“Life, like art, should be a celebration of a vision.” –Michael Larson
Every person with diabetes has a compelling reason to take good care of his health: It’s the best way to live a long, healthy life with diabetes and to minimize the risk of diabetes-related complications. Women with diabetes who are pregnant or who are even thinking about becoming pregnant have at least two compelling reasons to take the best care possible of their general health and their diabetes: their own well-being, as well as that of their planned child.
Having high blood glucose during the first 6–8 weeks of pregnancy raises the risk of birth defects, and the higher a woman’s HbA1c during that time, the higher the risk. (HbA1c is a measure of blood glucose control over a period of 2–3 months.) But many women don’t realize they are pregnant until several weeks after conception. That’s why it’s so important to plan a pregnancy, to use a reliable method of contraception until you’re ready to become pregnant, and to take any steps necessary to get your HbA1c level in goal range (as close to “normal” as possible) at least three months before you become pregnant.
The planning stages
Even if you’re not ready to have a baby, if you are a woman of childbearing age and think you might like to have a child at some point, it’s worth talking with your diabetes care team about preconception planning. Most likely, your discussions will focus on the benefits of tight blood glucose control before pregnancy. That’s because high blood glucose during pregnancy — even very early in a pregnancy — not only raises the risk of birth defects but also raises the risk of spontaneous abortion, or miscarriage. It can also cause a developing fetus to become too large (called macrosomia), making delivery difficult, and it often leads to hypoglycemia in the newborn.
The goals for blood glucose control listed in the American Diabetes Association’s clinical reference guide Medical Management of Pregnancy Complicated by Diabetes for women who are planning to become pregnant are “tighter,” or closer to normal, nondiabetic levels, than those for women who are not planning a pregnancy. (See “Pre-pregnancy Blood Glucose Targets”) If your blood glucose levels are not routinely at the recommended pre-pregnancy levels, talk to your diabetes care team about the changes you would need to make to get them there.
If you are ready to start actively planning a pregnancy, you need to line up appropriate medical and obstetrical care for both before and during pregnancy. The best approach for management of diabetes and pregnancy is to have a multidisciplinary team of health-care professionals that also includes you as an important member of the team. Teams may vary in their makeup, but they should generally include a physician that specializes in diabetes (such as a diabetologist, endocrinologist, or internal medicine specialist), a physician that specializes in pregnancy (an obstetrician, ideally one who is familiar with pregnancy and diabetes), a diabetes educator, a dietitian who specializes in diabetes management, a social worker, and any other specialists necessary for your care.