Updated September 24, 2009

Pregnancy With Diabetes
A Doable Challenge

by Gabrielle Kaplan-Mayer

Establishing "tight" blood glucose control before conception is important, because keeping blood glucose levels in the recommended range during the first trimester is critical to preventing birth defects—and a woman doesn’t always know exactly when she becomes pregnant. Uncontrolled high blood glucose can even cause a woman to miscarry early in her pregnancy.

In addition to blood glucose control, a woman needs to make sure that she is in optimal health in every way and needs to be assessed for any possible complications that could be made worse during pregnancy, including retinopathy (eye disease), kidney disease, high blood pressure, and cardiovascular disease. Women with Type 1 diabetes should additionally be screened for thyroid disease.

"Six months before I tried to get pregnant, I made my appointment to see that my eyes were all right," says Karen Eason, a mom with Type 1 diabetes who has two healthy daughters. "All of those appointments—eyes, kidneys—to make sure that I was all right were just part of what I knew I needed to do before we began trying."

Knowing your health status in every way—mentally, physically, and emotionally—before trying to conceive is the first step toward achieving a healthy pregnancy. (Check out "Preconception Planning Checklist" for a list of steps to take before becoming pregnant.)

Finding a health-care team
When Bjay Wooley, editor of DiabeticMommy.com and mom of a healthy four-year-old son, got pregnant, she was a student at a major university and went to see the campus doctor there. He gave her the impression that pregnancy wouldn’t be a big deal, despite Wooley’s Type 2 diabetes. Fortunately, at the same time, she went to see a certified diabetes educator (C.D.E.) who referred her to an experienced perinatologist who had seen many women in her position. Wooley was admitted to the hospital to help get her blood glucose under control, and with the help of her C.D.E. and obstetrical team (and her own dedication), she was able to continue through with a healthy pregnancy.

Ideally, the time to assemble the medical professionals you need during pregnancy is before conception. Begin by talking with the doctor who provides your diabetes care and getting a referral to an obstetrical practice affiliated with a hospital equipped with a neonatal intensive care unit (NICU), in case the baby should have any complications after delivery. It is not uncommon for babies of mothers with diabetes to have some hypoglycemia after delivery. This is a short-term, reversible problem, but it may need to be treated in the NICU depending on its severity.

Set up an appointment to meet with a doctor from the practice to talk about how he works with women with diabetes. Look for a doctor that you "click" with—remember, you will be seeing him frequently throughout your pregnancy. Talk with both your diabetes care provider and the obstetrician about who will help you to manage your blood glucose levels during the pregnancy. Some obstetricians prefer to keep track with you, while others are happy to have you work with your endocrinologist or C.D.E., as long as you are keeping them posted.

Jennifer Ferry, who has Type 1 diabetes and is the mom of two healthy daughters, worked with a high-risk practice during her first pregnancy that had her make daily calls with her blood glucose reports. During her second pregnancy, however, she preferred working with a C.D.E. who followed her blood glucose levels with a weekly fax and follow-up phone call. “That felt more than sufficient to me, and my blood sugars were right in the recommended range,” Ferry says.

Also in this article:
Preconception Planning Checklist

Gabrielle Kaplan-Mayer is a writer and educator based in Philadelphia. She is the author of the book Insulin Pump Therapy Demystified.

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