Planning for Your Healthy Baby: Pregnancy and Diabetes (Amarillo Diagnostic Clinic)

By Rachel Pessah Pollack, MD

Do you have diabetes? Are you thinking about getting pregnant? If so, there are things you need to do for the health of you and your baby during pregnancy. Your blood sugar control is very important.

Diabetes during pregnancy is on the rise.

Amarillo Diagnostic Clinic Blog

More and more people are getting diabetes. There are about 1.5 million new cases per year. As a result, many more women with type 2 diabetes are becoming pregnant.

Elevated blood sugar (glucose) levels during pregnancy are bad. They can cause a higher risk of birth defects, miscarriage, birth injury, preterm delivery and certain complications such as pre-eclampsia. By being careful with blood sugar levels before becoming pregnant and during the early weeks of pregnancy, these potential problems can be prevented.

Here is what you can do to optimize your care and ensure a successful outcome:

Schedule your doctors’ visits

*Your doctor may send you to a specialist before you get pregnant to help you with your diabetes control.

*Obstetrical [ob-steh-trih-kal] care – some patients with diabetes may see obstetricians [ob-steh-TRIH-shen] who specialize in high-risk pregnancies. Your doctor will help you make this decision based on how long you have had diabetes and how well your diabetes is controlled.

•Eye disease – every woman with diabetes should see an eye

doctor for an eye examination before getting pregnant. You may

be counseled on the risk of getting diabetic eye disease (retinopathy

[reh-tin-AH-pah-thee]). Eye exams are also recommended in the

first trimester, during pregnancy, and after birth. Sometimes the

eye disease may become worse with pregnancy; however, this risk

can be prevented with laser surgery.

•Kidney disease – all women with diabetes who want to get pregnant

should be checked for diabetic kidney disease (nephropathy [neh-

FRA-pah-thee]). A urine test is used for this test.

•High blood pressure – your doctor will want to make sure that

your blood pressure is under good control before you get pregnant.

You may have to switch or add blood pressure medications.

•Nerve disease – your doctor may suggest you see a foot specialist

(podiatrist [poe-DYE-ah-trist]) to determine if you have diabetic

nerve disease. This is also known as peripheral neuropathy [per-

IH-fer-al noor-AH-puh-thee]. It is important to take good care

of your feet before and during pregnancy and to check your feet

each day to keep infections at bay.

Focus on healthy eating now

Before pregnancy, it is a good time to pay close attention to what you eat. Eating properly is important to achieve and maintain normal sugar levels throughout pregnancy. You are hopefully already following a healthy diabetes diet, including fruits, vegetables, and fiber. You can continue to eat the same foods as you plan for pregnancy. However, be aware that, during pregnancy, how many carbohydrates there are in each meal is the most important factor affecting your blood sugar control, both before and after your meals. It may be useful to meet with a registered dietician or diabetes educator before you get pregnant. This will help you learn how to count calories and choose healthy foods. In addition to watching your diet, all women who want to become pregnant should take a daily prenatal multivitamin containing at least 400 micrograms of folic acid. Folic acid prevents neural tube defects, such as spina bifida [spine-a BIH-fid-a] in babies.

Target normal blood sugar levels

Studies have shown that poor blood sugar control during pregnancy can lead to poor pregnancy outcomes and risk for birth defects. During the first trimester, the baby’s organs are forming and normal sugar levels can decrease the risk of any problems during this period. For this reason, it is very important to wait to conceive until blood sugars are under excellent control.

Hemoglobin A1C, which is a measurement of your blood glucose control over the prior two to three months, should be checked before you get pregnant to help with your overall diabetes treatment plan. Talk with your health care provider about what your blood sugar range and A1C level should be both before pregnancy and during pregnancy to reach your goal of a normal blood sugar. Blood glucose self-monitoring is recommended by many different diabetes organizations (each has different target levels). During pregnancy you will be asked to check blood sugar levels one to two hours after the first bite of your meal. This is different from when you weren’t pregnant.

Review your medications for safety

Before you get pregnant, have your doctor review your medications and determine if you need to switch them to ones that are safe in pregnancy. Some examples are listed below:

•Diabetes medications – Many of the diabetes pills that are taken

when not pregnant cannot be taken when pregnant. Before you

get pregnant discuss with your doctor whether you may need to

start insulin before or during pregnancy. Or, you might find out

that diet and carbohydrate monitoring are all you need. In

general, if insulin is needed, you will likely need to use more

insulin the further you get into your pregnancy, especially during

the third trimester. Although there is some good data with certain

pills for diabetes, it is not known how safe and effective they are,

and insulin is often recommended to control blood sugar.

•Blood pressure medications: ACE inhibitors and ARBs used

for blood pressure control and kidney disease are not advised

during pregnancy, since they are likely to harm the baby. Before

you get pregnant, consult your health care team about changing

your blood pressure medications.

•High-cholesterol medications: “Statins,” a class of medication used

for its cholesterol-lowering effects, should be stopped before you

get pregnant.

Evaluate your pre-pregnancy weight

Women with diabetes who are overweight or obese have a higher chance of having problems during pregnancy. These problems include higher rates of cesarean section, high blood pressure, birth defects, and premature infants. The good news is that if you are overweight and are able to reduce or normalize your body weight before you get pregnant, you can prevent many of these poor outcomes from occurring. Losing just a few pounds can help you maintain better control of your sugars and lower your blood pressure.

Plan to exercise

Once your doctor has decided that you are healthy for physical activity, add exercise to your daily regimen. Choose activities that you enjoy and are most likely to continue with and have a goal of 30 minutes of aerobic exercise most days of the week. Keeping fit will help with both weight loss and control of your blood sugar. Check your sugar level before and after exercising because you may need to eat a snack to prevent low blood sugar during physical activity. Continue your exercise routine during pregnancy unless your doctor advises against it.

Avoid bad habits

It is very important to get counseling from your doctor before you become pregnant so that you have a healthy pregnancy. Women with diabetes should be screened for depression, tobacco and alcohol use, drug abuse, weight management, and exercise.

• If you are a smoker or are still drinking alcohol, the perfect

time to stop is before you get pregnant.

• If you are abusing drugs (prescription/non-prescription),

now is the time to stop and get help if necessary.

• If you have missed doses of insulin or if you don’t take your

medications as prescribed, focus on taking the best care of your

body as you prepare for pregnancy and avoid missing doses.

Know when you need to wait

It is important for each woman with diabetes to know when a pregnancy is not safe. If your diabetes is not under good control, you should wait to become pregnant. By working with your health care team and making adjustments to your treatment, you can improve control of your blood sugar and ensure a healthy outcome for you and your baby.

There is a lot of planning to be done. However, you must remember that the patience and additional work is worth the end result: your healthy baby!

Dr. Rachel Pessah Pollack is a second year endocrine fellow at Mount Sinai Medical Center in New York City, where she also received her internal medicine training. She is the AACE Fellow-in-Training Representative and has a special interest in pregnancy-related endocrine disorders. She has published articles and given presentations on gestational diabetes, Cushing’s disease during pregnancy, and iodine deficiency during pregnancy. This fall she will be joining a private endocrinology practice in New York.

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