Women with type 1 and type 2 diabetes have a slightly higher risk of complications during pregnancy. The risk of stillbirth and birth defects is also slightly increased. However, most women can deliver healthy babies and avoid complications by following a diabetes management plan designed for pregnancy.
Pre-pregnancy diabetes management plan
Planning for a healthy baby should start before a woman with diabetes becomes pregnant.
Healthy blood glucose levels are the most important factor during pregnancy. Since pregnancy affects blood glucose levels, it’s important to get levels as close to normal as possible before conception. This helps to avoid pregnancy complications and promotes healthy development for the baby.
As soon as pregnancy is planned, make an appointment with a health care professional to discuss an appropriate pre-pregnancy plan. This may involve an adjustment to medications and/or lifestyle changes.
The goal will be to reduce blood glucose to normal healthy levels, and to establish and maintain healthy weight targets. Pre-natal folic acid is also likely to be prescribed.
Medical care during pregnancy
Women with diabetes should be referred to an obstetrician who specializes in high-risk pregnancies, and who is familiar with the special care required for diabetes.
Don’t be afraid of the term ‘high-risk’. It is simply the term that is used for women who require extra observation during pregnancy. All women with diabetes should already be receiving an extra level of medical observation as part of everyday life with diabetes. Expect the same extra care during pregnancy, both for the mom-to-be and for the developing baby.
Managing blood glucose levels
Blood glucose control is the top priority during pregnancy and delivery for women with diabetes. Medications may be changed or adjusted at different stages of the pregnancy to meet desired targets.
For women with type 1 diabetes, this may mean adjusting insulin levels to meet factors such as morning sickness or changes in eating habits. Increased insulin is also often needed during the last three months, when hormones from the placenta can reduce the impact of insulin.
Pregnant women with type 2 diabetes can expect to have their medication schedule adjusted. Some oral medications are not recommended during pregnancy. In some cases, a switch to insulin is advised to avoid complications and promote the birth of a healthy baby.
Frequent blood glucose monitoring is usually recommended throughout pregnancy. Check in with your health care provider regularly to follow up on levels and ensure that any issues are caught quickly and controlled.
Labour and delivery
Labour and delivery with diabetes calls for careful management, including close monitoring of blood glucose levels. In some cases, labour is induced before term to help cut the risk of complications for the mother and baby.
Poor blood glucose levels during pregnancy can result in babies that are too large for normal delivery. If this occurs, the baby will be delivered by C-section.
After delivery, baby will be closely monitored to ensure blood glucose levels are normal and to check for signs of jaundice. This shows up in a yellowish discolouration of the eyes and skin, and can usually be managed with light therapy.
Gestational diabetes (GDM) is a temporary form of diabetes that can arise during pregnancy. Careful management can usually keep GDM under control and lead to the birth of a healthy baby.
GDM ends with delivery but may re-occur in future pregnancies. Women who have had the condition are also at greater risk of developing type 2 diabetes in later years. For more information, read our article on this site Life after gestational diabetes.
