Diabetes And Pregnancy

What do I need to know about diabetes and pregnancy?

Plan your pregnancy ahead of time so you can improve your chances of having a healthy pregnancy and baby. Decrease your risk of health problems by controlling your blood sugar levels before and during pregnancy.

What are some ways that I can prepare for pregnancy?

Keep your blood sugar level as close to normal as possible before you get pregnant. The following are some ways that you can prepare for pregnancy:

• Diabetes medicine and insulin: Take your diabetes medicine or insulin as directed by your caregiver.
  
  
• Blood sugar testing: Test your blood sugar levels with a blood glucose meter every day. You will need to test your blood sugar level several times a day. You may need to check your blood sugar level in the morning before breakfast (fasting), before and after meals, and at bedtime. Ask your caregiver what times of day you should check your blood sugar. Your caregiver will tell you what your blood sugar levels should be at different times throughout the day.
  
  
• Do not smoke: Smoking causes lung cancer and other long-term lung diseases. It increases your risk of many cancer types. Smoking also increases your risk of blood vessel disease, heart attack, and vision disorders. Not smoking may help prevent such symptoms as headaches and dizziness for yourself and those around you. Smokers have shorter lifespans than nonsmokers.
  
  
• Do not drink alcohol: Some people should not drink alcohol. These people include those with certain medical conditions or who take medicine that interacts with alcohol. Alcohol includes beer, wine, and liquor. Tell your caregiver if you drink alcohol. Ask him to help you stop drinking.

What should I know about eating and exercise to help prepare for pregnancy?

• Exercise: Regular exercise, such as walking, can help you keep your blood sugar levels under control. Exercise can also help you lose weight if you are overweight. Ask your caregiver how much exercise you should get each day.
  
  
• Meals: You will need to eat healthy foods and follow a meal plan that is right for you. Carbohydrate counting is one type of meal plan that you can use. This meal plan can help you eat the right amount of carbohydrates to keep your blood sugar levels under control. Your caregiver or dietitian can help you choose a meal plan that works best for you.
  
  
  • Calories: You may need to decrease the amount of calories in your diet if you are overweight. Your risk of problems such as high blood pressure and premature labor are higher if you are overweight. Ask your caregiver or dietitian how many calories you need each day.
    
    
  • Folic acid supplements: Take 5 mg of folic acid each day to decrease the risk that you will have a baby with birth defects. Start taking folic acid before you get pregnant and continue until you are at least 12 weeks pregnant.

What are other things I should know about diabetes and pregnancy?

• Medical problems caused by diabetes: These problems include eye, kidney, nerve, and heart disease, which can affect your health and your pregnancy. Eye and nerve disease can get worse during pregnancy. Kidney disease increases the risk of high blood pressure and premature labor. You may need to have tests to find out if you have these health problems before and during your pregnancy.
  
  
• Medicines: Certain medicines are not safe to use during pregnancy. You may need to stop taking certain medicines or change the type of medicine you take before you get pregnant. If you have type 2 diabetes and you take diabetes pills, you may need to stop taking them and start using insulin. Insulin is safe to use during pregnancy. Ask your caregiver about any medicines you are currently taking.
  
  
• Preexisting conditions: Medical conditions that you may already have, such as high blood pressure, should be closely watched by caregivers during your pregnancy. Ask your caregiver about monitoring any preexisting conditions.

How do I manage diabetes during pregnancy?

• Insulin: The amount of insulin you need will increase throughout your pregnancy, so your caregiver may change your dose. Your caregiver may also change your dose if you have nausea, vomiting, or a decreased appetite during the first trimester.
  
  
• Blood sugar testing: Test your blood sugar levels with a blood glucose meter at least 3 times each day. Ask your caregiver how often and what times to check your blood sugar, and what your blood sugar level should be.
  
  
• Hypoglycemia: Your risk of hypoglycemia (low blood sugar) is higher during pregnancy because you may not feel the symptoms. This risk is often highest during the first trimester. Eat regular meals and snacks to avoid hypoglycemia. Always keep glucagon (sugar tablets) with you in case your blood sugar gets low. If you do not have glucagon, you can drink milk, juice, or regular soda, or you can eat jellybeans. Tell your family about the symptoms of hypoglycemia so they can help you if you cannot help yourself. Ask your caregiver how to manage hypoglycemia.
  
  
• Diabetic ketoacidosis: Diabetic ketoacidosis (DKA) is a serious condition that can happen when your blood sugar gets too high. Conditions that increase your risk of DKA are pregnancy and infections, such as the flu or a urinary tract infection. The symptoms of DKA include stomach pain, nausea, vomiting, and confusion. Your caregiver may suggest that you test your ketones using ketone testing strips when your blood sugar level is high. He may also ask you to check your ketones regularly if you are sick. Ask your caregiver how to prevent DKA.

• Prenatal care: Keep all appointments with your caregivers. Your caregivers will help you manage your diabetes during pregnancy. You may need to see your caregiver every 1 to 2 weeks during the first and second trimesters of your pregnancy. As the end of your pregnancy gets closer, you may need to see your caregiver every week. Your caregiver may do a test called hemoglobin A1C every 3 months, or more often, while you are pregnant. This blood test shows the average amount of sugar in your blood over the past 2 to 3 months.
  
  
• Diet: Eat healthy foods during your pregnancy. You may need to make some changes to your meal plan because you need more calories while you are pregnant. The amount of calories you need depends on your weight before you got pregnant. Your caregiver or dietitian will tell you how many calories you need each day. Your caregiver or dietitian can also help you make changes to your meal plan.
  
  
• Activity: Ask your caregiver what types of physical activity you can do while you are pregnant. Your caregiver may suggest low impact physical activity, such as walking or swimming. Your caregiver may suggest that you limit your physical activity to armchair exercises only.

What can I expect during labor and delivery?

• Labor and delivery: As your due date gets closer, your caregiver will check your baby’s and your health very closely. You may go into labor on your own or labor may be induced (started with medicine). In some cases, the baby may be born by cesarean section (C-section). This is surgery done to take your baby out through a cut in your abdomen.
  
  
• Blood sugar control: Caregivers will check your blood sugar level while you are in labor. They will give you insulin or glucose throughout your labor to keep your blood sugar at the right level.

What can I expect after delivery?

• Follow-up care: Make and keep all appointments. Caregivers will continue to help you manage your diabetes. You should also talk with your caregiver about birth control. It is important to prepare for the next pregnancy if you plan to have another child.
  
  
• Diabetes medicine and insulin: If you have type 2 diabetes, you may be able to take your diabetes medicine again. There are certain diabetes medicines that you may not be able to take if you breastfeed. If you have type 1 diabetes, the amount of insulin you need will decrease after you have your baby.
  
  
• Other medicines: If you were taking medicines for other medical conditions before pregnancy, you may need to start taking them again. Some medicines are not safe to take while breastfeeding. Tell your caregiver if you plan to breastfeed.
  
  
• Hypoglycemia: Your risk of hypoglycemia is higher if you breastfeed. Eat a snack before you breastfeed your baby to avoid hypoglycemia. Tell your caregiver if you plan to breastfeed.

What are the risks of diabetes and pregnancy?

High blood sugar levels can increase your risk of having a large baby, a baby with birth defects, and stillbirth. Stillbirth is the loss of a fetus (unborn baby) after 20 weeks of pregnancy. Having diabetes and being pregnant can increase your risk of high blood pressure, premature (early) labor, and miscarriage. A miscarriage is the loss of a fetus before 20 weeks of pregnancy.

When should I contact my caregiver?

Contact your caregiver if:

• You have questions about diabetes and pregnancy.
  
  

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have symptoms of hypoglycemia. You may be shaky or dizzy. You may sweat or have a headache.
  
  
• Your blood sugar level is over 200 mg/dL and you have stomach pain, nausea, vomiting, and confusion.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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