If you have diabetes and would like to get pregnant, you share special health concerns with other women like you. Pregnancy will put new demands on your body. It's more important than ever -- even before pregnancy -- to monitor carefully and control your blood sugar levels. You also need to do a good job of managing your diabetes medications.
You may find, however, that the prospect of a pregnancy is a great motivator. Now is an excellent time to take steps to lessen risks to both you and your baby.
Diabetes Evaluations Before Pregnancy
Medical tests. Your diabetes health care provider will help you see if your diabetes is under control. One way to do this is with the hemoglobin A1c test (HbA1c). This blood test can help evaluate your blood sugar control over the past eight to 12 weeks.
Other medical tests before pregnancy can help monitor your health and prevent diabetic complications during pregnancy. These might include:
- A urine test to screen for diabetic kidney complications
- Blood work to check for kidney problems and liver problems depending on medication.
- Cholesterol and triglyceride blood tests
- Eye exam to screen for glaucoma, cataracts, and retinopathy, which are more common if you have diabetes
Blood sugar control. Your health care provider will no doubt reinforce the importance of good blood sugar control before you become pregnant. That's because many women don't even know they are pregnant until the baby has been growing for two to four weeks. And, poorly managed diabetes can have a big impact on your baby during those early weeks.
Preconception checkup. A preconception checkup with your health care provider is another important step in preparing for pregnancy. This helps you see if you are physically and emotionally ready for pregnancy. At this time, you can talk about the team of health care providers you'll need to best manage your diabetes during pregnancy.
How Diabetes May Affect Your Baby and You
Diabetes does carry risks during pregnancy, but you can work with your doctor to lower these risks.
High blood sugar levels can increase the risk of:
- Birth defects
- Diabetes-related complications
Because you have diabetes, your baby is also at greater risk of being born too large and having low blood sugar levels right after birth.
A large newborn (macrosomia). If you have too-high blood sugar levels, your baby may be born quite a bit larger than other babies. This occurs when your baby receives too much sugar through the placenta.
Sometimes the baby becomes too large to deliver vaginally. Then you need a cesarean delivery. Your doctor will closely monitor your baby's size and will plan for the safest type of delivery for you both.
Low blood sugar levels. What if you have high blood sugar levels throughout pregnancy, especially in the 24 hours before delivery? Then your baby may develop dangerously low blood sugar right after delivery.
For this reason, your doctor will check your baby's blood sugar level after birth. If it's low, your baby will receive glucose through a vein. Your baby may also need medication to improve any mineral imbalances.
Controlling Blood Sugar Before and During Pregnancy
You can keep blood sugar levels under control by balancing meals, exercising, and taking diabetes medications. This will help you keep blood glucose levels within the ideal range:
- Less than 90 mg/dL before meals
- Less than 120 mg/dL two hours after eating
- 100-140 mg/dL before the bedtime snack
If you have well-controlled diabetes or do a great job of controlling your diabetes, you have a good chance of carrying your baby to term without any problems. Many women like you do. However, just in case, your health care provider may plan for an early delivery, around 38-39 weeks. Blood sugar control remains important even during labor.
Diabetes drugs. Whether you take insulin or oral medications, your doctor may recommend changes during pregnancy.
If you take oral medications to control your diabetes, your health care provider may switch your medication to insulin during pregnancy. Depending upon the type of medication you take, this may be safer. It may also allow for better sugar control.
If you take insulin to control your diabetes, your health care provider can tell you how to adjust your medication. It's likely you'll need more insulin, especially during the last three months of pregnancy. When labor begins, you may continue to receive insulin by injection or your doctor may give it to you intravenously. Right after delivery, you may need much less insulin.
Diabetes diets. Work with your health care provider to adjust your diet while you're pregnant. Changing your diabetes diet during pregnancy will help you avoid problems with low and high blood sugar levels. You may also need to adjust your meal plan to include more calories for your growing baby.
Exercise. Many women find that exercising, especially after meals, can help keep blood sugar within a target range. But it's best to have a conversation with your health care provider about your exercise plan during pregnancy. Exercise during pregnancy is important.