Diabetes During Pregnancy – Part 1

Diabetes and pregnancy is a special concern because what the mother does during pregnancy can definitely affect the baby and its life for good or bad. Let me be very clear that this is not an easy topic for me and my children were born without gestational diabetes and other complications. As such, I may miss some points that are important.

Whether you are a person with type 1 diabetes, type 2 diabetes, or do not have diabetes, there are some steps every woman needs to take before starting a family. Yes, starting a family requires more planning when you are a mother-to-be with diabetes, but these steps should also be carefully considered for all mothers-to-be. 

The following are all important:

See an OB GYN if at all possible or a doctor that does understand pregnancy. Set up an appointment approximately three to six months before you plan to conceive. For women without diabetes, some of these will not be done.

• Order an A1C test to find out if your diabetes is controlled well enough for you to stop using birth control.
• Test your blood and urine for diabetes-related kidney complications.

• Look for other problems linked with diabetes, like organ, nerve, or heart damage.

• Take your blood pressure.

• Rule out thyroid disease (if you have type 1 diabetes).

• Check your cholesterol and levels of a type of blood fat called triglycerides.

• Suggest an eye exam to screen for glaucoma, cataracts, and retinopathy.
• Do other blood work looking for various vitamin and mineral deficiencies.

• Recommend pre-conception counseling.

Pre-conception counseling is important for all women planning to conceive, but is especially important for women with diabetes and those that have had gestational diabetes with a previous child. The session will be educational and should help you become physically, emotionally, and healthy for pregnancy. The points for discussion will include at least the following:

1. Your weight: Try to reach your ideal body weight before you get pregnant. If you have a few extra pounds, losing them will help prevent complications from diabetes. If you’re underweight, adding pounds can make you less likely to deliver a low-birth-weight baby.

2. Your lifestyle: If you smoke or drink alcohol, you'll need to stop. Smoking during pregnancy affects both you and the baby before, during, and after birth. When you smoke, the nicotine (the addictive substance in cigarettes), carbon monoxide, and other toxins travel through your bloodstream and go directly to your baby. These substances can:

• Deprive you and the baby of oxygen.
• Raise the baby’s heart rate.
• Boost the chances of a miscarriage or a stillbirth.
• Increase the odds of a premature, low-birth-weight baby.
• Make the baby prone to future problems with the lungs or breathing.

Drinking alcohol during pregnancy can lead to a pattern of birth defects that includes mental retardation and certain physical problems. No amount of alcohol is known to be safe while pregnant, and there’s no safe time during pregnancy to drink.

3. Prenatal vitamins: At least one month before you get pregnant, start taking a daily vitamin that has folic acid. It’s been shown to lower the risk of having a baby with a neural tube defect like spina bifida, a serious condition in which the brain and spinal cord don’t form normally. The CDC recommends you take 400 micrograms of folic acid daily before conception and throughout pregnancy. Most drugstores sell over-the-counter prenatal vitamins that don’t require a prescription.

4. Your blood sugar: The doctor will check to see if your blood sugar is in control. This is key, because you may not know you’re pregnant until the baby has been growing for 2-4 weeks. High blood sugar during the first 13 weeks can cause birth defects, lead to miscarriage, and put you at risk for diabetes complications. Get screened for gestational diabetes at 24 weeks, even if you don’t have symptoms.

5. Your medications: You'll need more insulin during pregnancy, especially the last 3 months. The doctor will tell you how to adjust your dose. If you take diabetes pills, the doctor may switch you to insulin, because some of these drugs can harm the baby. So can some high blood pressure treatments used with diabetes. Bottom line: Discuss all medications and dietary supplements you take with your doctor.

6. Meal planning: You’ll need to make some changes while you’re pregnant to avoid swings in blood sugar levels. You’ll also need to take in more calories to feed your growing baby.