Diabetes and Pregnancy

If you have diabetes or prediabetes and you want a child, can you do it? What will you be getting yourself into? If you’re considering children, here are some things you should know.

Pregnancy in diabetes carries serious risks to mother and child. The American Diabetes Association (ADA) says that women with poor diabetes control are at greater risk for birth defects and also miscarriage.

Advertisement

Your baby’s organs are completely formed by seven weeks after your last period. That time may be up before you realize you are pregnant. High glucose levels can damage those developing organs. So it’s important, says ADA, to get glucose levels under control before getting pregnant. Doctors recommend three to six months of very good control before trying to conceive.

If you have high glucose levels, you may not get pregnant at all. You may conceive normally, but the fertilized egg won’t attach to the uterine lining.

Not getting pregnant may be better than pregnancy with out of control diabetes. The ADA lists some common complications for babies of mothers with diabetes.

• Three to four times greater risk of birth defects such as heart, brain, and spinal defects, oral clefts, kidney defects, and gastrointestinal problems.

• Premature delivery

• Miscarriage

• Prolonged jaundice (yellowing of the skin)

• Respiratory distress (difficulty breathing)

The mother faces her own risks. Diabetic eye and kidney problems could get worse. She is at higher-than-normal risk of preeclampsia (high blood pressure, often with protein in the urine), which can be life-threatening. Delivery may be difficult or may require a C-section.

Prediabetes pregnancy also risky
If you have prediabetes, pregnancy could push you over the line into diabetes. This is called “gestational diabetes.” It can even happen to women who have never been diagnosed with prediabetes. If you have risk factors such as family history of Type 2 diabetes, high blood pressure, a history of poverty, nonwhite ancestry, fatness, or lack of exercise, you should be tested for diabetes before getting pregnant.

Gestational diabetes happens because hormones released in pregnancy increase insulin resistance. It usually comes on about the 24th week of pregnancy. Gestational diabetes may go away after the baby is born, or it may turn into Type 2 and stay around. It’s a definite risk factor for later Type 2, and it carries some of the risks for the baby that Type 2 brings.

Having a healthy child
That’s enough scary news for now. Take it seriously because, although people with diabetes have healthy babies all the time, it is not easy. There are several strategies that can help.

Whether you had diabetes before pregnancy or develop it during pregnancy, you want to keep the best glucose control ever. Very good control for pregnancy is often defined as an HbA1c less than 6% and after-meal glucose spikes less than 130 mg/dl. Not easy, but doable.

In an excellent article in Diabetes Self-Management magazine, Gabrielle Kaplan-Mayer, a mother with diabetes wrote, “Women with diabetes can and do experience healthy, uneventful pregnancies and give birth to perfectly healthy babies… [however, this] 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.”

Kaplan-Mayer’s efforts started well before getting pregnant. “Besides getting my HbA1c lower, I [spent] 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.”

Doing what’s needed can include:

• Very frequent glucose monitoring. This might be the time for a continuous glucose monitor, if that can be worked out.

• Dietary changes such as reducing carbohydrates, sometimes increasing calories, and increasing protein to help the baby grow.

• Supplements. The National Institute of Diabetes and Digestive and Kidney Diseases recommends supplements, especially folic acid, iron, vitamin D, and calcium

• Exercise every day to help your body stay strong. You should start before you get pregnant. See ideas for exercise here.

STOP SMOKING!

• Insulin. Mothers-to-be with diabetes will have an increased need for insulin as they get bigger and more insulin resistant. If you do need insulin, you also need someone to communicate with closely about how much to take, because that changes frequently. An insulin pump might help a lot.

• Get checked for eye and kidney complications. Have regular appointments with your diabetes doctor.

• Get help with childcare and housework so that you can devote extra time to rest, exercise, and taking care of your diabetes. You can ask partners, relatives, and friends for help. It’s not selfish; it’s for your baby.

• If you can, assemble a medical team, including a high-risk obstetrician who knows about diabetes, a diabetes doctor who knows about pregnancy, and a diabetes educator. Ideally, you might also want a nutritionist and someone to help with exercise planning.

Planning for and going through the delivery brings a whole new set of issues. I encourage you to read about them here along with other great ideas on pregnancy with diabetes. It’s quite possible to have a near-normal pregnancy and a totally normal baby, but it will take a strong commitment, hard work, and good support.