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Diabetes and Pregnancy

AMBULATORY CARE:

What you need to know about diabetes and pregnancy:

Plan your pregnancy so healthcare providers can help you have a healthy pregnancy and baby. Control your blood sugar levels before and during pregnancy to decrease your risk of health problems. Your diabetes care team providers may recommend A1c levels less than 6.5% before you get pregnant. During pregnancy, your A1c levels may need to be between 6% and 7%.

Seek care immediately if:

  • Your blood sugar level is over 200 mg/dL and you have stomach pain, nausea, vomiting, or confusion.

Call your doctor or care team provider if:

  • You are shaky or dizzy.
  • You are sweaty or have a headache.
  • You have changes in your vision.
  • You have questions or concerns about your condition or care.

Prepare for a healthy pregnancy:

  • Have a physical exam. Your care team provider may recommend tests to make sure you are as healthy as possible. Tests may be used to check for sexually transmitted infections, thyroid disease, or complications of diabetes, such as retinopathy. If you already have retinopathy, you will be checked often to make sure it is not getting worse. Depending on your age and family history, your provider may recommend screenings to check for genetic conditions.
  • Start taking folic acid as directed. Folic acid helps prevent certain conditions, such as spina bifida. Your provider will tell you how long before you become pregnant to start. He or she will tell you how much folic acid you need each day. He or she will recommend prenatal vitamins that contain folic acid.
    Sources of Folic Acid
  • Tell your provider if you use medicines, drugs, or alcohol. Include prescription and nonprescription medicines and supplements. Your provider will tell you if you should stop any before you become pregnant. Tell your provider if you currently smoke cigarettes, vape, drink alcohol, or use illegal drugs. These are not safe for your unborn baby. Your provider can help you quit before you become pregnant.
  • Tell your provider if you have upcoming travel plans. You should not travel to an area where the Zika virus is common. Zika virus may be passed from a mother to her unborn baby. This may cause birth defects such as poor brain development. It may also cause pregnancy loss. There is currently no vaccine to prevent Zika virus infection. The Zika virus can stay in your body for several months. Tell your provider if you recently traveled to an area where Zika is common. You may need to be tested for Zika before you become pregnant.
  • Reach or maintain a healthy weight. Your provider can tell you if your weight is healthy. He or she may recommend that you lose or gain weight before you become pregnant. A healthy weight will help you control your blood sugar and blood pressure.
    Weight Checks THA
  • Learn about pregnancy and nutrition. A dietitian can help you plan healthy meals to control your glucose and A1c levels before pregnancy. He or she can help you plan for changes during and after pregnancy. Your calorie needs depend on your weight before you got pregnant. Your dietitian will tell you how many calories you need each day.
  • Ask about physical activity. Physical activity, such as exercise, helps with weight management and blood sugar control. Make physical activity a routine before you become pregnant. Your provider will tell you which activities are safe for you to continue during pregnancy. He or she will help you create a safe physical activity plan.
    Walking During Pregnancy
  • Ask about vaccines you may need. Diseases such as rubella are dangerous for unborn babies. You can get vaccines to help protect you and your baby. Some vaccines are given routinely before pregnancy, such as the hepatitis B vaccine. You will also be given 1 dose of Tdap when you are 27 to 36 weeks along. Tdap protects against tetanus, diphtheria, and pertussis. You may need other vaccines, such as the flu or chickenpox vaccine. Tell your provider about all vaccines you have had. Tell him or her if you do not know your vaccine history. He or she will recommend vaccines for you. Your provider will also tell you how long after you get a vaccine to wait before you become pregnant.

Manage diabetes during pregnancy:

During pregnancy and for a time after delivery, your obstetrician (OB) becomes part of your care team. Tell your OB about your diabetes care team providers. Your diabetes care team will provide a plan for your care during your pregnancy.

  • Check your blood sugar level. You may need to test your blood sugar level at least 3 times each day. Ask your care team provider when and how often you should check your blood sugar. He or she will tell you what your blood sugar levels should be at different times throughout the day. Your care team provider may want your blood sugar levels to be 60 mg/dL to 95 mg/dL before meals, at bedtime, and during the night. He or she may want them to be 100 mg/dL to 129 mg/dL 1 hour after meals, or 100 mg/dL to 120 mg/dL 2 hours after. Your care team provider can show you how to use a blood glucose meter to check your levels.
    How to check your blood sugar
  • Ask about medicines. Some medicines are not safe to take when you are 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.
  • Check your blood pressure often. High blood pressure can cause problems with your health and your pregnancy. Blood pressure readings are usually written as 2 numbers. If you do not have high blood pressure before pregnancy, your systolic blood pressure (the first number) should be between 110 and 129. Your diastolic blood pressure (the second number) should be between 65 and 79. If you have high blood pressure before pregnancy, your systolic blood pressure should be between 120 and 160. Your diastolic blood pressure should be between 80 and 105.
    How to take a Blood Pressure
  • Maintain a healthy weight. The recommended weight gain for women who are overweight is 15 to 25 pounds. The recommended weight gain for women who are obese is 10 to 20 pounds. Your risk of problems such as high blood pressure and premature labor are higher if you are overweight.
  • Continue to get regular physical activity. Physical activity can help control your blood sugar level and blood pressure.
  • Do not drink alcohol. Alcohol is dangerous for your unborn baby. Alcohol can also increase your blood sugar levels and make your diabetes more difficult to manage. Ask your care team provider for information if you need help to quit drinking alcohol.
  • Help prevent hypoglycemia. Your risk of hypoglycemia is higher during pregnancy because you may not feel the symptoms. This risk is highest during the first trimester. Eat regular meals and snacks to avoid hypoglycemia. Always keep glucose tablets with you in case your blood sugar level gets low. If you do not have glucose tablets, drink milk, juice, or regular soda. Tell your family about the symptoms of hypoglycemia so they can help you if you cannot help yourself. Ask your care team provider how to manage hypoglycemia.
    Ways to Raise Your Blood Sugar
  • Help prevent diabetic ketoacidosis (DKA). This is a serious condition that can happen when your blood sugar level gets too high. Pregnancy increases your risk for DKA. The symptoms of DKA include stomach pain, nausea, vomiting, and confusion. Your care team provider may suggest that you test the levels of ketones in your urine when your blood sugar level is high. He or she may also ask you to check your ketones regularly if you are sick.

What else you can do to have a healthy baby:

  • Keep all appointments with your care team providers. They will help you manage your diabetes during pregnancy. You may need to see your care team provider 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 care team provider each week. During these exams, your care team provider may check your eyes, your A1c levels, and how you and your baby are doing.
  • Take folic acid supplements. Start taking folic acid before you get pregnant and continue until you are at least 12 weeks pregnant. Folic acid decreases the risk that your baby will have birth defects. Ask your healthcare provider how much folic acid you should take.
  • Do not smoke. Nicotine is harmful to your baby and makes it more difficult to manage your diabetes. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your care team provider for information if you currently smoke and need help quitting.

Diabetes management during and after delivery:

Healthcare providers will check your blood sugar levels while you are in labor. They will give you insulin or glucose throughout your labor to keep your blood sugar at the right level. Do the following after delivery:

  • Go to all follow-up appointments. Care team providers will continue to help you manage your diabetes after delivery. Talk with your care team provider about birth control options. It is important to prepare for the next pregnancy if you plan to have another child.
  • Take your medicine as directed. If you have type 2 diabetes, you may be able to take your diabetes medicine again. If you have type 1 diabetes, the amount of insulin you need will decrease after you have your baby. There are certain medicines that you may not be able to take if you breastfeed. Ask your care team provider when and how often to test your blood sugar level. You may need to check at least 3 times each day.
  • Help prevent hypoglycemia if you breastfeed. Your risk of hypoglycemia is higher if you breastfeed. Your dietitian will help you create a meal plan that works for you. Eat a snack before you breastfeed. Eat regular meals and snacks to keep your blood sugar level steady.

Risks of diabetes and pregnancy:

You have an increased risk for high blood pressure, eye disease, premature (early) labor, and miscarriage. A miscarriage is the loss of a fetus before 20 weeks of 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.

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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.

Learn more about Diabetes and Pregnancy (Ambulatory Care)

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