Diabetes and Pregnancy

Managing diabetes and pregnancy? Here’s what to expect when you’re expecting and how to stay in control.

Dorothy Foltz-Gray
Reviewed by
Philip Levy, MD
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Kelly Scott, 33, a marketing director in Kirkland, WA, always wanted children, despite having type 1 diabetes. So throughout both her pregnancies she remained vigilant, keeping her blood sugar levels tightly controlled. The results: two healthy daughters, now 5 and 2.

Pregnancies among women with diabetes are no rarity. A 2010 report by the Agency for Healthcare Research and Quality found that more than a quarter million women, or 6.4% of women who had babies in U.S. hospitals in 2008, had pre-existing diabetes or developed it during their pregnancy.

Women with diabetes who become pregnant are well advised to follow Kelly’s example. Keeping blood sugar in check like she did can lower the baby’s risk for birth defects, such as heart abnormalities or spina bifida (partial closure of the spinal canal). Other reasons to be extra watchful: Women with diabetes are at greater risk for miscarriage or for carrying overweight babies that can complicate delivery.

“But if [glucose] remains normal, risks to the baby are no greater than those for the general population,” says maternal fetal specialist Robert Atlas, MD, chief of Obstetrics and Gynecology at Mercy Medical Center in Baltimore.

To keep you and your baby healthy, here’s how to stay in control.

    • Plan ahead. “Blood sugar should be controlled at least one to two months before conception,” says Atlas. “The longer a woman is in good control of her diabetes, the fewer long-term problems that woman has.” Kelly saw an obstetrician specializing in diabetic pregnancies a year before she conceived, switching from injected insulin to an insulin pump, easing glucose control.
    • Step up blood sugar monitoring. Check before meals and one hour after eating, says Atlas. Women with diabetes who are pregnant are more likely to have high or low blood sugar at night. So, if glucose is high in the morning, check it at 2 AM until it is better controlled.
    • Eat often. Snack on protein and carbohydrates, like a glass of skim milk, between each meal. The protein and fat raises your blood sugar and keeps it level longer than a sugary snack that can cause your blood sugar to crash. And never use insulin without eating, says Atlas: “You can become hypoglycemic [low glucose], which can damage your brain.” If you’re nauseated or vomiting, reduce insulin to a sick- day amount that you and your endocrinologist have worked out ahead of time. Kelly saw a nutritionist who tweaked her eating plan and offered ideas for meals and snacks.
April 2013