Diabetes and Pregnancy

There are two types of diabetes that women may experience during pregnancy. First, there is Type I or II diabetes that the mother may have as a pre-existing condition before she gets pregnant, and that, if not properly controlled, may have an impact on the health and development of her unborn child. The second type, "gestational diabetes," is a form of diabetes that develops in the mother during pregnancy, and goes away after birth. This, too, can have an impact on the mother and the baby.

How does Type I or II diabetes affect a pregnancy?
Despite advances in care, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk for birth defects.

Specifically, poorly controlled diabetes affects a growing fetus by:

Interfering with the development of the baby's internal organs, especially during the first six weeks of pregnancy. High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.

When extra sugar is in your blood, the baby is "fed" extra sugar, too. All this excess sugar can make the baby grow too large and overweight. While this isn't life threatening, delivery of big babies is harder on mom and baby.

Because your baby is getting extra sugar, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out extra insulin. The baby must be watched, and treated if the blood glucose level drops too low.

Though the reason is not fully understood, babies born to women with diabetes often are born jaundiced. Jaundice is a build up of old red blood cells that the body can't process fast enough. This is a minor problem which goes away rapidly with treatment, usually by placing the baby under special lights that help build up the bilirubin the baby's skin, which is needed to break down the excess red blood cells. Brief treatment cures the problem.

How is the treatment of gestational diabetes different?
While the effects may be similar, the two conditions are quite different in some striking ways. Gestational diabetes usually develops late in a pregnancy, often after 28 weeks. So the risks to the development of the baby's internal organs are slight. However, gestational diabetes can create babies who are very high in birth weight, which can be a cause for concern. Women who develop gestational diabetes are put on diets to control their blood glucose levels, and given sensible exercise plans. They also must regularly monitor their blood sugar. Fortunately, the condition usually disappears after birth. However, there is some evidence to suggest that women who develop gestational diabetes during pregnancy are far more likely to develop it again with subsequent pregnancies. And women who develop gestational diabetes are at an elevated risk to contract Type II diabetes later in life. Maintaining a healthy weight, exercising and eating a healthy diet can help keep these risks at bay.

I am diabetic. What should I do before I get pregnant?
Despite the risks, women with diabetes can have healthy pregnancies and give birth to thriving babies. It takes planning, effort, and a very close watch on your diet and glucose levels, however.

Ideally, coming to a perinatology practice such as ours three to six months before you plan to get pregnant will help set you on the right track. Together, we can put together a plan to strictly manage your blood glucose levels involving diet, exercise and frequent monitoring of your glucose levels. When you become pregnant, it is especially important to see a perinatologist who can help you manage your risks during pregnancy, and be on the lookout for any developing complications. If you feel you need extra help managing your diet either before or during your pregnancy, we refer to a number of registered dieticians in the area who can help you develop an eating plan you can live with during pregnancy.

What about weight gain during pregnancy?
A diabetic woman will not necessarily gain more weight than other women during pregnancy. However, if you are coming into pregnancy overweight, it will make your pregnancy more uncomfortable. If at all possible, it is best to lose weight and boost your fitness level before pregnancy. If you come into a pregnancy overweight, attempting to lose weight while pregnant is never a good idea. Instead, work with a dietician to make sure you and your baby are getting the nutrients you need, without promoting excess weight gain. During a healthy pregnancy, most women will gain 25 to 35 pounds. If you come into the pregnancy underweight, you may need to gain more than this amount during pregnancy.

Should I exercise when I'm pregnant?
Discuss your exercise plans with your diabetes team. Ask for guidelines. Exercise can help you stay healthy during pregnancy. However, if you have high blood pressure; eye, kidney or heart problems; damage of the small or large blood vessels; or nerve damage, you should take extra care to consult with your treatment team about whether you should exercise.

In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming or water aerobics.

Should I change the way I monitor my blood glucose during pregnancy?
Check your blood glucose levels at the times your diabetes team advises; this may be up to eight tests daily and will probably include after-meal checks. Be sure to write down your results at every check, and keep notes on your meal plan and exercise. It may be a bit of extra work, but this will help us pinpoint potential problems before they arise, and adjust your treatment plan accordingly.

What should I expect during my delivery?
No matter how you deliver your baby, we will be working during labor and delivery to keep your blood glucose level under control. At the start of active labor, your insulin needs will drop. You will most likely not need any insulin during labor and for 24 to 72 hours after delivery.

To help you prepare for labor, many hospitals and other organizations offer classes (such as Lamaze) to help you have a smooth delivery. They teach you what to expect during delivery, techniques to improve delivery and to relieve pain during labor, and how to care for your baby after birth. Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.