How can I manage diabetes while pregnant?

Angela Ginn
Nutrition & Dietetics Specialist

Having a healthy baby is every woman’s dream. And when you are living or newly diagnosed with diabetes during your pregnancy, a dream team must be in place for a healthy baby. The ultimate dream team includes:

  • Certified Diabetes Educator
  • Registered Dietitian
  • Endocrinologist

This dream team will provide education, treatment and management of the diabetes throughout your pregnancy and postpartum care.

Having diabetes during pregnancy can increase your risk for miscarriage, early labor and delivery, preeclampsia and congenital defects in the baby. However, the best thing you can do to prevent these issues is to control your blood sugar levels before and during your pregnancy. In fact, all guidelines regarding pregnancy and diabetes recommend starting insulin therapy before getting pregnant so women can achieve target blood sugar (glucose) levels before conceiving.

Taking insulin during your pregnancy is perfectly safe. One study that reviewed 10 years of pregnancy outcomes in women with type 2 diabetes found those taking insulin during pregnancy had significantly lower rates of complications. If you use oral medications for blood sugar control, talk to your healthcare provider about whether they are approved for use during pregnancy.

Dr. Maria F. Daly, DO
OBGYN (Obstetrician & Gynecologist)

Type 1 Diabetes is further classified according to the age when diabetes was diagnosed. The earlier the age of diagnosis, the more challenging its effects on both mother and fetus. The classifications are B with less than 10 years of diabetes and insulin. Type C has had diabetes for 10 to 19 years. Type D,F R and H, as well as B and C, need a high risk obstetrician to closly follow the mother and fetus. Insulin needs are increased with each trimester of pregnancy. The fetus is closly monitored for growth and development. Mothers are placed on nutritious and closly-monitored dietary intake.

Preparing for pregnancy is an exciting time. Millions of perfectly healthy babies have resulted from pregnancies of women with diabetes. It's very important to manage diabetes before, during and after pregnancy to ensure your and your baby's health. The trick is to pay special attention to your blood glucose levels during this exciting time. High blood glucose levels during pregnancy can lead to serious, long-term complications for you and your baby. Even if you have had type 2 diabetes for several years, your body will experience many changes during pregnancy that affect your blood glucose differently. It's very important to be aware of these new changes and adjust your treatment accordingly.

See your doctor before you become pregnant to discuss your best treatment options.

Stacy Wiegman, PharmD
Pharmacy Specialist

The best way to manage your diabetes while pregnant is to work with your doctor and other health experts to create the best plan for you. You should begin as soon as possible in your pregnancy. Your team of experts may include your endocrinologist or other diabetes specialist, your obstetrician and a dietician or diabetes educator. The overall goal of your health plan should be to keep your blood glucose levels as normal as possible throughout your pregnancy. Your doctor may recommend that you check your blood glucose levels many times a day and also set up a schedule for frequent checkups and lab tests to monitor your blood sugar levels and overall health. You may also need a fitness plan, with recommended ways to stay active during your pregnancy. A meal plan to help you make smart food choices and have guidelines on when and how much to eat may also be a good idea. With careful monitoring and proper care, you can have a happy, normal pregnancy and deliver a healthy baby.

Laura Motosko, MSEd, RD
Nutrition & Dietetics Specialist

Your obstetrician should refer you to a diabetic clinic or endocrinologist to treat gestational diabetes. A registered dietitian and registered nurse, of which either is a diabetic educator, is essential to see for diabetes management.

If you are a woman with diabetes, you still can have a healthy baby. Talk with your doctor about whether it is safe for you to become pregnant, what you need to do before you get pregnant, how to prevent pregnancy while you are getting your blood sugar under control and how to keep your blood sugar under tight control both before and during your pregnancy.

Controlling your diabetes before and during your pregnancy will help prevent such problems as birth defects, prematurity, miscarriage and stillbirth.

Steps women can take before and during pregnancy to help prevent problems:

  • Plan your pregnancy, if possible, and get your body ready before you get pregnant.
  • Eat healthy foods and stay active.
  • Take your medicines.
  • Monitor your blood sugar often.
  • Control and treat blood sugar right away.
  • Follow up with the doctor regularly.
Dr. Douglas S. Denham, DO
Family Practitioner

Women with type 1 diabetes require very close observation and diabetic control throughout their pregnancy. Poorly controlled diabetes during pregnancy can cause multiple health problems for both the mother and the baby. If you are a diabetic and planning to get pregnant, discuss this with your obstetrician or endocrinologist prior to getting pregnant. More intensive therapy may be warranted before you get pregnant.

In this video from Discovery Health, learn how to manage diabetes during pregnancy.

You have the good fortune to live when you do. Health care providers no longer discourage women with diabetes from becoming pregnant. However, before you get pregnant, you need to make sure all the medicines you take are safe to use during pregnancy. Some drugs commonly used to treat diabetes may not be recommended. You’ll need a thorough physical exam before you become pregnant to assess any problems that could jeopardize your health or that of your baby.

Keeping blood glucose levels low, even before pregnancy, decreases the risk of birth defects. Birth defects occur early in pregnancy as the baby’s organs are being formed.

Sample target blood glucose ranges during pregnancy are:

  • Before meals: 60 to 99 mg/dl             
  • One hour after meals: 100 to 129 mg/dl
  • A1C less than 6 percent

The ideal pregnancy health care team for people with diabetes includes:

  • Diabetes care provider
  • Obstetrician experienced in treating pregnancy complicated by diabetes
  • Pediatrician experienced in the care of infants of mothers with diabetes
  • Registered dietitian
  • Diabetes nurse educator experienced in teaching women how to intensively manage their diabetes

Your baby will be closely watched after birth. He or she is at risk for hypoglycemia and will have frequent blood glucose monitoring during the first 24 hours after birth. Hypoglycemia occurs because the baby has been producing enough insulin to cover the high glucose levels in the uterus. This does not mean your baby has diabetes.

Breastfeeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. Hormonal changes, emotional shifts, irregular sleep patterns, and fatigue may hide or change your symptoms of high or low blood glucose as well.

Jennifer Shaw
Nutrition & Dietetics Specialist

There is nothing wrong with taking insulin while you're pregnant, and in fact, the risks of not taking it and having excessively high blood sugars can sometimes be greater than any potential risks from taking it. Insulin is a hormone your body naturally makes itself, so you already have it in your body, whether you take it or not. Some oral medications for diabetes are contraindicated during pregnancy, so if diet and exercise alone do not control blood sugars, which is often the case particularly late in the pregnancy, often insulin is the best option.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.