This topic is important to my husband and I. One day, we would really love to welcome a child into our lives, but I have to make sure I am healthy enough to get pregnant. Here’s what I have been able to uncover so far.
During pregnancy, women who have type 2 diabetes may need to up their dosage of insulin, take different medication, or may not need to change anything at all. Women who don’t already have diabetes can develop gestational diabetes which can be controlled by diet and exercise and may need insulin injections. Usually gestational diabetes goes away after giving birth, but if it doesn’t go away it could develop into type 2 diabetes. Most women who have gestational diabetes can develop type 2 diabetes later in life.
Being diabetic and pregnant means you have to visit the doctor a few more times than other women, and that’s okay.
If diabetes isn’t controlled during pregnancy it could increase your chances for birth defects, macrosomia, miscarriage, and stillbirth for the baby. For mommy, it increases your chances of developing preeclampsia which could put baby and mommy in danger and the need to induce labor earlier than the due date will increase.
Macrosomia is when the baby is born bigger than normal. The high blood sugar of the mother is absorbed through the placenta and causes the baby’s pancreas to create more insulin to process the blood sugar. The extra sugar in the baby’s body gets converted to fat.
When you’re diabetic, pregnancy comes with a whole bunch of complications and worries, but it’s not impossible to give birth with diabetes. To prepare for your pregnancy, it’s best to prepare far in the future. Some women may need six months or more to get their diabetes under control enough to conceive.
What goes into this preparation? You need to undergo a series of tests to check where your diabetes is at currently and how much needs to be changed to be ready to conceive, then you retake those tests until you’re ready to go. You need to speak to the members of your diabetic health team to go over those results and make the necessary changes. These changes can include a healthier diet, regular exercise, losing weight, and taking vitamins and supplements, such as folic acid.
Some tests you should undergo:
- urinalysis – checks if there are any problems with your kidneys
- blood tests – check your cholesterol, triglycerides, and kidney and liver function
- eye exam – check for glaucoma, cataracts, and retinopathy
- electrocardiogram – check your heart function
- foot exam – check for nerve damage
You need to get your blood sugar levels close to range before and during pregnancy. High sugar levels can harm your baby during the first 4 to 8 weeks of pregnancy, even before you know you’re pregnant. The baby’s organs start developing during the first few weeks and are very vulnerable to high sugar levels.
You need to check your A1C, too. If your A1C is 10% or higher, you have a 1 in 5 chance of giving birth to a baby with a malformation such as a heart, kidney, brain, or spinal cord defect. Try to get your A1C down below 7% to lower the chances of a malformation in your baby.
Make sure your weight is within a healthy range as well. Being overweight or obese can cause complications in your diabetes, pregnancy, and may lead to other diseases.
Once everything looks good and you’ve spoken to your various doctors and a dietician, hopefully you are ready and able to conceive.
During your pregnancy, the biggest thing to remember is DO NOT STOP YOUR MEDICATION. It is much worse for you to stop your medications and have your blood sugar increase than to have a fear of your medication. There is no evidence as of yet that your medication could cause a malformation to your baby. Remember, none of the medication you’re on have been 100% proven to cause any harms.
If you do have any concerns about your medication and your baby, talk to your doctor before stopping your medication. Your doctor can work with you to figure something out to keep your sugar levels low throughout your pregnancy. Besides, your body changes multiple times during your pregnancy and you’ll be going back to your doctor throughout to keep everything in check and make sure you make the right changes at the right time.
Insulin injections will be your number one drug during pregnancy because the insulin doesn’t cross the placenta therefore does not cause any affects on your baby. With diabetes, you might also be put on oral medications to help overcome insulin resistance.
Make sure to meet with your dietician to make sure the diet you were on during your preconception is still the right diet to be on now that you are pregnant, most times it will be, but just double check to make sure. During the early part of pregnancy, blood sugar levels can decrease from your normal levels and you might not need all the medication or the low glycemic-index foods. Check with them to be sure.
During your first trimester, you don’t have to load up on calories. Morning sickness will probably get to you anyway.
Exercising will help you lower your stress levels, blood sugar levels, and might make labor easier for you. It doesn’t have to be intense, just enough to get your heart pumping and a little sweat to start. Obviously, avoid training for a marathon, contact sports, any exercise that raises your temperature too much, and heavy lifting. When in doubt, contact your doctor.
It’s natural to gain weight during your pregnancy. The goal is not to gain more than 25 to 30 pounds if you’re already at a healthy weight, and nothing more than 20 pounds if you’re overweight or obese. Studies have found that babies born to obese mothers tend to develop heart disease, asthma, or type 2 diabetes.
By your third trimester, your need for more insulin will increase. Your medication, diet, and exercise might need to be tweaked at this point. Your doctor might order you more tests and scans at this point to keep any eye on baby’s development, especially the size. Babies born from diabetic mothers tend to be larger than normal and that could be a concern at this stage. If the baby is big in size, it could complicate a vaginal delivery and might require a C-section. Your doctor might not want you to go on beyond 39 weeks.
Hopefully, delivery goes well and you and baby come out okay.
Ideally, you are lucky enough to go to a hospital with a good neonatal intensive care unit on hand in case your baby has some special needs that need monitoring after delivery. In case the baby is born prematurely, with low blood sugar, or any other need, the NICU should be able to take care of it.
After delivery, your insulin needs should decline, but you may be in danger of hypoglycemia. Two weeks after delivery, you should see your doctor for a checkup. Please note that insulin also doesn’t affect breast milk, so if you want to stay on insulin (if you weren’t on it before pregnancy) after delivery, you totally can. Breastfeeding is the best option, if you are able to produce enough or have the time to do so, it does take a lot of energy to breastfeed. There are many benefits for you and the baby, like it helps lower your blood sugar and it can lower the risk of the baby developing type 2 diabetes.
Postpartum depression is a serious condition for mothers and even moreso in diabetic mothers. If your “baby blues” don’t improve after two weeks, consult your doctor about meeting with a mental health professional. You don’t want to stress yourself out with your new responsibilities as a mother while also taking care of yourself. Sometimes it can be too much, please remember you don’t have to go through this alone. No one will think any less of your capabilities to be mother if you need to ask for help.
I’m not a professional, but if you ever want to talk to anyone, please know that you can always reach out to me and I will be a friendly, non-judgmental ear you can talk to.
Having diabetes doesn’t mean you can’t have a family of your own, it just means it’ll be a lot more work to have your family. If you really want a family, you’ll be able to go through it. Just know you are not alone.
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Center for Disease Control and Prevention
National Institute of Diabetes and Digestive and Kidney Disease
Diabetes Forecast, May/June 2019, p. 44-49.