Your team members should work together to help you care for your diabetes and get your blood glucose levels as close to pre-pregnancy goals as possible. Your physician may also recommend that you start taking a prenatal vitamin containing at least 400 milligrams of folic acid, which is a B vitamin associated with a lower risk of a type of birth defects known as neural tube defects. Until you have achieved the best possible HbA1c level, it is recommended that you continue to use a reliable method of contraception.
In addition to focusing on blood glucose control, your team will want to evaluate you for any diabetes-related complications and treat any that are present before you become pregnant.
(Click here for some resources on pregnancy and diabetes.)
Certain medical conditions, particularly cardiovascular disease, can make pregnancy very risky. In addition, pregnancy can worsen some diabetes complications. For this reason, women with diabetes who are contemplating pregnancy should have a thorough medical evaluation before becoming pregnant and, if needed, receive treatment for any existing complications such as diabetic retinopathy (eye disease), nephropathy (kidney disease), neuropathy (nerve disease), and cardiovascular disease (heart disease).
Retinopathy. In some cases, diabetic retinopathy can worsen during pregnancy. The best way to prevent worsening is to gradually bring blood glucose levels into goal range prior to pregnancy. Ideally, all women with diabetes should have a dilated eye exam by a retinopathy specialist before becoming pregnant. At your exam, you will want to ask about the health of your eyes, any potential problems that could occur, as well as whether any further evaluation of your eyes might be needed during a pregnancy.
Nephropathy. It is important to have your kidney function evaluated before becoming pregnant. Your physician will likely order both blood tests and urine tests for a baseline assessment of your overall kidney health. If kidney disease is present, it can contribute to high blood pressure during pregnancy. You and your diabetes care team should discuss your kidney health as it relates to pregnancy.
Neuropathy. Diabetes management during pregnancy may be complicated by the presence of neuropathy. Any health problems or changes in bodily functioning caused by neuropathy should be treated before conception occurs. Some of the problems that can be caused by neuropathy include the following:
• Gastroparesis, or slowed stomach emptying
• Urinary retention
• Hypoglycemia unawareness, in which a person does not sense or does not experience the early signs of low blood glucose
• Orthostatic hypotension, or low blood pressure that occurs upon rising from a seated or lying-down position
• Carpal tunnel syndrome, or numbness, tingling, burning, pain, or a dull ache in the fingers, hands, or wrists, caused by pressure on the median nerve; worsening or onset of carpal tunnel syndrome is common during pregnancy.
Cardiovascular disease. Women with cardiovascular disease experience a high mortality rate during pregnancy, so if you have cardiovascular disease, you will want to discuss your level of risk with your diabetes care team. Because pregnancy creates increased demands on the heart, it is important that the heart be evaluated and that you have an exercise tolerance test to help determine if your heart can withstand the demands of pregnancy.