1 AnswerIf you are planning to get pregnant, have a complete eye exam. Talk with your eye doctor about what can happen to your eyes during pregnancy. Pregnant women with diabetes need an eye exam in the first 3 months. They also need to be checked again for one year after the baby is born.
1 AnswerBlood sugar that remains high in a woman with gestational diabetes can cause her baby to grow very large (about 9 pounds or more). Being very large makes it hard for the baby to be born through the birth canal and can cause nerve damage to the baby's shoulder during birth. A very large baby has an increased chance of being overweight or obese later in life. Being overweight or obese increases the chance of also having diabetes later in life.
Blood sugar that remains high in a pregnant woman with type 1 or type 2 diabetes can cause her baby to have the following health problems:
- Birth defects, especially of the brain, spine, and heart
- Increased birth weight
- Nerve damage to the shoulder during delivery
- Low blood sugar after birth
- Increased chance of overweight, obesity, and/or diabetes later in life
2 AnswersFor women who have type 1 or type 2 diabetes before becoming pregnant, 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. But gestational diabetes does not usually occur until more than halfway through the pregnancy. By the halfway mark, the baby’s organs are already formed.
Although women with diabetes and their unborn children face additional risks because of diabetes, these can be kept to a minimum through careful blood glucose management, before and during pregnancy, and intensive obstetrical care. For this reason, all women with diabetes need to plan ahead before becoming pregnant.
The first step is to meet with your health care team to consider the specific challenges you may face during your pregnancy. You need a complete evaluation of your overall health and any diabetes complications. It’s important to get a good idea of how much extra work and expense may be involved before you become pregnant.
You may have specific questions for your health care provider. You may be concerned that your baby could develop diabetes. You may be worried for your own health. Your glucose levels may also be an issue.
2 AnswersStacy Wiegman, PharmD , Pharmacy, answeredIf you have diabetes, your doctor may treat your pregnancy a little differently. For example, if a woman has diabetes, some doctors would prefer to deliver her baby a week or two before the due date to lower the risk of certain problems at birth. After you deliver, you should breastfeed your baby. But because breastfeeding can lower the amount of insulin your body needs, you'll need to check your blood sugar and adjust any medications accordingly. You'll also want to plan your meals and snacks carefully around breastfeeding so you don't experience very low blood sugar.
1 AnswerBe aware that your blood sugar can change very quickly, becoming too high or too low. What you eat, how physically active you are, and your growing baby will change your blood sugar many times during the day. Check your blood sugar often—as directed by your doctor and any time you have symptoms. Know what blood sugar levels mean. Learn how to adjust what and when you eat, how physically active you are, and, if prescribed, how much insulin to take depending on your blood sugar tests. Check your blood sugar right away if you have symptoms. Treat low blood sugar quickly. Always carry with you a quick source of sugar, like hard candy or glucose tablets. Wear a medical alert diabetes bracelet.
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1 AnswerAs your due date nears, your doctors will study your health and that of your growing baby if you have diabetes. Then, you and the team will discuss the best time and method for delivery. To determine the safest time and method to deliver your baby, your health care team will examine a variety of factors: blood glucose control, blood pressure, kidney function, and any diabetes complications you may have. The team will also study your baby's size and movements, his or her heart-rate pattern and the amount of amniotic fluid in the uterus.
Your labor may start on its own, or you may decide to have labor induced or have a planned cesarean section (C-section). During a cesarean birth, an incision is made through the abdomen and uterus, through which the baby is removed. Because of the surgery, your recovery time may be longer than if you delivered your baby vaginally.
No matter how you deliver your baby, your doctors will be working during labor and delivery to keep your blood glucose level under control. At the start of active labor, your insulin needs will drop. You will most likely not need any insulin during labor and for 24 to 72 hours after delivery. Your blood glucose will be checked frequently (probably every few hours) and your insulin and glucose regimen will be tailored to your needs during that time.
To help you prepare for labor, many hospitals and other organizations offer classes (such as Lamaze) to help you have a smooth delivery. They teach you what to expect during delivery, techniques to improve delivery and to relieve pain during labor, and how to care for your baby after birth. Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.
It's important to have a partner or coach helping you throughout the labor and delivery process. This can be a spouse, parents, relative, or friend. Having a support system with you before and during the birth can help you be more relaxed during your time at the hospital.
The first step is to choose blood glucose targets for your pregnancy. Talk to your health care team about how to personalize blood glucose target ranges to your health and your lifestyle.
Sample Target Blood Glucose Ranges During Pregnancy
- Before meals: 60–99 mg/dl
- One hour after meals: 100–129 mg/dl
- A1C less than 6%
In the first trimester, targets are designed to help you minimize the risk of birth defects or miscarriage. In the second and third trimesters, the targets will help prevent your baby from growing too large. If you have trouble staying in the target range, or if you have frequent or severe hypoglycemia, talk to your health care team about revising your treatment plan or your targets.
1 AnswerThe following suggestions can help prevent diabetes-related health problems during pregnancy:
- Plan your pregnancy. If you have diabetes, it is very important for you to get your body ready before you get pregnant. If you are already pregnant, see your doctor right away.
- See your doctor. Your doctor needs to look at the effects that diabetes has had on your body already, talk with you about getting and keeping control of your blood sugar, change medications if needed, and plan for frequent follow up.
- Monitor your blood sugar often. Pregnancy affects your blood sugar control. You will probably need to check your blood sugar more often than when you are not pregnant. Talk with your doctor about how often to check your blood sugar.
- Take your medications on time. If medications are ordered by a doctor, take them as directed.
- Control and treat low blood sugar quickly. Having tight blood sugar control can lead to a chance of low blood sugar at times. Keep a ready source of sugar, such as glucose tablets or gel or hard candy, on hand at all times. Talk with your doctor about how to treat low blood sugar.
- Follow up with the doctor regularly. You will need to see your doctor more often than a pregnant woman without diabetes. Together, you can work with your doctor to prevent or catch problems early.
- If you had gestational diabetes, talk with your doctor about getting your blood sugar checked after delivery and every 1-3 years. About half of all women who had gestational diabetes develop type 2 diabetes later.
You’ll need more frequent visits to your obstetrician, perhaps every two weeks for the first part of your pregnancy and weekly during the last month. The reason for these visits is to make sure that your baby is developing as expected and that you stay in good health.
Common Tests During Pregnancy
- You will be screened for neural tube defects early in pregnancy (around weeks 15–18) by measuring the concentration of alpha-fetoprotein in your blood.
- You’ll need an ultrasound test early in your pregnancy (to show when your baby was conceived) and several more throughout your pregnancy to follow the baby’s growth.
- A fetal echocardiogram may be done around the middle of your pregnancy.
- Other monitoring includes counting your baby’s movements for an hour each day and fetal movement and heart rate monitoring during the last 6–12 weeks of pregnancy. These tests help ensure your baby’s well-being and will assist your health care team in deciding when to deliver your baby.