Diabetes? Pregnant? Learn How To Manage Both!

Finding out that you’re pregnant is (for many) a very special and exciting time. It is also a time to be hyper-vigilant about your diabetes management to help ensure the health of you and your growing baby.

Did you know? “The prevalence of diabetes in pregnancy has been increasing in the U.S. The majority is gestational diabetes mellitus (GDM) with the remainder primarily preexisting type 1 diabetes and type 2 diabetes.”1

“Both type 1 diabetes and type 2 diabetes confer significantly greater maternal and fetal risk than GDM.”1

Potential complications of uncontrolled diabetes in pregnancy: 1

  • Spontaneous abortion
  • Fetal anomalies
  • Preeclampsia
  • Fetal demise
  • Macrosomia
  • Neonatal hypoglycemia
  • Neonatal hyperbilirubinemia

What steps can you take over the next 9 months to reduce the risk of potential complications?

Prenatal Care:

Optimal prenatal care starts with assembling your medical team. This team of people may include any of the following healthcare professionals:2

  • An obstetrician who handles high-risk pregnancies and has experience caring for pregnant woman with diabetes.
    • You may require closer follow-up and additional tests during the course of your pregnancy.
  • A physician, such as an endocrinologist, who also has experience caring for pregnant woman with diabetes.

Glucose Monitoring During Pregnancy:

  • The first trimester of pregnancy marks a time of increased insulin sensitivity. If you have insulin treated diabetes, you may be at greater risk for hypoglycemia during this period of time.
  • The second and third trimester of pregnancy is a time of reduced insulin sensitivity as pregnancy hormones (estrogen, cortisol, and human placental lactogen) counteract insulin action. At this point, insulin needs typically increase.3
  • Given the spectrum of insulin sensitivity to insensitivity during pregnancy, blood glucose levels need to be monitored more often. You should decide with your health care team how frequently to monitor your blood glucose and your target blood glucose range.
  • The American College of Obstetricians and Gynecologists and the American Diabetes Association (ADA) recommend the following glycemic (blood glucose) targets during pregnancy:
    • Fasting: < 95 mg/dL
    • One-hour post meal: < 140 mg/dL
    • Two-hour post meal: < 120 mg/dL 

A1c Test During Pregnancy

  • “Due to increased red blood cell turnover, A1c is lower in normal pregnancy than in normal non-pregnant woman.” 1
    • The ADA recommends a target A1c of 6-6.5 % during pregnancy
    • “These levels should be achieved without hypoglycemia…”
    • During pregnancy, A1c levels may need to be monitored more frequently (every month, instead of every 3-6 months)

Medication During Pregnancy

  • “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 doses will likely need to be adjusted weekly to keep your blood glucose levels within your target range. Your physician and/or diabetes educator can assist you with any necessary adjustments.
  • If your diabetes was managed with diet and exercise and/or oral medications prior to being pregnant, you may still require insulin in the second and/or third trimester of pregnancy as insulin sensitivity declines.
  • At the present time, the ADA does not recommend the use of oral medication during pregnancy as oral medications cross the placenta, potentially putting your baby at risk. Additional research is still needed in this area. 2

Nutrition During Pregnancy:

  • Nutrition is of utmost importance during your pregnancy, not only to help optimize blood sugar control but also to nourish your growing baby.
  • Certain nutrients are needed in greater amounts during pregnancy. Some of which include:
    • Protein: protein needs are increased to help ensure the growth of fetal tissues, this includes your babies growing brain.
    • Folic Acid: folic acid needs are increased to prevent neural tube defects (defects of the brain, spine, and spinal cord) 4
      • Food Sources: green leafy vegetables, fortified cereals/breads
    • Iron: iron needs are increased to help support an increase in blood volume that is necessary for you and your growing baby. Low iron levels may put your baby a greater risk for being born prematurely and/or at a low birth weight. 5
      • Foods Sources: Red meat, poultry, legumes, raisins, and fortified cereals
    • Taking a daily pre-natal vitamin will help you meet vitamin and mineral needs.
    • Insulin sensitivity during the second and third trimester of pregnancy is reduced, making blood sugar control more challenging. This is especially true upon rising in the morning. You may find that you blood glucose levels run higher in the morning, both before and after breakfast.
      • In addition to insulin/medication adjustments recommended by your physician, you may find it helpful avoid refined/processed carbs at breakfast (such as cereal and juice) as well as reducing your carb intake at breakfast. Including fiber rich and protein dense foods at breakfast can help lessen post meal blood sugar spikes.
        • Sample meal: Omelet (made with 2 eggs, spinach, mushrooms, and tomatoes) with 1 slice whole wheat toast and avocado spread.

Weight Gain During Pregnancy:

  • Your physician can assist you in determining a weight gain goal for your pregnancy.
  • The Centers for Disease Control and Prevention recommend the following weight gain goals:
    • Normal Weight (BMI 18.5-24.9): 25-35 pounds
    • Overweight (BMI 25.0- 29.9): 15-25 pounds
    • Obese (BMI >30): 11-20 pounds

Are you pregnant? What has your experience been like? Please share your story with the type2diabetes.com community.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Type2Diabetes.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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