Having diabetes doesn’t mean that you can’t enjoy a safe and happy pregnancy. Whether you already have diabetes (type 1 or type 2) or have just been diagnosed with gestational diabetes, there are some things you can do to ensure that you and your baby remain healthy.
Pre-existing diabetes
If you have type 1 or type 2 diabetes, it’s important to plan your pregnancy. If you are thinking about getting pregnant, visit your healthcare team to ensure that you get your pregnancy off to a healthy start. A pre-pregnancy exam typically includes measuring your A1C level to make sure blood glucose levels are at target, as well as an assessment of complications (for example, high blood pressure, heart disease, and kidney, nerve, and eye damage).
It is also important to review all of your medications and supplements with your primary care team to make sure that they are safe to continue using during pregnancy. Insulin is safe for both mother and baby during pregnancy. If you take insulin, your diabetes healthcare team will work with you very closely to manage your insulin needs.
You can increase your chances of delivering a healthy baby by keeping your blood glucose at the recommended levels before conception and throughout your pregnancy. Blood glucose levels are especially critical during the first trimester, when the baby’s organs are beginning to develop. If a mother’s blood sugar levels are high during this time, there is a greater chance of miscarriage or fetal malformation, particularly the heart and spinal chord. That’s why it’s important for you to:
- Discuss the use of your diabetes medications with your healthcare team
- Monitor blood sugars as recommended
- Eat healthy meals and snacks, and spread them out throughout the day
If you are taking insulin, you may be at higher risk of hypoglycemia during pregnancy, especially if you have type 1 diabetes. That’s why it’s important to monitor your blood sugar as recommended, and carry a source of fast-acting carbohydrate with you, and also, if recommended, glucagon.
Gestational diabetes
Gestational diabetes is a type of diabetes that is diagnosed during pregnancy. It occurs when a woman’s body cannot produce enough insulin to handle the effects of a growing baby. Gestational diabetes is usually diagnosed in the second or third trimester of pregnancy.
If gestational diabetes is not diagnosed or treated, it can increase the risk that your baby will weigh more than 4 kilograms (9 pounds), which may result in a difficult delivery. Gestational diabetes can also increase the risk of your baby becoming overweight and developing type 2 diabetes in the future.
Depending on how high their blood sugar levels are at diagnosis, a woman with gestational diabetes may be treated through lifestyle alone. This means:
- Eating healthily. Spreading out your food intake by eating smaller meals and snacks will help you manage your blood sugar levels and provide the best nutrition for you and your growing baby. Choosing more low glycemic foods will also help improve post-meal glucose levels.
- Being physically active. Regular exercise can help control your blood glucose levels. As well, it can boost your energy, help you sleep better and reduce stress levels.
Your healthcare team can help you develop a meal plan as well as recommend physical activity that are appropriate for you and your baby.
Women whose gestational diabetes is not able to be managed by activity and meal planning will need medication to help achieve targets for a healthy pregnancy. This is, most often, insulin, which is very safe for both mother and baby during pregnancy. In the last few years metformin, a medication that has been used for type 2 diabetes has also been used. Your diabetes healthcare team will be able to help you choose which medication will be best for you and your baby.
After the baby is born, blood sugar levels in women with gestational diabetes may return to normal. However, some women will have diabetes or prediabetes post delivery. It is important to have followup blood work to check blood sugar levels post delivery.
For more information about gestational diabetes, click here.
Blood glucose targets during pregnancy
Checking blood glucose both before and after meals is recommended. For gestational diabetes, your team will help you find a routine for monitoring. For type 1 diabetes, continuous glucose monitoring may be helpful. Targets during pregnancy – whether you have type 1 or type 2 diabetes, or gestational diabetes – are as follows:
- Fasting blood glucose (blood glucose before a meal): less than 5.3 mmol/L
- One hour after a meal: less than 7.8 mmol/L
- Two hours after a meal: less than 6.7 mmol/L
With planning – in addition to paying close attention to nutrition planning, physical activity and medication needs – women with diabetes can enjoy a happy and healthy pregnancy!
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