Women with Type 1 or Type 2 diabetes who are considering pregnancy have reason to feel optimistic. That’s because women with diabetes can and do experience healthy, uneventful pregnancies and give birth to perfectly healthy babies. That said, however, a pregnancy with preexisting diabetes is always considered high-risk, and its outcome is largely dependent on a woman’s efforts to keep her blood glucose levels as close to the normal range as possible for the entire duration of her pregnancy.
The American Diabetes Association recommends blood glucose goals for pregnant women that are lower than those suggested for the general population: 80–110 mg/dl before meals and lower than 155 mg/dl (plasma values) two hours after eating. Anyone with diabetes knows that staying in that range every day for nine months requires tremendous commitment, even when not pregnant. Achieving those goals while pregnancy hormones are wreaking havoc with your insulin needs and while your whole body is growing and changing is another thing altogether. Add morning sickness, exhaustion, swollen ankles, and normal pregnancy anticipation into the mix, and you have a full bag of stress triggers.
So how does a pregnant woman with diabetes manage to keep herself and her baby healthy while also balancing her usual family, work, and other life responsibilities? This article offers strategies based on experiences from my own two pregnancies as well as those from other women with diabetes who have made the effort to do all that was in their power to bring healthy children into the world. (Note: This article focuses on women with existing Type 1 or 2 diabetes before pregnancy rather than women who develop gestational diabetes during pregnancy).
When I first mentioned wanting to have a baby to my endocrinologist, he urged me to get my glycosylated hemoglobin (HbA1c) level to 6% or lower (it was 6.6% at the time). The HbA1c test gives an indication of average blood glucose levels over 2–3 months; a normal HbA1c level in person who doesn’t have diabetes is 4% to 6%. He also gave me a referral to meet with a perinatologist, or high-risk obstetrician. That meeting was a moment of truth for me: The doctor spelled out in plain terms the birth defects, including spinal and other major organ damage, that could happen to my baby if I did not maintain his recommended blood glucose control while pregnant.
I remember leaving his office feeling scared but also determined. He had encouraged me by telling me that he had lots of patients with diabetes who had worked hard and given birth to babies with no birth defects at all. Though I ultimately chose a different high-risk obstetrical practice, I am still thankful that in my meeting with that doctor, he didn’t try to sugarcoat the facts (no pun intended).
Besides getting my HbA1c lower, I knew that my other assignment was to spend time figuring out, with all of my heart and soul, if I truly wanted a baby and could do what was needed to make sure that baby would come into the world with just as good a chance as any of not having permanent birth defects. While I worked on both of those things, my husband and I continued to use birth control.
Like the other doctors I spoke with, endocrinologist Lois Jovanovic, C.E.O. and Chief Scientific Officer of the Sansum Diabetes Research Institute and author of Medical Management of Pregnancy Complicated by Diabetes, strongly urges women with diabetes to make a conscious choice to become pregnant and to get their blood glucose levels in the recommended range before trying to conceive. “Love your baby first,” she says. “That means you’ll do anything, even checking your blood sugar every hour, 24 hours a day, to make sure your baby is healthy. A woman with diabetes needs to be really unselfish and make sure that this is the right point in her life for a pregnancy.”