Pregnancy is often a time of great highs and lows. It can be awesome and thrilling—when you hear the baby's heartbeat or feel the first tiny kick. It can also be frustrating and even scary.
Because we know more about diabetes than ever before, there has never been a better time for you to plan a pregnancy. For the best prenatal care, assemble a team that includes the following:
- 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 pediatrician (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 dietitian 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
- An eye care provider who can be sure your eyes are in good shape for pregnancy
It’s important to remember that YOU are the leader of your health care team. Keep track of any questions you have and make sure to ask your health care team.
Checking Your Blood Glucose
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 checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy.
Blood glucose targets are designed to help you minimize the risk of birth defects, miscarriage and help prevent your baby from getting too large. If you have trouble staying in your target range or have frequent low blood glucose levels, talk to your health care team about revising your treatment plan. Target blood glucose values may differ slightly in different care systems and with different diabetic teams. Work with your health care team on determining your specific goals before and during pregnancy.
The American Diabetes Association suggests the following targets for women with preexisting diabetes who become pregnant. More or less stringent glycemic goals may be appropriate for each individual.
- Before a meal (preprandial) and Bedtime/Overnight: 60-99 mg/dl
- After a meal (postprandial): 100-129 mg/dl
- A1C: less than 6%
*Postprandial glucose measurements should be made 1-2 hours after the beginning of the meal, which is generally when levels peak in people with diabetes.
Check your blood glucose levels at the times your diabetes team advises; this may be up to eight tests daily and will probably include after-meal checks.
- Write down your results.
- Keep notes on your meal plan and exercise.
- Make changes in your meal plan and insulin only with the advice of your diabetes team.
Insulin and Diabetes Pills
Insulin is the traditional first-choice drug for blood glucose control during pregnancy, because it is the most effective for fine-tuning blood glucose and it doesn’t cross the placenta. Therefore, it is safe for the baby. Insulin can be injected with a syringe, an insulin pen, or through an insulin pump. All three methods are safe for pregnant women.
If you have 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 three months of pregnancy. The need for more insulin is caused by hormones 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 diabetes, you too need to plan ahead. If you are taking diabetes pills to control your blood glucose, you may not be able to take them when you are pregnant. Because the safety of using diabetes pills during pregnancy has not been established, your doctor will probably have you switch to insulin right away. Also, the insulin resistance that occurs during pregnancy often decreases the effectiveness of oral diabetes medication at keeping your blood glucose levels in their target range.
For women with gestational diabetes, meal planning and exercise often work to keep blood glucose levels in control; however, if blood glucose levels are still high, your doctor will probably start you on insulin.
Only a small number of studies have been published analyzing the safety and effectiveness of oral medications during pregnancy. Unlike insulin, oral medications cross the placenta to the unborn baby in varying degrees. For these reasons, the American Diabetes Association does not recommend their use in pregnancy. However, oral medications are now used more frequently than in the past by some health care providers to manage blood glucose levels that are not controlled by diet and exercise alone during pregnancy.
During pregnancy you and your dietitian or doctor may need to change your meal plan to avoid problems with low and high blood glucose levels. This is the most important reason for keeping track of your blood glucose results. For most women, the focus of a good meal plan during pregnancy is improving the quality of foods you eat rather than merely increasing the amount of food eaten. A good meal plan is designed to help you avoid high and low blood glucose levels while providing the nutrients your baby need to grow.
Including a variety of different foods and watching portion sizes is key to a healthy diet. Healthy eating is important before, during, and after pregnancy, as well as throughout your life. Healthy eating includes eating a wide variety of foods, including:
- whole grains
- nonfat dairy products
- lean meats
Many people think eating for two means eating a lot more than you did before. This isn’t true. You only need to increase your calorie intake by about 300 more calories each day. If you start pregnancy weighing too much, you should not try to lose weight. Instead work with your dietitian or doctor to curb how much weight you gain during pregnancy.
Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15–25 pounds. You can determine your healthy weight by finding your BMI level by using our BMI calculator.
|Pregnancy Weight Goals|
|If your prepregnancy weight is…||Then gain…|
|These are averages to give you an idea of how much weight you should gain. Talk to your health care provider about your specific weight goals during pregnancy. (Adapted from American Diabetes Association Complete Guide to Diabetes, 5th edition, American Diabetes Association, 2011).|
Exercise 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 diabetes team. Ask for guidelines. Pregnant women frequently question whether it is safe to exercise during pregnancy. Regular physical activity is not only safe for pregnant women, it benefits health by offsetting some of the problems of pregnancy, such as varicose veins, leg cramps, fatigue and constipation. For women with diabetes, exercise, especially after meals may help the muscles use the glucose in the bloodstream, and help keep your blood glucose levels in your target range. But if you have any of the following conditions (see the list below), then you will need to talk to your diabetes team about the risks of exercise during pregnancy.
- High blood pressure
- Eye, kidney, or heart problems
- Damage of the small or large blood vessels
- Nerve damage
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. Activities to avoid during pregnancy are:
- Activities that put you in danger of falling or receiving abdominal injury, such as contact sports
- Activities that put pressure on your abdomen (exercises done while lying on your stomach)
- Scuba diving
- Vigorous, intense exercise, such as running too fast to carry on a conversation
- Activities with bouncing or jolting movements (horseback riding or high-impact aerobics)
Personal Story from The Type 1 Diabetes Self-Care Manual by Jamie Wood, MD and Anne Peters, MD
The Dreaded Third
I’m at the end of my second pregnancy with type 1 diabetes. It took me a long time to get comfortable with the idea of being pregnant with type 1. I didn’t have the confidence that I could do what it takes to have a healthy baby. I was really worried that high blood sugars would cause harm to my baby, and for this reason, my husband and I seriously considered surrogacy (even asking his sister to carry for us after we met with fertility doctors).
Not really having a great surrogate option plus, having some really reassuring conversations with other type 1 mommas, I decided to go for it. It is a lot of work, but to my surprise was definitely doable! My A1Cs were in the 6s and 5s for the first time in my life! Diabetes definitely took front stage in my life. I altered the way I ate, worked, traveled, exercised, and followed up with my diabetes team.
My first pregnancy was very stressful. I had just moved to a new state and started a new job, so life was anything but routine. Also, with every high blood sugar, I worried that I was harming my baby. Every ultrasound brought a sigh of relief. The heart anatomy ultrasound came back normal (sigh.) The limbs were forming normally (sigh). The baby was moving and growing (sigh).
The good thing is you get to see your baby A LOT as a type 1! In the third trimester, I went to my high-risk OB’s office two times a week for monitoring. I gave birth to a healthy baby boy at 38 6/7 weeks via planned C-section, no NICU time, no low blood sugars for me.
My second pregnancy came quickly after my first. This pregnancy has been harder in some ways, and easier in others. It’s hard to give diabetes the focus it had during my first pregnancy because I am taking care of my toddler. That being said, I have the confidence to know that I can do what needs to be done. My blood sugars have been a little easier to control this time. I’m in the middle of the dreaded third-trimester insulin resistance. It’s harder to prevent those post-meal high blood sugars and even harder to bring those blood sugars down. Interestingly, 160 is high for me now. Nonpregnant, I would never say that!
The biggest difference for me being pregnant vs. not being pregnant is the attention and effort. I carb count, log meals, send in data to my team regularly, see my endocrinologist more often, see my diabetes educator more often, etc. It all pays off, though.