DIABETES IN PREGNANCY

About Diabetes in Pregnancy

Diabetes occurs when your body doesn’t make enough insulin or you can’t use it correctly. Insulin is a hormone made by your pancreas that lets you turn blood sugar into energy. You develop high blood sugar when insulin cannot do its job. Healthcare providers no longer discourage women with diabetes from getting pregnant. Fortunately today, with good medical care, you can look forward to having a healthy baby. If you have diabetes you should plan your pregnancy. See your healthcare provider for counseling and a physical exam before you get pregnant and get early prenatal care. Poorly controlled diabetes before or during your pregnancy puts your baby at a greater risk for having certain birth defects and other problems.

Types of Diabetes in Pregnancy

The two types of diabetes that can occur during pregnancy are pre-existing diabetes and gestational diabetes. The type you have depends upon whether your diabetes started before your pregnancy or during your pregnancy.

Pre-existing Diabetes

About 1 in 100 women of childbearing age has diabetes that started before pregnancy. This is called pre-existing diabetes. If you have this type of diabetes you should see your healthcare provider before getting pregnant. The first few months of pregnancy are critical because your baby’s organs are forming during this time and you are not aware that you are pregnant yet. Extra sugar in your blood can pass through the placenta, which is the organ that supplies your growing baby with nutrients, through the umbilical cord. Too much sugar in early pregnancy increases the chance of birth defects. Too much sugar later in pregnancy can affect your baby during delivery. This affects both types of diabetes. During pregnancy, your diabetes control will take more work. Start 3 to 6 months before you want to get pregnant. Your healthcare provider will give you a diabetes treatment plan to help you. You should also start a multivitamin with folic acid beginning 3 months before your pregnancy; this helps decrease birth defects, too.

Gestational Diabetes

Another 3 to 5 percent of pregnant women will develop diabetes that only occurs during pregnancy. This is called gestational diabetes and it usually develops after 28 weeks. The cause of gestational diabetes is unknown. It starts when your body is not able to make and use the insulin it needs for pregnancy. When this happens, you can develop high blood sugar. The good news is you can probably control your blood sugar with simple changes in your activity and the way you eat.

Risk Factors for Developing Gestational Diabetes

Even though most women have no known risk factors, there are certain conditions that increase the risk of developing gestational diabetes. Let your healthcare provider know if you have any of these risk factors:

  • If this is your first pregnancy.
  • If a close family member, such as your parent, brother, or sister, has diabetes.
  • If you are overweight at the start of your pregnancy. Gaining a lot of weight during your pregnancy is not a risk factor.
  • If you are older than 30 years.
  • If you had gestational diabetes during another pregnancy.
  • If you gave birth to a baby weighing more than 9 pounds.
  • If you gave birth to a stillborn baby. Stillborn means your baby died before your delivery.

Symptoms of Gestational Diabetes

Normally, gestational diabetes will not cause you symptoms. However, if you develop any of the following problems, tell your healthcare provider:

  • If you have extreme hunger.
  • If you notice extreme thirst.
  • If you feel extreme fatigue. These symptoms can be found in normal pregnancies, too.

Screening and Diagnosis of Gestational Diabetes

Most healthcare providers screen every pregnant woman for gestational diabetes. Others might not if you are under 25 years old and without any other risk factors. Screening for gestational diabetes is usually done between 24 and 28 weeks of pregnancy. It could be ordered earlier if you have certain risks. It does not mean that you have gestational diabetes if your screening test is too high. A second test will be done to confirm the diagnosis.

Complications Of Diabetes During Pregnancy

Pre-existing diabetes can cause problems throughout the pregnancy. Both pre-existing and gestational diabetes can cause high blood sugar later in pregnancy that can hurt your baby even after delivery.

  • Pre-existing diabetes can cause birth defects if your blood sugar levels are too high before you get pregnant and during early pregnancy. Good control of your blood sugar can help prevent many of these from occurring.
  • Gestational diabetes does not cause birth defects. Most birth defects occur in the first few months of pregnancy when extra blood sugar can affect your baby’s developing organs. Because your blood sugar levels were normal when you got pregnant, you do not have to worry about birth defects.
  • Your baby may grow too large. This may cause longer labor, a difficult delivery or a birth injury. Your healthcare provider may advise early delivery.
  • If your baby is born prematurely or too early then Respiratory Distress syndrome may develop. This is a condition that makes breathing difficult.
  • If gestational diabetes is undetected, your baby has a higher risk of being stillborn.
  • If you have gestational diabetes, you are more likely to have it again in another pregnancy.
  • Poorly controlled diabetes can cause your newborn baby to develop breathing difficulties, low blood sugar levels, and jaundice. This can be treated but it is easier to prevent them by controlling your blood sugar during pregnancy.

Treatment of Gestational Diabetes

The key to keeping your baby healthy and avoiding complications during delivery is controlling your gestational diabetes. The good news is that you can probably control your blood sugar with simple changes in your activity and the way you eat. Rarely would you need to add medication.

  • You need to monitor your blood sugar to know if it is staying in the normal range. This is the key to your treatment plan.
  • You need to eat a healthy diet. Fruits, vegetables, and whole grains supply important nutrients. Your healthcare provider may have you see a dietician to help you plan a diet that fits your blood sugar levels and daily life.
  • You should exercise. Your body uses insulin better when you do. Do not start any exercise program without checking with your healthcare provider first.
  • Rarely will you be given medicine to help lower your blood sugar to safe levels. You probably won’t need it after the baby is born because gestational diabetes usually goes away after delivery.
  • You may have ultrasounds to measure the growth of your baby. An ultrasound is a test that combines sound waves and a computer to make pictures of your baby in your womb or uterus.
  • Toward the end of your pregnancy, your prenatal care provider may recommend special tests.
  • Your prenatal care provider may want you to deliver the baby early. It may not be safe for your baby to wait until your due date to be born.

Gestational diabetes usually goes away after delivery. However you are at a greater risk for developing diabetes later in life. An exercise and weight loss program can prevent this.

What to Do

  • If you have pre-existing diabetes, see your healthcare provider for pre-pregnancy counseling before you get pregnant.
  • If you have problems sticking to your treatment plan, talk to your healthcare provider for more advice.
  • Start your prenatal care early and keep all of your appointments.
  • Keep your stress low. Diabetes during pregnancy may increase your emotional stress and learning more about it may help.

What We Have Learned

  1. Pre-existing diabetes is diabetes that occurs before pregnancy.
    True or False
    Answer: True
  2. Many complications of gestational diabetes cannot be prevented.
    True or False
    Answer: False
  3. The key to a healthy pregnancy with diabetes is good control of your blood sugar.
    True or False
    Answer: True

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