Women with diabetes may need to plan more when preparing for pregnancy, and there are simple steps they can take to ensure that they and their child are safe and healthy.
When should I see a doctor?
One of the first tasks should be to see your doctor 3 to 6 months before you plan to become pregnant.
- Glycosylated hemoglobin tests to assess whether diabetes is well controlled and to determine if contraception can be stopped.
- A blood and urine test to assess for diabetes-related kidney complications.
- Check for other problems associated with diabetes, such as organ, nerve, or heart damage.
- Measure blood pressure.
- Exclude thyroid disease (for people with type 1 diabetes).
- Check cholesterol and triglyceride (a type of blood lipid) levels.
- Eye exams are recommended to screen for glaucoma, cataracts, and retinopathy.
- Preconception counseling is recommended.
What is preconception counseling?
This is another important step in preparing women with diabetes for pregnancy. This counseling session will help patients prepare physically and mentally for conception and ensure physical and mental health. During this visit, the physician will discuss the following questions with the patient.
- The patient’s weight should be as close to ideal weight as possible before pregnancy. If overweight, losing excess weight can help prevent diabetic complications. For those who are underweight, gaining weight may reduce the risk of delivering a low birth weight newborn.
- Lifestyle of the patient For those who normally smoke or drink alcohol, they need to quit. Smoking during pregnancy affects both the mother and child, and impacts the health of the child before, during, and after birth. Nicotine (the addictive substance in cigarettes), carbon monoxide, and other toxic substances in tobacco are passed directly to the child through the pregnant woman’s bloodstream. These substances can cause the following effects.
- Deprives the pregnant woman and child of oxygen.
- Increases the child’s heart rate.
- Increases the risk of miscarriage and stillbirth.
- Increases the risk of preterm birth and low birth weight babies.
- Children are at risk for future lung or breathing problems.
Drinking alcohol during pregnancy can lead to birth defects (including mental retardation and certain physical problems). There is no safe dose of alcohol to consume during pregnancy and no safe time to consume it.
- Prenatal vitamins Start taking vitamins containing folic acid, which has been shown to reduce the risk of neural tube defects such as spina bifida in babies, at least 1 month before pregnancy. Spina bifida is a serious condition that causes a child’s brain and spinal cord to not form properly. The U.S. Centers for Disease Control and Prevention (CDC) recommends that women take 400 micrograms of folic acid daily before conception and throughout pregnancy. Most pharmacies sell over-the-counter prenatal vitamins that do not require a doctor’s prescription.
- Patient’s blood sugar The doctor will check to make sure the blood sugar is under control. This is critical because a pregnant woman may not know she is pregnant until her fetus is 2 to 4 weeks old. High blood sugar in the first 13 weeks of pregnancy can cause birth defects, lead to miscarriage, and increase the risk of developing complications from diabetes.
- Patient medication Insulin doses need to be increased during pregnancy, especially in the last 3 months. Your doctor will tell you how to adjust your dose. For patients taking oral medications for diabetes, your doctor may switch from oral medications to insulin because some oral medications may be harmful to the fetus, as are medications for high blood pressure taken by people with diabetes. The bottom line for pregnant women is that they should discuss all medications they apply with their doctor.
- Meal planning: Some dietary changes are needed during pregnancy to avoid fluctuations in blood glucose levels, and more calories are needed to provide for the growing child.