You have the good fortune to live when you do. Doctors no longer discourage women with diabetes from becoming pregnant.
We now know that the key to a healthy pregnancy for a woman with diabetes is tight blood glucose control both before she is pregnant and during her pregnancy. Tight control means keeping your blood glucose near normal.
To do this, you need a diabetes treatment plan that keeps meals, exercise, and insulin in balance. This plan will change as you change with pregnancy. You will also need to test your blood glucose often and keep a record of your test results.
With your blood glucose in the near-normal range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.
Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk of birth defects.
High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.
For this reason, good blood glucose control before you get pregnant is very important. Most women do not know they are pregnant until the baby has been growing for two to four weeks.
But during the first eight weeks of pregnancy, the baby's organs are forming. Your blood glucose levels during these early weeks affect the baby's growing organs. High blood glucose levels can lead to birth defects.
Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in good control, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control 3 to 6 months before you plan to get pregnant. You'll want to keep excellent glucose control during pregnancy and after as well.
How do high blood glucose levels cause problems?
When extra glucose is in your blood, the baby is "fed" extra glucose, too. All this excess glucose can make the baby too big and fat. Delivery of big babies is harder on mom and baby.
Because your baby is getting extra glucose, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out extra insulin. The baby must be watched over and treated if the blood glucose level drops too low.
For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of old red blood cells that the body can't process fast enough. This problem goes away rapidly with treatment.
Good Prenatal Care
Because we know more about diabetes than ever before, there has never been a better time for you to plan a pregnancy. With the tools for testing your blood glucose level at home, you can work with your regular doctor and obstetrician to keep your diabetes under good control.
For the best prenatal care, have a team that includes:
A doctor trained to care for people with diabetes who has cared for pregnant women with diabetes.
An obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes.
A paediatrician (children's doctor) or neonatologist (doctor for newborn babies) who knows and can treat special problems that can happen in babies of women with diabetes.
A registered dietician who can change your meal plan as your needs change during and after pregnancy.
A diabetes educator who can help you manage your diabetes during pregnancy.
Pregnancy is often a time of great highs and great lows. It can be awesome and thrilling when you hear the baby's heartbeat or feel the first tiny kick. It can be frustrating, even scary. It is always a time of change.
Your body is changing as the baby grows. Because you have diabetes, these changes will affect your blood glucose level. Pregnancy can also make symptoms of low blood glucose hard to detect.
During pregnancy, your diabetes control will require more work. The blood glucose tests you do at home are a key part of taking good care of yourself and your baby before, during, and after pregnancy.
Insulin and Diabetes Pills
If you have insulin-dependent (type 1) diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body's need for insulin will go up. This is especially true during the last 3 months of pregnancy.
The need for more insulin is caused by hormones that the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother's insulin. As a result, your insulin needs will increase.
If you have type 2 (non-insulin-dependent) diabetes, you too need to plan ahead. If you are taking pills to control your blood glucose, you will not be able to take them when you are pregnant because they can cause birth defects. Your doctor will switch you to insulin before you get pregnant.
Testing Your Blood Glucose
Blood tests will help you keep the best glucose control.
Test your blood glucose levels at the times your doctor advises; this may be up to eight tests each day and will probably include after-meal tests.
Write down your results.
Keep notes on your diet and exercise.
Make changes in your diet and insulin plan only with the advice of your doctor and dietician.
Pregnancy and Food
Because of diabetes, hopefully you already have good eating habits. During pregnancy, you and your dietician or doctor may need to change your meal plan to fine-tune your diet to avoid problems with low and high blood glucose levels. This is the most important reason for keeping blood glucose testing results.
If you start pregnancy weighing too much, you should not try to lose weight. Instead your doctor will help you curb how much weight you gain during pregnancy.
Your doctor will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 22 and 32 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, your doctor will help you limit your weight gain to about 15 pounds.
Pregnancy and Exercise
Exercise, especially for people with type 2 diabetes, is a key part of diabetes treatment. Just as you need to get your blood glucose under control before getting pregnant, it's best to get fit before you get pregnant. Can you keep your current exercise program during pregnancy? Is it safe to start exercise after you are pregnant?
Discuss your exercise plans with your doctor. Ask for guidelines. Exercise can help you stay healthy during pregnancy. But if you have 1) high blood pressure, 2) eye, kidney, or heart problems, 3) damage of the small or large blood vessels, or 4) nerve damage, you will need to talk to your doctor about the risks of exercise during pregnancy.
In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics.
Delivery
As your due date nears, your doctors will study your health and that of your growing baby. Then, you and the team will discuss the best time and method for delivery.
Your labour may start on its own, or you may decide to have labour induced or have a planned caesarean section. No matter how you deliver your baby, your doctors will be working during labour and delivery to keep your blood glucose level under control.
At the start of active labour, your insulin needs will drop. You will most likely not need any insulin during labour and for 24 to 72 hours after delivery.
Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.
After Delivery
After your baby arrives, your body begins to recover from the hard work of pregnancy and delivery. Some new mothers have better glucose control in the first few weeks after delivery. For many, it's a period of odd blood glucose swings. Not being able to predict how your body will act may leave you puzzled and upset.
Breast-feeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. During the first weeks at home with baby, you are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood glucose is a real danger.
It's important for your baby's safety to avoid blood glucose reactions that could confuse you. For all of the above reasons, it is important to test your blood glucose often during this time. And your records of your blood glucose levels will help you and your doctor adjust your insulin dose.
With baby's arrival, your focus turns to caring for your little one. But keep in mind that to take good care of your baby you need to take good care of yourself. Stick to your habits that helped you have excellent blood glucose control during pregnancy.
Breast-Feeding
To help prevent low blood glucose levels due to breast-feeding:
Plan to have a snack with protein and carbohydrate before or during nursing.
Drink enough fluids. Plan to sip a glass of water or caffeine-free tea while nursing.
Keep something to treat low blood glucose nearby when you nurse, so you don't have to stop a feeding to treat low blood glucose.
Women who breast-feed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose control. You will need to work with your doctor and dietician to adjust your meal plan while you are nursing.
We now know that the key to a healthy pregnancy for a woman with diabetes is tight blood glucose control both before she is pregnant and during her pregnancy. Tight control means keeping your blood glucose near normal.
To do this, you need a diabetes treatment plan that keeps meals, exercise, and insulin in balance. This plan will change as you change with pregnancy. You will also need to test your blood glucose often and keep a record of your test results.
With your blood glucose in the near-normal range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.
Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk of birth defects.
High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.
For this reason, good blood glucose control before you get pregnant is very important. Most women do not know they are pregnant until the baby has been growing for two to four weeks.
But during the first eight weeks of pregnancy, the baby's organs are forming. Your blood glucose levels during these early weeks affect the baby's growing organs. High blood glucose levels can lead to birth defects.
Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in good control, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control 3 to 6 months before you plan to get pregnant. You'll want to keep excellent glucose control during pregnancy and after as well.
How do high blood glucose levels cause problems?
When extra glucose is in your blood, the baby is "fed" extra glucose, too. All this excess glucose can make the baby too big and fat. Delivery of big babies is harder on mom and baby.
Because your baby is getting extra glucose, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out extra insulin. The baby must be watched over and treated if the blood glucose level drops too low.
For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of old red blood cells that the body can't process fast enough. This problem goes away rapidly with treatment.
Good Prenatal Care
Because we know more about diabetes than ever before, there has never been a better time for you to plan a pregnancy. With the tools for testing your blood glucose level at home, you can work with your regular doctor and obstetrician to keep your diabetes under good control.
For the best prenatal care, have a team that includes:
Pregnancy is often a time of great highs and great lows. It can be awesome and thrilling when you hear the baby's heartbeat or feel the first tiny kick. It can be frustrating, even scary. It is always a time of change.
Your body is changing as the baby grows. Because you have diabetes, these changes will affect your blood glucose level. Pregnancy can also make symptoms of low blood glucose hard to detect.
During pregnancy, your diabetes control will require more work. The blood glucose tests you do at home are a key part of taking good care of yourself and your baby before, during, and after pregnancy.
Insulin and Diabetes Pills
If you have insulin-dependent (type 1) diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body's need for insulin will go up. This is especially true during the last 3 months of pregnancy.
The need for more insulin is caused by hormones that the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother's insulin. As a result, your insulin needs will increase.
If you have type 2 (non-insulin-dependent) diabetes, you too need to plan ahead. If you are taking pills to control your blood glucose, you will not be able to take them when you are pregnant because they can cause birth defects. Your doctor will switch you to insulin before you get pregnant.
Testing Your Blood Glucose
Blood tests will help you keep the best glucose control.
Pregnancy and Food
Because of diabetes, hopefully you already have good eating habits. During pregnancy, you and your dietician or doctor may need to change your meal plan to fine-tune your diet to avoid problems with low and high blood glucose levels. This is the most important reason for keeping blood glucose testing results.
If you start pregnancy weighing too much, you should not try to lose weight. Instead your doctor will help you curb how much weight you gain during pregnancy.
Your doctor will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 22 and 32 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, your doctor will help you limit your weight gain to about 15 pounds.
Pregnancy and Exercise
Exercise, especially for people with type 2 diabetes, is a key part of diabetes treatment. Just as you need to get your blood glucose under control before getting pregnant, it's best to get fit before you get pregnant. Can you keep your current exercise program during pregnancy? Is it safe to start exercise after you are pregnant?
Discuss your exercise plans with your doctor. Ask for guidelines. Exercise can help you stay healthy during pregnancy. But if you have 1) high blood pressure, 2) eye, kidney, or heart problems, 3) damage of the small or large blood vessels, or 4) nerve damage, you will need to talk to your doctor about the risks of exercise during pregnancy.
In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics.
Delivery
As your due date nears, your doctors will study your health and that of your growing baby. Then, you and the team will discuss the best time and method for delivery.
Your labour may start on its own, or you may decide to have labour induced or have a planned caesarean section. No matter how you deliver your baby, your doctors will be working during labour and delivery to keep your blood glucose level under control.
At the start of active labour, your insulin needs will drop. You will most likely not need any insulin during labour and for 24 to 72 hours after delivery.
Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.
After Delivery
After your baby arrives, your body begins to recover from the hard work of pregnancy and delivery. Some new mothers have better glucose control in the first few weeks after delivery. For many, it's a period of odd blood glucose swings. Not being able to predict how your body will act may leave you puzzled and upset.
Breast-feeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. During the first weeks at home with baby, you are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood glucose is a real danger.
It's important for your baby's safety to avoid blood glucose reactions that could confuse you. For all of the above reasons, it is important to test your blood glucose often during this time. And your records of your blood glucose levels will help you and your doctor adjust your insulin dose.
With baby's arrival, your focus turns to caring for your little one. But keep in mind that to take good care of your baby you need to take good care of yourself. Stick to your habits that helped you have excellent blood glucose control during pregnancy.
Breast-Feeding
To help prevent low blood glucose levels due to breast-feeding:
Women who breast-feed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose control. You will need to work with your doctor and dietician to adjust your meal plan while you are nursing.
