Diabetes Self-Management Articles

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Pregnant and Pumping
Great Expectations

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and Patti Geil, MS, RD, LD, CDE

A healthy pregnancy with diabetes is a challenge, but consider this: Less than 100 years ago, before the discovery of insulin, many young women with Type 1 diabetes didn’t even live to reach childbearing age. And less than 30 years ago, physicians routinely told young women with Type 1 diabetes that pregnancy was far too dangerous for both mother and child. Today, thanks to advances in diabetes treatment, plus improvements in medical care for infants, there has never been a better time for you to have a healthy baby. Insulin pump therapy is one of the options available to women today for managing diabetes during pregnancy.

Challenges of pregnancy
Pregnancy with diabetes presents a variety of challenges for you and your diabetes management team far beyond the routine morning sickness, fatigue, and strange food cravings experienced by many women who are expecting. The length of time you’ve had diabetes as well as the course of your disease influences the seriousness of medical risks during your pregnancy. For example, if you have mild retinopathy, it may progress during pregnancy. Your kidney status could worsen. Women with diabetes are at higher risk for frequent and severe hypoglycemia (low blood glucose) during pregnancy because glucose crosses the placenta to provide nutrition for the growing baby. The pregnancy state also tends to allow diabetic ketoacidosis — a dangerous condition usually accompanied by very high blood glucose — to develop quickly. Having a thorough medical evaluation prior to pregnancy is extremely important for determining your individual situation and management solutions. Good blood glucose control before and during pregnancy will minimize all risks to the mother.

Risks to the baby are also a consideration when a woman has diabetes. Most birth defects in infants born to mothers with diabetes are directly related to the mother’s degree of high blood glucose at the time of conception. Infants of mothers with poorly controlled diabetes have an increased rate of congenital malformations of the heart, skeleton, and nervous system. Spontaneous abortion, or miscarriage, is also known to occur more often in women with high blood glucose. Additional potential problems include macrosomia, which means the baby is larger than normal for its developmental age, low blood glucose in the baby at birth, and respiratory distress syndrome.

Because the fetal organs are largely developed within the first eight weeks of pregnancy, which may be before you even realize you are pregnant, optimal blood glucose control before conception should be your primary goal. The good news is that if you can maintain normal blood glucose levels before conception and during your pregnancy, you can reduce the risks to yourself and your baby to those of women who don’t have diabetes.

Prepregnancy planning
When you have diabetes, it’s critically important to plan for pregnancy before conception. For women with no immediate desire to start or expand their family, that includes finding a reliable method of birth control to prevent an unplanned pregnancy.

If you would like to become pregnant within the next year, you should meet with your obstetrician to determine your overall health, stamina, and ability to conceive and carry a pregnancy to term. Genetic counseling may also be beneficial. A diabetes educator can provide intensive education to help you understand the effects of pregnancy on diabetes, as well as work toward optimal blood glucose control for diabetes and pregnancy. Ideally, you should strive for near-normal blood glucose levels for at least three months prior to pregnancy. During this time, be sure to use a reliable method of birth control, and use this time to make sure you have the personal commitment, along with family support, to sustain you through frequent medical and obstetrical visits during the nine months of pregnancy.



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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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