Diabetes & The Body

Pregnancy Plans

Pregnancy

For women with insulin dependent diabetes, pregnancy requires special care and attention. You and your husband need to understand the effects of diabetes on pregnancy and the effects of pregnancy on diabetes. You will both need to know about insulin doses, diet, exercise, and how to recognize and treat hypoglycemia. Attaining excellent control of blood sugar levels prior to pregnancy and maintaining good control during pregnancy greatly increases your chance of delivering a healthy baby.
Find the care that you need for your condition.

Before You Become Pregnant

As you plan your pregnancy, you and your husband should both be aware that it will be more expensive for you than for women without diabetes. You will need special care during pregnancy and special precautions during delivery, and your child may require special attention at birth. Choose your medical team before you become pregnant. Your obstetrician, pediatrician, diabetologist, and diabetes educator will work together to provide you with the best care and advice. They will help you choose a hospital that has the latest monitoring and testing equipment and a high-risk nursery.

Statistics indicate that 5-7% of babies born to women with insulin dependent diabetes have abnormalities. The good news is that, with excellent blood sugar control prior to and during the first three months of pregnancy, the risk of abnormalities is reduced to that of women without diabetes: 2-3 % . Your level of control can be measured by blood glucose monitoring records and by a blood test called a glycosylated hemoglobin. This test provides information on your blood sugar control over the past 8-12 weeks. The result should be in the normal range before you become pregnant.

During Pregnancy

During the first trimester, hypoglycemia may be a problem, due to morning sickness or nausea that causes you to eat less. Hypoglycemia may also occur because your baby takes sugar from your blood to support its own rapid growth. During the second and third trimesters, your insulin requirements double and triple. Frequent blood glucose monitoring, insulin adjustments, exercise, proper rest, and a good meal plan will help you stay in good control.

Care during pregnancy

See your doctor every 1 to 2 weeks.
Stick to your prescribed diet and exercise program
Check your blood glucose 4 to 8 times daily, and record the results.
Inject insulin as prescribed by your doctor. You may need 3 to 4 shots per day, and you may have to make frequent insulin adjustments.

Remember that hospitalization may be necessary during your pregnancy if your diabetes is out of control.

Hypoglycemia occurs more frequently during pregnancy, so you must always carry a fast-acting sugar and you must never skip meals or snacks. Ketosis may develop more rapidly during pregnancy when you are ill. Be sure to check your urine for ketones on sick days and any time your blood sugar is over 250 mg. Other, less common problems that may also affect women without diabetes include:

Polyhydramnios or excessive amniotic fluid
Toxemia, characterized by elevated blood pressure, protein in the urine, and swelling of the hands and feet
Edema or generalized swelling
Women in poor diabetic control have a higher rate of miscarriages, but in healthy women with diabetes the risk is no higher than for women without diabetes.

As a direct result of elevated blood sugar, babies born to women with diabetes may be larger than average. If your blood sugar is very high, especially during the last trimester, your baby may be over 10 pounds. Your baby's growth will be measured several times during pregnancy by a technique using sound waves (sonography ).

For another test (the LS ratio), your doctor will insert a fine needle into your uterus and obtain a small amount of amniotic fluid. The LS ratio provides information about your baby's ability to breath on its own after birth. Standard classifications of diabetes have been developed to help predict the outcome of pregnancy. Based on your classification and test results, your doctor will decide on the best delivery date.

Delivery

Most women with diabetes can deliver close to their due date in uncomplicated cases. To be safe, obstetricians usually deliver their patients slightly before the due date by inducing labor or by Cesarian section. Most babies born to women with diabetes are cared for in a high-risk or intensive-care nursery. This is done to ensure a close watch and quick treatment for any problems that may develop. Your baby may have low blood sugar and require extra glucose in feedings or by IV. Special care may also be required if your baby is premature.

After your baby is born, you will experience a tremendous decrease in your insulin requirements. If you have a planned induced delivery date, you will need only half of your pre-pregnancy insulin dose. This may last several weeks. Keep a careful record of your blood sugar levels; your medical team will need this information to determine appropriate insulin adjustments. If you decide to breast feed your baby, you will need less insulin, more calories, and lots of fluids. Hypoglycemia can occur rapidly in breast-feeding mothers, so keep sugar close by.

GESTATIONAL DIABETES

Gestational diabetes is diabetes that is diagnosed during pregnancy. It occurs more frequently in women who are overweight or have a family history of diabetes. After delivery, 98% of these women no longer have diabetes, but they are at greater risk of developing diabetes in the future. Treatment of gestational diabetes always begins with diet and exercise; insulin is introduced only if diet and exercise fail to keep blood sugars in a normal range. The goal is to normalize pre-meal blood sugars and keep after-meal blood sugars below 140 mg (120 mg at some clinics). If you are diagnosed with gestational diabetes, your obstetrician may expand your health-care team to include a diabetes educator, diabetologist, dietician, and neonatologist.