Diabetes and Pregnancy
Today, with improved health care, women with diabetes can expect to deliver a healthy baby. If you have your diabetes in good control before you get pregnant, and take special care of your diabetes during pregnancy, you have a much better chance of having a healthy baby. You also lower your risk of getting other health problems from diabetes while you are pregnant.
Getting pregnant
If you have Type 1 or Type 2 diabetes and have it in good control, you have the same chance as other women to get pregnant. But when you have diabetes, you and your partner have other things to consider. It is important to plan for your pregnancy. Both your health and your baby’s health depend on good planning.
Steps you must take include a healthy diet, exercise, and very careful control of your blood glucose (sugar). For more information about diabetes, see the UPMC patient education sheets Diabetes: Basic Facts and Diabetes: Your Management Plan. The most important step is to see your doctor early. If possible, see your doctor before you get pregnant.
Close control of diabetes
Close control of your blood glucose is very important before you become pregnant and during the first 6 weeks that you are pregnant. Close control during these times may lower the risk of birth defects and miscarriage. With Type 1 diabetes, the risk for birth defects is a little higher than with Type 2. Most women with diabetes can have a normal, healthy pregnancy.
While you are pregnant, your body’s need for insulin increases. To control your diabetes, you will need to make constant adjustments. Some women may need to stay in the hospital a few days to adjust their insulin level.
Gestational diabetes
Some women get diabetes only while pregnant. The name for this kind of diabetes is gestational (jess-TAY-shun-ul). Pregnancy hormones increase your body’s need for insulin. Sometimes, your body cannot make enough insulin to meet the increased need. Other times, your body may not properly use the insulin it makes.
How do you know if you have diabetes?
Blood glucose tests are the main way to learn if you have gestational diabetes. For one test, you will drink a glucose solution. Glucose is a name for sugar. One hour after drinking the glucose, a blood sample will be taken and tested. If your blood glucose level is 140 or higher, you may need to have another blood glucose test.
This second test is called a glucose tolerance test and takes longer. Your blood will be tested several times over 3 hours. The test results are based on the 4 blood glucose levels listed below:
- 95 before drinking a glucose solution
- 180 one hour after drinking the glucose
- 155 two hours after drinking the glucose
- 140 three hours after drinking the glucose
If your blood glucose level is higher than 2 of these levels, you have gestational diabetes. Talk to your doctor about your results.
What happens after pregnancy?
Gestational diabetes usually goes away after pregnancy. You may get gestational diabetes in future pregnancies. Some women with gestational diabetes get Type 2 diabetes years later. To reduce risk for Type 2 diabetes later in life, do the following:
- Keep your weight normal.
- Eat healthy foods.
- Exercise regularly.
Are you at risk for diabetes?
You are at risk for diabetes if one of the following describes you:
- pregnant and over 25 years old
- overweight before getting pregnant
- family history of diabetes
- African American, Hispanic, Asian, Pacific Islander, or Native American
If you are pregnant and are at risk for diabetes, get your blood glucose checked about 6 months into your pregnancy. That is usually between the 24th and 28th weeks. It is very important to have your blood glucose checked.
Your medical care
If you have Type 1, Type 2, or gestational diabetes, you will receive medical care from a health care team. Members of the team have special training in different fields:
- Your obstetrician (OB-steh-TRISH-un) is a doctor specially trained to care for pregnant women. He or she watches your health and your baby’s health. Your doctor visits are like those for other pregnant women. With diabetes, however, you must see your doctor more often.
- A maternal-fetal (FEE-tal) medicine doctor has skills in treating complications
in pregnancy. Complications are other health problems, like diabetes, that can occur or get worse when you are pregnant. This doctor helps both you and your baby when you have diabetes.
- An internist (in-TER-nist) is a doctor trained to detect and give medical care for certain diseases in adults, like diabetes.
• An endocrinologist (EN-doh-crin-OLoh-jist) is a doctor specially trained to treat diabetes.
You will have regular visits with your maternal-fetal medicine doctor, internist, or endocrinologist. At each visit, your blood glucose level will be tested, usually two hours after you eat. If you follow a diet without insulin, the doctor may ask you to not eat anything before your visit. If you check your blood glucose at home, you will need to bring your blood glucose meter and log book with you.
- A dietitian (DIE-eh-TISH-en) specializes in nutrition. He or she tells you how you must change your diet during pregnancy. What you eat affects the way your baby grows and develops before birth. Your dietitian will create a meal plan for your special needs.
- A diabetes educator teaches you about diabetes, especially during pregnancy. He or she can show you how to give yourself insulin shots and how to test your blood glucose level. Your diabetes educator also can arrange for loan of a blood glucose meter, if you need help to get one.
Testing
To watch the health of your unborn baby, your doctor may order several kinds of tests:
- blood glucose tests — You will need to have your blood glucose level checked often.
- ultrasound (UL-truh-sound) — Another name for this test is sonogram (SO-nuhgram). The test helps the doctor to see how your baby is growing and developing. You may have this test several times during your pregnancy.
- NST (non-stress test) — This test helps detect stress in your baby’s heart rate patterns. You will have this test in the last 8 to 12 weeks of pregnancy.
- amniocentesis (AM-nee-oh-sen-TEEsis)— The fluid around the baby is tested to learn how well the lungs are developing. You may have this test between 36 and 39 weeks of pregnancy.
Labor and delivery
If you and your unborn baby stay healthy, you may be able to carry your baby until the 38th to 41st week of pregnancy. The doctor often induces labor at that time. If the baby is too large or there is question of your baby’s health or your health, the doctor may deliver the baby before the 38th week. If the doctor is going to induce labor, you will receive instructions beforehand.
During labor, you will probably get insulin through an intravenous line (IV). Your blood glucose level will be closely watched. Your doctor may tell you to bring your own blood glucose meter and supplies with you to the hospital.
In other ways, you will go through labor the same as a woman who does not have diabetes. The baby’s heart rate will be watched closely during labor. Your contractions also will be closely watched. When you have diabetes, you can use prepared childbirth methods or anesthesia. Having diabetes does not mean you must have a C-section (cesarean delivery). But as with any pregnancy, the need for a C-section is a possibility.
Your newborn infant
When a mother has diabetes, the baby rarely has diabetes at birth. Soon after delivery, a pediatrician (PEE-dee-uh-TRISH-un) will give your baby an exam. A pediatrician is a doctor with special skills in the care of babies and children. Your baby’s blood glucose level will be checked for low blood glucose. Another name for low blood glucose is hypoglycemia (HI-po-glice-EEM-ee-uh).
During pregnancy, your insulin does not cross the placenta and reach your baby, but your blood glucose does. High blood glucose makes your baby produce large amounts of insulin. At birth, your blood glucose is cut off from the baby. Then the baby may be making more insulin than needed. Low blood glucose may result.
To help raise the blood glucose level, your baby will be fed early with either breast milk
or formula. Your baby’s blood glucose level will be watched closely until stable. Some babies need closer attention and may be given glucose by IV. In most cases, your baby will stay with you during your recovery and hospital stay after delivery. Soon after birth, the baby will start making less insulin.
After you deliver
After you deliver your baby, your body will slowly return to its normal hormone levels. Your insulin need usually becomes the same as before pregnancy. If you have Type 1 or Type 2 diabetes, your doctor will help you adjust insulin dosages as needed. If you have gestational diabetes, your blood glucose levels usually return to normal in hours. At your 6-week check-up, you will probably get a glucose tolerance test. The test shows if your blood glucose levels are back to normal.
When you have diabetes, you can still breast-feed your baby. Many of your calories go to the baby through your breast milk, so your insulin dosages may need to be adjusted.
If you have questions
If you have any questions or need more information, call your doctor, nurse, or diabetes educator.