetes educator teaches you about diabetes, especially during pregnancy. He or she can show you how to give yourself insulin shots and how to test your blood glucose level. Your diabetes educator also can arrange for loan of a blood glucose meter, if you need help to get one.
You will have regular visits with your maternal-fetal medicine doctor, internist, or endocrinologist. At each visit, your blood glucose level will be tested. You may be asked to test your blood glucose fasting, one or two hours after meals, and at bedtime. Be sure to ask what your specific blood glucose goals are and when to test. If you check your blood glucose at home, you will need to bring your blood glucose meter and log book with you.
To watch the health of your unborn baby, your doctor may order several kinds of tests:
- Blood glucose tests — You will need to have your blood glucose level checked often. The following are recommended goals for blood glucose (if they can be achieved without excessive hypoglycemia):
- Before meals, bedtime and overnight: 60-99 mg/dl
- Peak after meal glucose (1-2 hours after): 100-129 mg.dl
- A1c less than 6%
- Ultrasound (UL-truh-sound) — Another name for this test is sonogram (SO-nuhgram). The test helps the doctor to see how your baby is growing and developing. You may have this test several times during your pregnancy.
- NST (non-stress test) — This test helps detect stress in your baby’s heart rate patterns. You will have this test in the last 8 to 12 weeks of pregnancy.
- Amniocentesis (AM-nee-oh-sen-TEEsis)— The fluid around the baby is tested to learn how well the lungs are developing. You may have this test between 36 and 39 weeks of pregnancy.
Labor and Delivery
If you and your unborn baby stay healthy, you may be able to carry your baby until the 38th to 41st week of pregnancy. The doctor often induces labor at that time. If the baby is too large or there is question of your baby’s health or your health, the doctor may deliver the baby before the 38th week. If the doctor is going to induce labor, you will receive instructions beforehand.
During labor, you will probably get insulin through an intravenous line (IV). Your blood glucose level will be closely watched. Your doctor may tell you to bring your own blood glucose meter and supplies with you to the hospital.
In other ways, you will go through labor the same as a woman who does not have diabetes. The baby’s heart rate will be watched closely during labor. Your contractions also will be closely watched. When you have diabetes, you can use prepared childbirth methods or anesthesia. Having diabetes does not mean you must have a C-section (cesarean delivery). But as with any pregnancy, the need for a C-section is a possibility.
Your Newborn Infant
When a mother has diabetes, the baby rarely has diabetes at birth. Soon after delivery, a pediatrician (PEE-dee-uh-TRISH-un) will give your baby an exam. A pediatrician is a doctor with special skills in the care of babies and children. Your baby’s blood glucose level will be checked for low blood glucose. Another name for low blood glucose is hypoglycemia (HI-po-glice-EEM-ee-uh).
During pregnancy, your insulin does not cross the placenta and reach your baby, but your blood glucose does. High blood glucose makes your baby produce large amounts of insulin. At birth, your blood glucose is cut off from the baby. Then the baby may be making more insulin than needed. Low blood glucose may result.
To help raise the blood glucose level, your baby will be fed early with either breast milk or formula. Your baby’s blood glucose level will be watched closely until stable. Some babies need closer attention and may be given glucose by IV. In most cases, your baby will stay with you during your recovery and hospital stay after delivery. Soon after birth, the baby will start making less insulin.
After You Deliver
After you deliver your baby, your body will slowly return to its normal hormone levels. Your insulin need usually becomes the same as before pregnancy. If you have Type 1 or Type 2 diabetes, your doctor will help you adjust insulin dosages as needed. If you have gestational diabetes, your blood glucose levels usually return to normal in hours. At your 6-week check-up, you will probably get a glucose tolerance test. The test shows if your blood glucose levels are back to normal.
When you have diabetes, you can still breast-feed your baby. Many of your calories go to the baby through your breast milk, so your insulin dosages may need to be adjusted.
If You Have Questions
If you have any questions or need more information, call your doctor, nurse, or diabetes educator.