How Diabetes Affects Pregnancy

Pregnancy is a time of big changes for any woman. These changes affect your blood sugar levels. Sometimes, a woman who is pregnant develops diabetes during the course of her pregnancy. This is called “gestational diabetes.” Gestational diabetes begins during pregnancy, and usually goes away after the baby is born. About 3 percent of pregnant women develop this condition. The blood sugar becomes too high, and if you don’t bring it under control, problems for both you and your baby can result.

The same is true for women who already had diabetes before they were pregnant. If you have type 1 diabetes, your need for insulin will probably increase when you’re pregnant. If you have type 2 and have been controlling it by diet, you may be able to continue in this way. But if you’ve been taking pills to control your blood sugar, you’ll have to switch to insulin injections when you’re pregnant because the pills can cause birth defects. You healthcare team will be able to help you with this big change.

How blood sugar affects baby and mother
Here are some of the problems high blood sugar can cause during pregnancy:

• High blood sugar levels and ketones pass through the placenta to the baby. In large amounts, ketones can be poisonous. This increases the chances of birth defects.
• The baby’s organs begin forming early in pregnancy, before you may even know you’re pregnant. High blood sugar levels can have a negative effect on these growing organs.
• When the mother’s sugar level is high, the baby consumes too much sugar and can become too big. This makes giving birth harder—for the mother and the baby.
• When babies consume too much sugar, their pancreas produces extra insulin. After birth, the pancreas may continue to produce insulin, so babies are at risk for developing low blood sugar.

If you already have diabetes…
If you’re thinking about becoming pregnant soon, talk about your plans with your healthcare team. If you don’t have a healthcare team, or if you haven’t connected with them in a while, now is a good time. Members of the team should include:

• Endocrinologist
• Diabetes educator
• Eye doctor
• Dietitian
• Obstetrician
• Pediatrician

The team can give you a thorough assessment of your health and recommendations about how to get yourself in the best possible condition for pregnancy. They can also help you plan ahead by explaining how pregnancy will affect your diabetes. For example, when you’re pregnant, you’ll probably need to test you blood sugar more frequently than you currently do. Your healthcare team may recommend that you get in that habit now.

Getting tested for gestational diabetes
When you’re pregnant, your doctor is likely to perform the following tests to screen for gestational diabetes:

Glucose screen: This is performed during the second trimester. For this test, you’ll either have your blood sugar level checked after 12 hours of fasting or you will drink a very sweet drink. An hour later, your blood will be drawn. If the result is positive, then you’ll probably have the glucose intolerance test.

Glucose intolerance test: For this test, you eat normally the day before and do not eat during the night. Before the test, you’ll have a sweet drink. Then your blood will be drawn once an hour for 3 hours. (It’s a good idea to have a book or magazine with you when you have this test done.)

If you have gestational diabetes, your doctor or other healthcare provider will talk with you about your treatment plan. You’ll need to work out a food plan and an exercise routine, and there’s a good chance you may have to take insulin for the rest of your pregnancy. Your healthcare team will help you all along the way, so that you have an excellent chance of keeping your blood sugar in a healthy range until your baby is born.

Source:
American Diabetes Association; Diabetes Forecast, December 1997; National Institute of Diabetes and Digestive and Kidney Diseases.