Planning a Pregnancy
Recent advances in diabetes research and management have made it possible for women with Type 1 diabetes to expect successful pregnancies resulting in healthy babies, with little or no additional risk of complications for the mother. However, a successful pregnancy does require extra planning and effort.
First, you must plan for exceptionally good control BEFORE you become pregnant. In fact, the “pre-pregnancy” appointment you make with your obstetrician will be one of the most important appointments you make. Before and during the pregnancy, you’ll need to have excellent blood sugar control and management, as well as the resources for extra medical tests and hospitalization. Make an effort to be at your ideal body weight, since being overweight complicates diabetes and pregnancy.
Your healthcare team should include an obstetrician who has had experience managing diabetic pregnancies, a dietician, a nurse educator, and a pediatrician. Lastly, plan to give birth in a well-equipped hospital.
Medical Care During Pregnancy
Extra Blood and Urine Tests
In order to give birth to a healthy baby, you must maintain excellent glucose control during the entire pregnancy. During the first third of pregnancy (first trimester), when the fetus’ organs develop, high HbA1c levels may lead to increased risk of birth defects. During the later stages of pregnancy, other reasons exist for keeping glucose levels within normal ranges. If you have high blood sugar levels, this can lead to your having a large baby, sometimes preventing a vaginal delivery and requiring a Cesarean section.
Insulin
Because of lost appetite during morning sickness and the fetus’ removal of glucose from your body, your insulin needs may go down initially; as the pregnancy progresses, they will increase. Some doctors put their patients in the hospital for tests and readjustments of insulin early on, or provide the tests in an outpatient setting. Make sure to keep daily records of your blood sugar levels and immediately tell your doctor about any highs or lows.
Diet
A carefully controlled diet is important to your health as well as that of your developing baby. You will need a personalized diet plan that you will adjust throughout your pregnancy.
Morning Sickness Management
Food may help morning sickness, or your doctor may prescribe a drug to reduce it.
Hypoglycemia, Infections, and Ketones
Pregnancy may increase the risk of blood sugar levels rising high (hyperglycemia) or falling low (hypoglycemia). High blood sugars can increase the presence of ketones in urine. Also, some pregnant women with diabetes have slightly higher rates of skin, vaginal, and urinary tract infections, but these are not usually major problems.
Some risks and effects of diabetes on pregnancy
Note that excellent blood sugar control lowers the risk for all of these
Miscarriages
If you maintain blood sugar control, your risk for miscarriage – about one of every nine or ten early-stage pregnancies – is no greater than that of the general population.
Large Babies
Women with diabetes may have large babies as a result of high blood sugar levels and require Cesarean sections; the chances for both can be reduced by keeping levels close to normal.
Polyhydramnios
Polyhydramnios (excessive amounts of amniotic fluid throughout pregnancy) is less common and rarely has harmful effects.
Toxemia
Toxemia is a general term used to describe the presence of toxins in the blood. This condition may increase blood pressure and the presence of protein in the urine, and cause hands and feet to swell. With good blood sugar control, this problem is no more common than it is in non-diabetic pregnancy.
Edema
Edema, or swelling, is a common occurrence and may be reduced by doing something as simple as limiting your salt intake.
Monitoring the baby's development
There are many tests which monitor your baby’s growth and the degree of intrauterine risk. These include a sonogram or ultrasound to map out your baby’s size, an amniocentesis test to evaluate his/her respiration, a non-stress test to check his/her heartbeat, and a contraction stimulation test to see if your baby can handle the stress of labor. Your doctor may also ask you to keep track of your baby’s movements.
Delivery
Because of added risk to the unborn baby, many doctors caring for pregnant women with diabetes will have them deliver before the due date, either by inducing labor or by performing a Cesarean section. Women with diabetes can have a normal vaginal birth if the pregnancy is uncomplicated and the baby is not too large.
After the Baby Is Born
Genetic Consideration: Will Your Baby Have Diabetes?
The fact that type 1 diabetes and type 2 diabetes have some genetic components does not mean your baby will have or get either, but you should still check for symptoms (e.g. a drop in blood sugar.) If it helps, keep in mind that 80 percent of people with type 1 diabetes have no family history of the disease.
Insulin Requirements After Delivery
For several weeks after delivery, you may need less insulin than you did before becoming pregnant. In case you feel the beginning of an insulin (hypoglycemic) reaction, keep snacks in every room.
Breastfeeding
If you have type 1 diabetes but are otherwise in good health, you may choose to breastfeed your baby. Have a snack before nursing in order to maintain glucose levels, which drop during nursing. Also, maintain your fluid and calorie intake to ensure that your baby receives nutrients. Watch out for pain or redness around the nipples or breasts, as this could be a sign of infection.
