If you have diabetes — either type 1 or type 2 — pregnancy presents unique challenges. Here are some suggestions for promoting a healthy pregnancy with diabetes and delivering a healthy baby.
Pregnancy and diabetes: Your health care team
Your diabetes health care team likely includes an endocrinologist or other diabetes specialist, a diabetes educator, a registered dietitian, and an eye specialist. As your pregnancy progresses, your health care team can help you manage your blood sugar levels and adjust your diabetes treatment plan as needed.
During pregnancy, your health care team will also include an obstetrician who can help you manage diabetes in pregnancy, teach you about potential complications to watch out for, and order special tests throughout your pregnancy.
The goal: Careful blood sugar management
Keeping your blood sugar in your target range before and during pregnancy is the best thing you can do for you and your baby. Good blood sugar management during pregnancy can:
- Reduce the risk of miscarriage and stillbirth. Good blood sugar management reduces the risk of miscarriage and stillbirth. People with uncontrolled diabetes have a higher risk of miscarriage and stillbirth.
- Reduce the risk of premature birth. The better your blood sugar management, the less likely you are to go into preterm labor.
- Reduce the risk of birth defects. Good blood sugar control before and during early pregnancy greatly reduces your baby's risk of birth defects, particularly those affecting the brain, spine and heart.
- Reduce the risk of excess fetal growth. Having persistently high blood sugar levels lets extra glucose cross the placenta, which may cause your baby to be significantly larger than average (fetal macrosomia). A large baby makes vaginal delivery difficult, increases the risk of a cesarean delivery and puts the baby at risk of injury during birth.
- Prevent complications for mom. Keeping your blood sugar in range reduces your risk of urinary tract infections and yeast infections. It can also help avoid diabetes complications such as kidney disease.
Prevent complications for baby. Sometimes babies of mothers who have diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is too high. Good blood sugar control can help promote healthy blood sugar levels for your baby, as well as healthy levels of calcium and magnesium in the blood.
Good blood sugar management also helps prevent breathing problems and a yellowish discoloration of the skin and eyes (jaundice) in your baby after birth.
The action plan
Your diabetes health care team will help you establish your target blood sugar range. Then you'll come up with your diabetes treatment plan together, which will likely include:
- Checking your blood sugar often. Frequent blood sugar monitoring can help you prevent low blood sugar and high blood sugar (hyperglycemia). Managing your blood sugar is the best way to promote a healthy pregnancy and prevent diabetes complications. Ask your doctor if continuous glucose monitoring (CGM) might be a better option for tracking your blood sugar throughout your pregnancy.
- Reviewing your medications with your doctor. Your health care provider will discuss the best medications for your diabetes and any other conditions you have during your pregnancy. While some diabetes medications are safe to use in pregnancy, others have not been well studied. Discuss your medications with your health care provider before stopping or continuing to take them. If you also have high blood pressure, some medications — such as angiotensin-converting enzyme (ACE) inhibitors — aren't considered safe in pregnancy.
- Adding medication during pregnancy. Beginning in the second trimester, low-dose aspirin is recommended to reduce the risk of preeclampsia, a pregnancy complication associated with high blood pressure.
Being flexible. If you're taking insulin, you'll need to adjust your dosage depending on your blood sugar levels, what you eat, whether you're vomiting and various other factors. The stage of your pregnancy affects your insulin needs, too.
In the beginning of your pregnancy, you'll likely need less insulin than usual. But during the last three months of pregnancy, hormones made by the placenta to help the baby grow can block the effect of insulin in your body. As a result, you might need more insulin than usual to counteract that resistance.
- Preparing for an emergency. If you don't already have glucagon on hand, ask your doctor for a prescription. Glucagon is a hormone that can quickly raise your blood sugar level if it dips dangerously low.
- Eating a healthy diet. Your diabetes diet probably includes plenty of fruits, vegetables and whole grains. Although you can eat the same foods during pregnancy, your health care provider or registered dietitian might suggest changes to your meal plan to help you avoid problems with low blood sugar or high blood sugar. It's also important to take prenatal vitamins containing folic acid.
- Managing weight gain. Talk with your health care provider about how much weight gain is appropriate during pregnancy. This will vary depending on your pre-pregnancy weight.
Including physical activity in your daily routine. Get your health care provider's OK to exercise, then choose activities you enjoy. Aim for at least 150 minutes of moderate aerobic activity a week.
If you haven't been active for a while, start slowly. Check your blood sugar before and after any activity, especially if you take insulin. You might need to eat a snack. Or have your health care provider adjust your medication before exercising to help prevent low blood sugar.
- Scheduling regular prenatal checkups. Your health care provider might recommend extra clinic appointments and prenatal screening tests to monitor your baby's growth and development.
Remember, your health care team is there to help you manage your blood sugar level and prevent complications. If you have questions or concerns, don't hesitate to ask for help.
Labor and delivery: What to expect
Your health care team will help you determine the best time and safest way to deliver your baby. Sometimes labor is allowed to begin naturally. In other cases, labor may need to be induced to reduce the risk of complications.
During labor, your health care team will closely monitor your blood sugar and adjust your medication dosage accordingly. If your baby is too large, your labor isn't progressing or you develop complications, you might need a C-section.
After delivery, your attention will turn to your baby — but it's still important to take care of yourself. Continue to check your blood sugar levels often, especially if you're breast-feeding. Keeping yourself healthy is the best thing you can do for your baby.