Planning a Pregnancy With Diabetes
If you have diabetes and are considering having a baby, there are a number of steps you should take before you get pregnant to ensure a safe and healthy pregnancy and baby. Here are some tips:
- Meet with your health care provider 3-6 months before becoming pregnant. Your doctor may order an A1C test that can help determine if your diabetes is controlled well enough for you to stop using your birth control method.
- Have your blood and urine checked for diabetic kidney complications.
- Check for other organ complications of diabetes, including nerve and heart damage.
- Check your blood pressure. Your doctor will also likely check for thyroid disease if you have type 1 diabetes.
- Check your cholesterol and triglyceride levels.
- Have an eye exam to screen for glaucoma, cataracts, and retinopathy.
- Undergo pre-conception counseling.
Counseling Before Getting Pregnant
A counseling appointment with your doctor before getting pregnant is another important step for women with diabetes. Pre-pregnancy counseling will help educate you so that you can be physically and emotionally prepared -- and healthy -- for pregnancy. Here's what a preconception appointment usually includes:
An evaluation of your weight: Try to reach your ideal body weight before becoming pregnant. This means losing weight if you are overweight to reduce your risk of diabetes complications, or gaining weight if you are underweight to reduce the risk of delivering a low birth-weight baby.
A discussion of your lifestyle: Smoking and drinking alcohol are two habits that must be stopped in order for you to have a healthy pregnancy and baby. Smoking during pregnancy affects you and your baby's health before, during, and after your baby is born. The nicotine (the addictive substance in cigarettes), carbon monoxide, and numerous other poisons you inhale from a cigarette are carried through your bloodstream and go directly to your baby. These substances can lower the amount of oxygen available to you and your growing baby; increase your baby's heart rate; increase the chances of miscarriage and stillbirth; increase the risk that your baby is born prematurely and/or born with low birth weight; and increase your baby's risk of developing respiratory problems. Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders (FASD). FASD is a pattern of birth defects that includes mental retardation, as well as cardiovascular, skeletal, and facial abnormalities. No amount of alcohol is known to be safe while pregnant and there is not a safe time during pregnancy to drink.
Discussion of prenatal vitamins: At least one month before becoming pregnant, start taking a daily vitamin that contains folic acid. Folic acid has been shown to decrease the risk of having a baby with a neural tube defect, such as spina bifida -- a serious condition in which the brain and spinal cord do not form normally. The Centers for Disease Control recommends taking 400 micrograms of folic acid daily before conception and throughout pregnancy. Many pharmacies sell over-the-counter prenatal vitamins that do not require a prescription.
Blood sugar screening: If you have diabetes, your doctor will check to see if your blood sugar is in control. Good blood sugar control is important before becoming pregnant, because many women do not even know they are pregnant until the baby has been growing for 2-4 weeks. High blood sugar levels early in the pregnancy (during the first13 weeks) can cause birth defects, and if not brought under control, can lead to miscarriage and increase your risk for more diabetes complications. All women should be screened for gestational diabetes after 24 weeks of pregnancy regardless of whether they have symptoms of the condition, according to a new draft recommendation statement issued by the U.S. Preventive Services Task Force (USPSTF).
Make medication adjustments: If you take insulin to control your diabetes, your doctor can tell you how to adjust your medication. Generally, your body will require more insulin during pregnancy, especially during the last 3 months of pregnancy. If you take oral medications to control your diabetes, your doctor may switch your medication to insulin during pregnancy, because certain oral medications could harm the developing baby. Discuss all over-the-counter and prescription medications that you take with your doctor. Some blood pressure medications commonly used in diabetes, such as ACE (angiotensin converting enzyme) inhibitors like benzapril (Lotensin), lisinopril (Zestril, Prinivil), and ARBs (angiotensin II receptor blockers) such as losartan (Cozaar) and valsartan (Diovan), can cause birth defects.
Diabetes meal planning: During pregnancy, you and your health care provider should work together to adjust your diabetes meal plan. Changing your meal plan will help you avoid problems with low and high blood sugar levels. Your meal plan will also be adjusted to include more calories for your growing baby.