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When you have diabetes, you have special concerns you need to manage to stay healthy. When you are pregnant and have diabetes, you also are faced with unique challenges. But it is possible to have a healthy pregnancy, even with diabetes. You just need to take extra care before and during your pregnancy.
What is diabetes?
Diabetes is a disease that occurs when your body doesn’t make or use the hormone insulin properly. It causes too much blood glucose (sugar) to build up in the blood. This can cause serious health problems, such as heart disease, kidney failure, or blindness. The 3 most common types of diabetes are:
- Type 1. This occurs when your body doesn’t produce enough insulin. You must take insulin to control it.
- Type 2. This occurs when your body doesn’t produce enough insulin or doesn’t respond to insulin as it should. It can sometimes be controlled through diet and exercise. Some people need to take insulin or medicine to manage it.
- Gestational diabetes. This is a special kind of diabetes that some women develop during pregnancy. It usually goes away soon after the baby is born. It is different than having diabetes before you are pregnant. However, it can put you at higher risk for developing Type 2 diabetes in later years.
How does diabetes affect a pregnant woman?
When diabetes is managed properly and blood sugar levels are controlled, you shouldn’t see many problems. However, if blood sugar levels are not well-controlled, diabetes can lead to problems for a pregnant woman, including:
- Making some long-term diabetes problems worse. These include eye problems and kidney disease.
- Increasing the risk of developing preeclampsia. This is when you develop high blood pressure and too much protein in your urine. It can cause serious or life-threatening problems for you and your baby.
- Increasing the risk of having a miscarriage or stillbirth. A miscarriage is the loss of a baby before 20 weeks. A stillbirth means the baby dies in the womb sometime after 20 weeks.
- Increasing the likelihood you will need a Caesarean section. Also called a C-section, this is when surgery is done to deliver the baby through the mother’s belly. It takes longer for the mother to recover and comes with risks of complications, as in any surgery.
How does diabetes affect a developing baby?
Having high blood sugar can harm your baby as soon as it starts developing. These problems can include:
- Birth defects.The baby’s organs form during the first 2 months of pregnancy. Uncontrolled blood sugar can affect those organs and cause birth defects. These include defects in the brain, spine, and heart.
- A large baby.When your blood sugar is high, the baby’s is too. This causes the baby to grow to a larger-than-normal size. It can lead to problems during delivery for both the mother and the baby. Large babies are also more likely to be obese or have diabetes when they are older.
- Preterm birth.This is when the baby is born too early. Babies born early have a higher chance of having problems with their breathing, heart, intestines, and vision. Women with diabetes are more likely to have their babies early.
- Low blood sugar.When a mother doesn’t control her diabetes during pregnancy, the baby’s blood sugar can dip very low after birth. This can be serious and must be treated quickly.
Path to improved health
When diabetes is well-controlled and blood sugar levels stay within a healthy range, you increase your chance of having a healthy baby. Follow these steps to have a healthy pregnancy when you have diabetes.
Plan ahead
Make an appointment with your doctor before you become pregnant. They will probably run tests to see how diabetes has affected your body. They will help you get your blood sugar levels under control and make sure it is safe for you to become pregnant.
See your doctor
When you have diabetes, you need to see your doctor more often than if you didn’t have diabetes. Go to all your prenatal appointments and follow your doctor’s instructions. Ask your doctor if you should see an ophthalmologist (eye doctor) or nephrologist (kidney specialist) during your pregnancy.
Eat healthy
See a dietitian if you don’t have one already. They can help you create a healthy meal plan that will help keep your blood sugar levels under control. Follow the plan and eat a healthy diet to help your baby be healthy.
Exercise
Exercise is an important part of diabetes management, especially when you’re pregnant. It helps balance food intake and keeps your blood sugar under control. Aim for at least 30 minutes of exercise 5 days a week.
Take your medicine
Whether its vitamins, diabetes pills, or insulin, take your medicine as your doctor prescribes. They may adjust what you take once you become pregnant. Some women with both type 1 and type 2 diabetes may need to take insulin during pregnancy. For others, diabetes can be controlled with oral medicines. Even if you were taking insulin before becoming pregnant, the amount you need will change when you are pregnant. Be sure to follow your doctor’s instructions. Medicine amounts may change as your pregnancy progresses.
Monitor your blood sugar often
Your blood sugar levels can change very quickly when you are pregnant. Follow your doctor’s instructions and check your sugar levels often. This will allow you to see how exercise, diet choices, insulin, or other medicines affect your blood sugar. That way you can adjust as they are needed. It will also allow you to see when your levels are getting too low before you have a severe reaction. Stress and illness also can affect your blood sugar levels.
Follow other healthy pregnancy guidelines
As with any pregnancy, there are certain things you should do for the best health for you and your baby.
- Don’t smoke.It can increase your chance of having a preterm or stillborn baby. It can also increase diabetes-related health problems, such as eye, heart, or kidney disease.
- Avoid alcohol.Alcohol can lead to serious problems in your baby that could affect it for the rest of its life.
- Take your vitamins.Folic acid is an important vitamin to take during pregnancy. You should start taking it before you become pregnant and continue throughout the pregnancy. Ask your doctor how much folic acid you should be taking, or if there are any other vitamins you should take.
Things to consider
Your body goes through many changes when you are pregnant. Any of these changes can affect your blood sugar at any time. They also can affect how you manage your diabetes. Even if your diabetes has been well-controlled in the past, you may need to change your habits. This includes your meal plan, your exercise routine, and the medicines you take. As your pregnancy progresses, you may need to change your management plan again. Be flexible and listen to your doctor. Follow their instructions. Take care of yourself and monitor your blood sugar levels to strive for a healthy pregnancy.
Postpartum
After you give birth (usually in the hospital) a pediatrician will check your baby for low blood glucose. Your baby was getting blood glucose from you (and making extra insulin to compensate) and will need time to readjust.
Your insulin needs will also decline—drastically—which puts you at risk for hypoglycemia too. Within just a few hours, your blood glucose levels might be back to the levels they were at before you were pregnant.
See your doctor within two weeks for a checkup. If you have type 2 diabetes and weren’t previously using insulin, you might be able to switch back to an oral medication, though some women prefer to stay on insulin longer because it doesn’t get into breast milk.
Whatever treatment you opt for, breastfeeding is strongly recommended by most health care providers. It helps lower your blood glucose and children who are exclusively breastfed have a lower incidence of type 2 diabetes. Not only that, but studies have found that mothers with gestational diabetes have a lower risk of developing type 2 in the future if they breastfeed.
Note that nursing requires a lot of energy. To prevent dangerous low blood sugar, remember to check your blood glucose before you breastfeed and, unless it’s already high, eat a snack.
Also know that postpartum depression is common in women with diabetes. Combine managing your diabetes, caring for a newborn, lack of sleep and major hormonal shifts, and you have a recipe for a potentially serious mood disorder. If your “baby blues” don’t improve after two weeks, or if you’re overcome by feelings of sadness or have thoughts of harming yourself or your baby, call the 988 Suicide and Crisis Lifeline. When you do checkups with your doctor, tell them so you can get treated and start feeling better.
Questions to ask your doctor
- How can I control my blood sugar?
- How often should I check my blood sugar?
- Do I need to take diabetes pills or insulin?
- Is it safe for the baby to take diabetes medicine?
- Do I need to take any vitamins or supplements?
- Should I see a dietitian?
- Should I see an ophthalmologist?
- What exercises can I do to stay active while I’m pregnant?
- Will I be able to breastfeed my baby?
Resources
American Diabetes Association: Diabetes and Pregnancy
Centers for Disease Control and Prevention, Diabetes and Pregnancy
National Institute of Diabetes and Digestive and Kidney Diseases, Pregnancy if You Have Diabetes
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