Diabetes and Pregnancy

Diabetes is often detected in women during their childbearing years and can affect the health of both the mother and her unborn child. Poor control of diabetes in a woman who is pregnant increases the chances for birth defects and other problems for the baby. It might cause serious complications for the woman, also. Proper health care before and during pregnancy will help prevent birth defects and other poor outcomes, such as miscarriage or stillbirth.

Becoming Pregnant When You Have Diabetes

Women with diabetes can have healthy babies, but it takes planning ahead and effort. Pregnancy can make both high and low blood glucose levels happen more often. It can make diabetic eye disease and diabetic kidney disease worse. High glucose levels during pregnancy are dangerous for the baby, too.

If you don’t want to become pregnant, talk with your health care provider about birth control.

Keeping your glucose levels near normal before and during pregnancy can help protect you and your baby. That’s why it’s so important to plan your pregnancies ahead of time.

Your blood glucose and A1C records will help you and your health care team know when your glucose range is safe for pregnancy.

If you want to have a baby, discuss it with your health care provider. Work with your diabetes care team to get and keep your blood glucose in the normal or near-normal range before you become pregnant. Your glucose records and your A1C test results will show when you have maintained a safe range for a period of time.

You may need to change your meal plan and your usual physical activity, and you may need to take more frequent insulin shots. Testing your glucose several times a day will help you see how well you're balancing things. shots. Record the test results in your logbook or on a log sheet.

Get a complete check of your eyes and kidneys before you try to become pregnant. Don’t smoke, drink alcohol, or use drugs—doing these things can harm you and your baby. All women who could become pregnant should get folic acid (400 micrograms) every day. An easy way to be sure you’re getting enough folic acid is to take a vitamin with folic acid in it.

Think about breast feeding your baby. Breast feeding has many benefits for you and your baby.

Having Diabetes During Pregnancy

Some women have diabetes only when they’re pregnant. This condition, which is called gestational diabetes, can be controlled just like other kinds of diabetes. Glucose control is the key. Your health care team can help you take charge of gestational diabetes. You are more likely to develop type 2 diabetes. Check again for diabetes at least 6 weeks after your baby is born and at regular times for the rest of your life.

If you learn you have diabetes when you’re pregnant, work closely with your health care team to stay healthy.

Controlling Diabetes for Women's Health

Some women with diabetes may have special problems, such as bladder infections. See Protecting Your Kidneys to find out about the signs of bladder and kidney infections. If you have an infection, it needs to be treated right away. Call your doctor.

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Some women get yeast infections in their vagina, especially when their blood glucose is high. A sign of a yeast infection may be itching in the vagina. If you notice vaginal itching, tell your health care provider, who can tell you about medicines you can buy at the drugstore and about how to prevent yeast infections.

Some women with diabetes may have trouble with sexual function. Discomfort caused by vaginal itching or dryness can be treated.

Ask your doctor how often you should get a Pap smear and a mammogram (breast X-ray). Regular Pap smears and mammograms help detect cervical and breast cancer early. All women—whether or not they have diabetes—need to have these tests regularly.

How does gestational diabetes differ from Type 1 or Type 2 diabetes?

Gestational diabetes happens in a woman who develops diabetes during pregnancy. Some women have more than one pregnancy affected by diabetes that disappears after the pregnancy ends. About half of women with gestational diabetes will develop Type 2 diabetes later.

If not controlled, gestational diabetes can cause the baby to grow extra large and lead to problems with delivery for the mother and the baby. Gestational diabetes might be controlled with diet and exercise, or it might take insulin as well as diet and exercise to get control.

Type 1 and Type 2 diabetes often are present before a woman gets pregnant. If not controlled before and during pregnancy, Type 1 and Type 2 diabetes can cause the baby to have birth defects and cause the mother to have problems (or her problems to worsen if they are already present), such as high blood pressure, kidney disease, nerve damage, heart disease, or blindness. Type 1 diabetes must be controlled with a balance of diet, exercise, and insulin. Type 2 diabetes might be controlled with diet and exercise, or it might take diabetes pills or insulin or both as well as diet and exercise to get control.

Will my baby have diabetes?

Babies born to mothers with diabetes do not come into the world with diabetes. However, if the mother’s diabetes was not controlled during pregnancy, the baby can very quickly develop low blood sugar after birth and must be watched very closely until his or her body adjusts the amount of insulin it makes.

Extra large babies are more likely to become obese and to develop Type 2 diabetes later in life. They especially need to develop healthy eating and regular exercise habits as they grow up to lessen the chance of obesity and Type 2 diabetes.

If the father of the developing baby has diabetes, does his diabetes affect the pregnancy?

Diabetes in the father does not affect the developing baby during pregnancy. However, depending on the type of diabetes the father has, the baby might have a greater chance of developing diabetes later in life.

What can happen to a woman with Type 1 or Type 2 diabetes who becomes pregnant?

Main Article: For Women with Diabetes: Your Guide to Pregnancy

Pregnancy is a time when a woman’s body goes through lots of changes as it nurtures a developing baby. All women need more nutrients, rest, and energy to grow the baby when they are pregnant. They also need to be physically active. When a woman with diabetes is pregnant, changes happen in her blood sugar, often quickly. If a woman with diabetes does not keep good control of her blood sugar, she might get some of the common problems of diabetes, or those problems might get worse if she already has them. Out of control blood sugar could lead to a woman having a miscarriage. Out of control blood sugar might also cause high blood pressure in a woman during pregnancy, and she will need extra visits to the doctor. High blood pressure during pregnancy might lead to a baby being born early and also could cause seizures or a stroke (a blood clot in the brain that can lead to brain damage) in the woman during labor and delivery. Sometimes, out of control blood sugar causes a woman to make extra large amounts of amniotic fluid around the baby which might lead to preterm (early) labor. Another problem common to a pregnant woman with uncontrolled diabetes is that her baby grows too large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby.

What can happen to the baby of a woman with Type 1 or Type 2 diabetes during pregnancy?

Diabetes in a pregnant woman can cause the baby to have birth defects, miscarry, be born early and have a low birth weight, be stillborn, or grow extra large and have a hard delivery.

A woman who has Type 1 or Type 2 diabetes that is not tightly controlled has a higher chance of having a baby with a birth defect than does a woman without diabetes. The organs of the baby form during the first two months of pregnancy, often before a woman knows that she is pregnant. Out of control blood sugar can affect those organs while they are being formed and cause serious birth defects, such as those of the brain, spine, and heart, or can lead to miscarriage of the developing baby.

If the woman’s blood sugar remains out of control throughout the pregnancy, the baby likely will grow extra large. Out of control diabetes causes the baby’s blood sugar to be high. The baby makes more insulin and uses the extra calories or stores them as fat. The baby is “overfed” and grows extra large. Extra large babies can occur in women with any out of control diabetes, including Type 1, Type 2, and gestational. The extra large baby can cause problems during and after delivery. Nerve damage to the baby can happen from pressure on the baby’s shoulder during delivery. A newborn might have quickly changing blood sugars after delivery. A large baby born to a woman with diabetes might have a greater chance of being obese and/or developing Type 2 diabetes later in life.

If the woman with diabetes has problems that lead to a preterm birth, the baby might have breathing problems, heart problems, bleeding into the brain, intestinal problems, and vision problems. A woman with diabetes might have a baby born on time with low birth weight. A baby with low birth weight might have problems with eating, gaining weight, fighting off infections, and staying warm.

What can happen to a pregnant woman with gestational diabetes?

A pregnant woman who does not have diabetes can develop “gestational diabetes” later in pregnancy. A woman with gestational diabetes will need to watch her blood sugar closely and balance food intake, exercise, and, if needed, insulin shots to keep her blood sugar in control. If a woman with gestational diabetes does not keep her blood sugar in good control, she could have several problems. She might have an extra large baby, have high blood pressure, deliver too early, or need to have a cesarean section (an operation to get the baby out of the mother through her abdomen). The extra large baby might cause the woman to feel uncomfortable during the last months of pregnancy. Also, it could lead to problems for both the woman and the baby during delivery. When the baby is delivered surgically by a cesarean section (C-section), it takes longer for the woman to recover from childbirth. High blood pressure when a woman is pregnant might lead to an early delivery and could cause seizures or a stroke in the woman.

Sometimes gestational diabetes in women does not go away after delivery. These women have converted to Type 2 diabetes. A woman whose diabetes does not go away after delivery will need to manage her diabetes for the rest of her life.

What can happen to the baby of a woman with gestational diabetes?

A woman who has gestational diabetes has less chance of having a baby with a birth defect than does a woman with Type 1 or Type 2 diabetes. Since gestational diabetes develops later in pregnancy, the baby’s organs are already formed. If her blood sugar is not controlled, a woman with gestational diabetes still has a greater chance of having a stillborn baby than a woman who doesn’t have diabetes.

If the woman’s blood sugar remains out of control throughout the pregnancy, the baby likely will grow extra large. Out of control diabetes causes the baby’s blood sugar to be high. The baby makes more insulin and uses the extra calories or stores them as fat. The baby is “overfed” and grows extra large. Extra large babies can occur in women with any out of control diabetes, including Type 1, Type 2, and gestational.

The extra large baby can cause problems during and after delivery. Nerve damage to the baby can happen from pressure on the baby’s shoulder during delivery. A newborn might have quickly changing blood sugars after delivery. A large baby born to a woman with diabetes might have a greater chance of being obese and/or developing Type 2 diabetes later in life.

If the woman with diabetes has problems that lead to a preterm birth, the baby might have breathing problems, heart problems, bleeding into the brain, intestinal problems, and vision problems. A woman with diabetes might have a baby born on time with low birth weight. A baby with low birth weight might have problems with eating, gaining weight, fighting off infections, and staying warm.

Can a woman with diabetes prevent the problems to herself and to her baby during pregnancy?

Main Article: For Women with Diabetes: Your Guide to Pregnancy

If a woman with diabetes keeps her blood sugar in tight control before and during pregnancy, she can lessen her risk of having a baby with a birth defect to that of a woman who doesn’t have diabetes. Controlling her blood sugar also reduces the risk that a woman will develop common problems of diabetes, or that the problems will get worse during pregnancy. The baby is less likely to grow extra large during her pregnancy if a woman keeps her blood sugar in tight control.

How can a woman with diabetes who wants to get pregnant prevent problems to herself and her baby?

Main Article: For Women with Diabetes: Your Guide to Pregnancy

• Plan the pregnancy. Unplanned pregnancies are more common among women with diabetes than among women who do not have diabetes. About 70% of women with diabetes don’t plan their pregnancies as compared to about 50% of women who don’t have diabetes. It is very important for a woman with diabetes to get her body ready before she becomes pregnant.
• See her doctor. Her doctor needs to look at the effects that diabetes has had on her body already, talk with her about getting and keeping control of her blood sugar, change medications if needed, and plan for frequent follow-up. Her doctor will remind her about the usual steps to get ready for pregnancy, such as to take prenatal vitamins (with folic acid), stop smoking, avoid alcohol, eat right, exercise, and avoid stress.
• Eat healthy foods from a meal plan made for her as a person with diabetes. If a woman is overweight, she might try to lose weight before getting pregnant as part of her plan to get her blood sugar in control. Talking with a dietitian can help her plan a good diet for a person with diabetes, especially if she plans to lose weight before she gets pregnant. A dietitian can also help her learn how to control her blood sugar while she is pregnant.
• Exercise regularly. Exercise is another way to keep blood sugar under control. Exercise helps to balance food intake. A woman should begin a regular exercise plan before she gets pregnant and stick with the exercise plan both while she is pregnant and after the baby comes.
• Monitor blood sugar often. Because pregnancy causes the body’s need for energy to change, blood sugar levels can change very quickly. A pregnant woman with diabetes needs to check her blood sugar more often, sometimes 6 to 8 times a day, which might be higher than when she is not pregnant. Checking blood sugar levels often can help a woman keep her blood sugar in control.
• Take medications on time. If insulin is ordered by a doctor, a pregnant woman with diabetes should take it when it’s needed. She should know how to adjust food intake, exercise, and insulin, depending on the results of her blood sugar tests, to keep the blood sugar in the range of tight control. For more information, see the American Diabetes Association website at http://www.diabetes.org/type-1-diabetes/tight-control.jsp.
• Control and treat low blood sugar quickly. Keeping tight blood sugar control can lead to a chance of low blood sugar at times. A pregnant woman with diabetes should have a ready source of carbohydrates, such as glucose tablets or gel, on hand at all times. It’s helpful to teach family members and close co-workers or friends how to help in case of a severe low blood sugar reaction.
• Follow-up with the doctor regularly. A pregnant woman with diabetes needs to see her doctor more often than does a pregnant woman without diabetes. Together, the woman can work with her doctor to prevent or catch problems early. Although there are no guarantees, a woman with diabetes who gets and keeps her blood sugar in control is more likely to have a healthy pregnancy and a healthy baby.