Diabetes and pregnancy: What you need to know to deliver a healthy baby.
You have diabetes and have learned that you're pregnant. Like most women, you're experiencing the joys and fears of having a baby. But you're concerned about the effects diabetes can have on your body, on labor and delivery, and especially on the health of your baby.
Because of your diabetes, you'll have extra challenges to deal with during your pregnancy. But the most important challenge is keeping your blood sugar under tight control. With the help of your health care team, you can monitor your blood sugar and avoid complications as your pregnancy progresses.
Your health care team: Who they are and what they can do
Achieving and maintaining tight blood sugar control during your pregnancy is easier if you assemble a health care team that's familiar with diabetes. The American Diabetes Association (ADA) suggests your team include these members:
- Your diabetes specialist. He or she may be an endocrinologist who specializes in the treatment of people with diabetes, including women who are pregnant.
- An obstetrician. He or she ideally should have experience in handling high-risk pregnancies and pregnancies of women with diabetes.
- A pediatrician or neonatologist. A pediatrician specializes in the treatment of children. A neonatologist is a pediatrician who specializes in the care of sick babies. These doctors have the expertise to treat babies born to women with diabetes.
- A registered dietitian. He or she can help you better manage your blood sugar by helping you create a meal plan for use during and after your pregnancy.
- A diabetes educator. Typically a registered nurse with certification in diabetes health education, he or she can teach you how to achieve tight blood sugar control.
If you live in a small town or a rural area and don't have easy access to specialists, ask your doctor about his or her experience treating pregnant women with diabetes. Find out if he or she has access to a specialist at a nearby university or metropolitan area. Your doctor may have you visit a specialist once during your pregnancy and consult with him or her during your pregnancy as needed.
Tight control: What is it?
During your pregnancy your chief goal is to keep your blood sugar under tight control. Tight control, also called intensive insulin therapy, is a means of keeping your blood sugar within a normal or near-normal range. You do this by frequently monitoring your blood sugar, using different types of insulin and adjusting your dosage based on blood sugar levels, diet and changes in routine. Your doctor will tell you what your target blood sugar range is.
If you have type 2 diabetes, you'll probably stop taking oral medications and take insulin to manage your blood sugar while you're pregnant. One reason your doctor will recommend you switch to insulin is that the safety of some oral diabetes medications for pregnant women and unborn babies is unknown when taken during all nine months of your pregnancy. Another is that often intensive insulin therapy can give you tighter control of your blood sugar.
Women without diabetes who develop gestational diabetes may benefit from the use of oral medications, but this condition does not arise until the second trimester alleviating many concerns related to drug safety.
Members of your health care team will teach you how to take insulin if you switch to intensive insulin therapy. They'll also tell you how often to check your blood sugar. Don't be surprised if you have to check it more often. Your body undergoes rapid change to support the healthy growth of your baby.
Why is tight control of your blood sugar important?
Blood sugar control is crucial not only to your health but to the health of your unborn child. If during the first six to eight weeks of your baby's development — when your baby's heart, lungs, kidneys and brain are being formed — your blood sugar is too high, your baby is at increased risk of birth defects. You could also have a miscarriage. With too little insulin, the level of acids in your blood (diabetic ketoacidosis) also can cause miscarriage.
Later in pregnancy, uncontrolled blood sugar can lead to death of your baby. Less extreme excesses of blood sugar can cause your baby to grow larger than normal and make delivery more complicated.
If your blood sugar is high your baby may be born with very low blood sugar, which can require emergency treatment. Another possible complication is a yellowish skin color (jaundice) from a buildup of old blood cells that aren't being cleared away fast enough by your baby's liver.
Your own risks from uncontrolled blood sugar during pregnancy include high blood pressure and a worsening of pre-existing diabetic complications, especially eye disease (retinopathy).
What to watch out for: Hypoglycemia, hyperglycemia and ketone buildup
Low blood sugar (hypoglycemia)
Tight blood sugar control can improve your chances of having a healthy pregnancy, but tight control also puts you at risk of low blood sugar. Your body needs your blood sugar to remain between a certain, narrow range. When your blood sugar falls below that normal range, you may not have enough sugar to provide the energy your brain needs to function correctly. Although easily treated with glucose, this problem can be very serious if it occurs while driving or in other situations where injury may occur if your attention is hampered.
High blood sugar (hyperglycemia)
High blood sugar will occur if your body doesn't have enough insulin, which may happen because you take in more calories than your insulin can handle, if you exercise less than you planned, or if you miss an insulin dose. Stress or illness, such as a cold or flu, also may cause high blood sugar. After the middle of the second trimester, pregnancy generally gives rise to higher and higher insulin requirements, so unless you make adjustments, your blood sugar will likely become too high.
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis is caused by inadequate insulin treatment leading to increased levels of ketones. These acidic chemicals in the blood are the product of breaking down fat for energy, the only choice your body has if there is inadequate insulin over a period of time. High levels of these ketones alter the chemistry of your body and endanger your health and that of your baby.
What you can expect during your pregnancy
Throughout pregnancy members of your health care team will actively help you support a healthy pregnancy. Here's what can happen as your pregnancy progresses.
First trimester
During the first 10 to 12 weeks of your pregnancy, you'll meet with your obstetrician regularly. Whoever is helping you manage your blood sugar through insulin dosage will want to be actively involved at this time as well. This is the time that your baby's organs are developing, so you want your blood sugar to be as close to normal as possible to prevent birth defects. Frequent blood sugar monitoring can help you do this. Because your body's need for insulin may drop slightly during this time, it's important to be alert to signs of low blood sugar.
Morning sickness (nausea) can further complicate the appropriate use of insulin by altering your absorption of carbohydrates in your diet. Contact your care providers to help control this symptom and for advice regarding insulin treatment.
At this stage of your pregnancy, it's also important to see an eye specialist. Damage to the small blood vessels in your eyes can progress during pregnancy.
Second trimester
In the second trimester, an ultrasound will be carried out to examine your baby for any congenital anomalies that might affect your care during the rest of the pregnancy. Because diabetes increases the risk of these problems, an ultrasound is highly advised.
Your doctor also will keep track of your weight gain. If your weight is normal when you start your pregnancy, research suggests a total weight gain of 25 to 35 pounds is healthiest for you and your baby. If you're too thin, you may need to gain more. If you're obese, you may need to work with a dietitian to limit your weight gain
Expect your insulin requirements to rise gradually between week 16 and 20, and then accelerate dramatically. Hormones made by the placenta to help your baby grow block the effect of insulin, so you'll need significantly more to compensate.
Third trimester
During the final three months of your pregnancy, your doctor will monitor you carefully. He or she will check for complications that can occur during the late stage of any pregnancy, such as high blood pressure, swollen ankles from fluid buildup and kidney problems. Your doctor may also recommend that you have your eyes examined again to check for eye damage.
Because women with diabetes are more likely to give birth to babies who weigh more than 9 pounds, you may receive another ultrasound to assess the size and health of your baby. Intensive evaluation of the baby's well being is required in the third trimester to assure that the placenta is functioning normally. This testing dramatically reduces the risk of intrauterine fetal death. At this stage, any potential problem for you or your baby may prompt early delivery of the baby.
Labor and delivery
Your health care team will help you determine the best time and safest method to deliver your baby. Delivering your baby at home is not recommended because of the increased potential for problems due to your diabetes.
The chance of Caesarean birth is greatly increased in diabetes due to the common need to promote birth before the uterus is fully ready and the risk of very large babies. Despite this risk, many women successfully deliver vaginally and should be given that chance unless a complication is detected. During labor, your blood sugar will be closely monitored to prevent a large reduction or increase in your blood sugar levels. Because your body is working so hard and using sugar as energy, you'll likely need less insulin.
Your care team will intensively monitor your labor's progress and the well-being of your fetus. Although there is a good chance of a normal labor, with diabetes there is a higher risk of complications during the labor that could lead to Caesarean birth.
However your baby is born, he or she will be closely watched by the pediatrics team to assure that complications such as low blood sugar do not become a problem in the first hours of life.
Following delivery of your baby, your insulin needs will decrease. However, it may take a few weeks to months before your body changes are complete and you return to your normal medication regimen.
Although many potential complications exist, with close blood sugar control and the partnership of a good care team, you can be confident that your baby will be healthy.
Last Updated: 02/10/2006
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