Women with diabetes need to pay special attention to a number of health issues before they become pregnant. In addition to the changes in the body brought on by pregnancy itself, blood sugar levels and diabetes medications can be affected.
If you are thinking about having a baby, there are steps you should take to reduce the risk to yourself and your baby.
Be prepared
Advance counseling is good for preparing both physically and mentally.
Find out from your doctor if your condition is well controlled and if you can stop using birth control. A blood test called a glycosylated hemoglobin (HbA1c) test can detect how well diabetes has been controlled in the past 8 to 12 weeks.
Some of the following medical tests can help avoid complications during pregnancy:
- Urine tests that can detect kidney problems;
- Cholesterol and triglyceride blood tests;
- Eye tests to confirm the presence of glaucoma, cataracts, or retinopathy;
- Electrocardiogram;
- Blood tests to ensure proper kidney and liver function;
- Foot testing.
Glucose control
High blood glucose levels early in pregnancy (first 13 weeks) may lead to birth defects and also increase the risk of miscarriage and diabetes-related complications.
But many women don’t know they are pregnant until the baby is 2 to 4 weeks along, which is why blood sugar should be controlled before you start trying to get pregnant.
Keeping blood sugar levels in the ideal range:
- 70 to 100 mg/dl before a meal;
- Lower than 120mg/dl 2 hours after a meal;
- 100~140mg/dl before bedtime snacking;
- 100~140mg/dl before bedtime snacking;
Must maintain blood glucose balance through diet, exercise, and diabetes medications.
How does diabetes affect your baby?
Babies born with diabetes are often much larger, a condition known as “macrosomia”.
Because the mother’s blood sugar levels are high, the fetus gets too much sugar from the placenta. The fetal pancreas senses this sugar and secretes more insulin to consume it. These excess sugars are converted to fat, leading to fetal weight gain.
After delivery in a diabetic patient, most hospitals will keep a close eye on the baby for several hours. If blood glucose levels remain relatively high during pregnancy (especially within 24 hours before delivery), this may cause the baby to be at risk for hypoglycemia at birth. The mother’s high blood sugar determines the fetus’ insulin levels, and if the mother’s high blood sugar suddenly interrupts her supply, the fetus’ blood sugar levels will drop rapidly, at which point the doctor will need to administer glucose to balance the baby’s blood sugar.
The baby’s calcium and magnesium levels may also drop, and these can be addressed with medications.
Some fetuses are too large for a normal delivery, and the doctor will keep a close eye on the size of the fetus to determine the safest way to deliver the baby.
Adjustment of diabetes medications
If insulin is used to control diabetes, your doctor will advise how to adjust the dose. People with diabetes are likely to need more insulin when they are pregnant, especially in the last 3 months of pregnancy.
If you are taking oral glucose-lowering medications, you will need to switch to insulin. This is because oral medications may not be safe, and insulin allows for better control of blood sugar.
Dietary adjustments
Adjusting your diet and the way you eat can help avoid a host of problems associated with high blood sugar.
More calories are needed for a growing fetus, and doctors and diabetes educators can help.
Can a pregnant woman with diabetes deliver full term?
Pregnant women with mild diabetes or well-controlled diabetes are often able to deliver full-term without any problems.
However, many doctors often recommend early delivery, usually at 38 to 39 weeks of gestation.
Watch your blood glucose levels during labor
Birth can be a stressful process for both the mother and the fetus. If the mother has been on insulin during pregnancy, she may also need insulin via subcutaneous or intravenous injection when labor begins.
After delivery, a pregnant woman with diabetes may have a rapidly declining need for insulin.