Type 1 Diabetes, Type 2 Diabetes and Pregnancy
Planning a Pregnancy
If you are a woman with type 1 diabetes or type 2 diabetes, you can have a successful pregnancy. Because of advances in diabetes research, knowledge, and management, the outlook for pregnant women with diabetes is better today than it was a generation ago. However, you will still face challenges that other women don't. In deciding to have a child, you and your partner should understand that a diabetic pregnancy involves:
- Extra effort and commitment
- Excellent blood sugar control
- Education in all areas of diabetes management
Before Your Pregnancy
If your blood sugar is in good control and you have no other medical problems, you should have no more difficulty becoming pregnant than a healthy woman without diabetes. To prepare for a healthy pregnancy, you should:
- Know how to monitor your blood sugar. If you are not now testing your blood sugar, ask your health care provider about self-monitoring of blood glucose.
- Have your blood sugar in excellent control before becoming pregnant. Studies have shown that good blood sugar control six months before conception, as well as throughout the entire pregnancy, reduces the incidence of birth abnormalities to that of the general population.
- Be at your ideal body weight before becoming pregnant. Being overweight complicates both diabetes and the pregnancy.
- Choose a health care team that includes an obstetrician with experience in managing diabetic pregnancies, your diabetes doctor, a dietitian, a nurse educator, and, in the last month of pregnancy, a pediatrician.
- Plan to have your baby at a well-equipped hospital with up-to-date testing and monitoring facilities.
Medical Care During Pregnancy
Extra Blood and Urine Tests
Gestational diabetes develops during some pregnancies. Diet control, careful monitoring of blood sugar, and, sometimes, insulin are required. Although this type of diabetes usually disappears when the pregnancy is over, women who have it are at increased risk for developing type 2 diabetes later in life.
Controlling your blood sugar levels is crucial during this time, so your doctor will advise you to test your blood and urine more frequently during your pregnancy.
Insulin
Early stages: Your insulin needs may go down during the early stages of pregnancy. This is because the rapidly developing fetus is removing glucose from your body at a very great rate. Also, morning sickness may cut your appetite and, therefore, the need for insulin will be reduced.
Later stages: As pregnancy progresses the need for insulin will increase. Some women may have to double their insulin dosage.
Tests: Some doctors put their patients in the hospital for tests and readjustments of insulin dosage early in pregnancy. This may not be necessary if such tests are available in the doctor's office, as an outpatient, or at home, using self-monitoring of blood glucose.
Keep daily records and report changes: Any significant changes in blood sugar levels and insulin needs, and episodes of low or high blood sugar should be brought to your doctor's attention immediately.
Diet
A carefully controlled diet is important to your health and that of your developing baby. You will need a personalized diet plan, and you will need to evaluate and adjust your plan during the months of your pregnancy.
Snacks in addition to your three regular meals, will help avoid extreme blood sugar levels and provide the developing baby a constant supply of nutrients.
Morning Sickness
Your doctor may prescribe a drug to reduce nausea (morning sickness). Sometimes, simply eating a dry cracker will help. By experimenting with various foods, you may find some foods that help.
Hypoglycemia, Infections, and Ketones
Pregnancy may increase the frequency of hypoglycemia (low blood sugar) and the presence of ketones in the urine. Keep your doctor closely informed. Also, some pregnant women with diabetes have slightly higher rates of skin, vaginal, and urinary tract infections. With care, these should not be major problems.
Some Risks and Effects of Diabetes on Pregnancy
Miscarriages
Women with poor blood sugar control or many severe complications are at some risk for miscarriage. In otherwise healthy women, the risk of miscarriage is no greater than that of the general population—approximately one out of every nine or ten early-stage pregnancies.
Large Babies
Women with diabetes may have large babies as a result of high maternal blood sugar levels. This effect can be reduced by keeping blood sugar levels close to normal. Obviously, a big baby makes delivery more difficult and for this reason, Caesarean sections are frequently performed.
Polyhydramnios
This condition—excessive amounts of amniotic fluid throughout pregnancy—is somewhat less common. Aside from the discomfort of an overly distended belly, polyhydramnios rarely has harmful consequences.
Toxemia
Toxemia is characterized by an increase in blood pressure, by the presence of protein in the urine, and by the swelling of hands and feet. Though toxemia was once a common complication of diabetic pregnancy, with good blood sugar control this problem is no more common than in a non-diabetic pregnancy.
Edema
Swelling or edema is a common occurrence. Limiting your salt intake may be all that is necessary to reduce this excessive accumulation of fluid. Advise your doctor if swelling occurs.
Monitoring the Baby's Development
There are many tests that give information about the development of the baby and the degree of intrauterine risk.
Sonogram or Ultrasound
This is a high frequency sound wave used to map out the size of the baby. Repetition of this test during pregnancy makes it easy to calculate the baby's rate of growth. A simple, painless, harmless test, a sonogram is carried out in the doctor's office or in a hospital on an outpatient basis.
Amniocentesis
This technique evaluates the maturity of the baby's respiratory tract and its ability to breathe on its own. In this test, a fine needle is inserted into the uterus, and a small quantity of the fluid around the baby is extracted. If the level of a material called surfactant is high enough, the doctor knows that the baby's lungs have matured, and the baby will be able to breathe on its own. Amniocentesis helps doctors decide on the best delivery time for the baby.
Non-Stress Test
This test checks on your baby's general well-being by recording your baby's heartbeat as he or she moves. A faster heartbeat would be a normal reaction. Non-stress tests are usually conducted one to three times each week in the last few weeks of pregnancy.
Contraction Stimulation Test (Stress Test)
Depending on the results of your non-stress test, you may need another test to determine if the baby can handle the stress of labor. During the contraction stimulation test, also called an oxytocin challenge test, you will be given a small dose of the hormone oxytocin, which stimulates the uterus to contract mildly. The purpose is to approximate the reduction in oxygen flow that happens during labor and to see if the baby's heartbeat is sound throughout.
Fetal Movement Records
Your doctor may ask you to keep track of your baby's movements and will instruct you on how and when to note these movements.
Delivery
Because of added risk to the unborn baby, many doctors caring for pregnant women with diabetes deliver their patients before the due date, either by inducing labor or by performing a Caesarean section.
Women with diabetes can have a normal vaginal delivery if the pregnancy is uncomplicated and all factors are normal. However, since babies born to women with diabetes can be large, a Caesarean section may be required. If a Caesarean section is performed, remember that this is one of the most common major operations and has become a relatively simple and safe procedure.
After the Baby Is Born
Genetic Consideration: Will Your Baby Have Diabetes?
Research has determined that there is a genetic component to both type 1 diabetes and type 2 diabetes, but this fact does not necessarily mean your baby will have diabetes or get diabetes. Nonetheless, you will want to keep a close watch for symptoms.
Common Problems to Watch For:
- A drop in the baby's blood sugar: If the baby has been subjected to high blood glucose levels for many months, it may suffer a drop in its blood sugar soon after birth. When this happens, the baby is given early supplements with sugar, either intravenously or by mouth. The baby will be watched closely until its blood sugar has returned to normal.
- Premature baby: A premature baby will require fairly extensive, highly specialized pediatric care.
Insulin Requirements After Delivery
Soon after delivery—often within a few hours—your insulin needs will drop, and you may need less insulin than you did before becoming pregnant. This state usually lasts for a period of several weeks. The extra activity involved in caring for a newborn also tends to reduce your insulin needs for a while. You may want to keep emergency snacks in every room while taking care of a new baby, in case you feel the beginning of an insulin reaction.
Breastfeeding
There is no reason an otherwise healthy woman with diabetes should not breastfeed her baby.- Baby in intensive care unit: Even if the baby is in intensive care, you can breastfeed after he or she is released. When your milk comes in, you can pump it manually, which will maintain milk production until you can actually nurse the baby.
- A snack before nursing: Because breastfeeding can often cause a sudden drop in your glucose level, have a glass of milk before you nurse the baby in order to maintain your blood sugar.
- Maintain fluid and caloric intake: When you nurse, you may have to increase your fluid and calorie intake to make up for the calories used by milk production.
- Minor infections: Any sign of pain or redness around the nipples or the breasts themselves must be promptly reported to the doctor. A minor infection can be quickly treated with antibiotics, and you usually don't have to stop nursing because of it.
** The information provided here is not intended to take the place of medical advice. For guidance on topics discussed, consult your health care professional.
