Getting Pregnant With Diabetes – Risks and Prevention
Diabetes for pregnant ladies is a major cause of worry. Although diabetes can occur at any age in any person, the risks are slightly increased when getting pregnant with diabetes since it also involves a developing baby in the equation. If you have diabetes before you become pregnant, your risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such as high blood pressure and kidney damage, are present. It is important to note that while pregnancy tends to make diabetes a little difficult to manage, it does not trigger or worsen its complications. In this article, we discuss everything related to what to do and how to manage type 1 and type 2 diabetes when pregnant.
Can a Diabetic Woman Get Pregnant?
Diabetes and pregnancy are not mutually exclusive. So the presence of diabetes doesn’t affect pregnancy in any way. However, one does need to take a bunch of precautionary measures so that the baby stays safe. Keeping sugar levels in check is one of the prime ones in this regard. Your doctor will ask you to repeat certain tests and check-ups regularly so that various factors involving your pregnancy are monitored appropriately.
What Are the Types of Diabetes?
There are three types of diabetes that are classified as follows:
1. Type 1 Diabetes
This is an autoimmune disorder in which the body’s immune system damages the cells in the pancreas that make insulin. In this case, the pancreas produces little to no insulin. If you are diagnosed with type 1 diabetes before becoming pregnant, it is called pregestational diabetes mellitus (1). Insulin is considered very important to treat type 1 diabetes during pregnancy. Pregnancy doesn’t cause type 1 diabetes. However, hormonal fluctuations can lead to challenges in the management of blood glucose.
2. Type 2 Diabetes
Type 2 diabetes is a condition in which the body does not use insulin effectively or use it normally. Over time, it may not produce enough insulin to maintain normal blood glucose levels. Stanford Medicine states that it is not an autoimmune disease (2).
When type 2 diabetes is present before pregnancy, it is very important to control it because uncontrolled blood glucose can increase the risk of complications in the mother, such as high blood pressure and preeclampsia and the baby’s risk of excessive growth, premature birth and other complications (3).
The American Diabetes Association suggests insulin is the ideal and preferred medication to manage type 2 diabetes during pregnancy (4). Along with medication, the doctor may also suggest glucose monitoring, changes in the diet, and physical activity.
3. Gestational Diabetes
In gestational diabetes mellitus (GDM), a person who did not have any history of diabetes develops diabetes during pregnancy. MSD Consumer Manual provides a simple explanation of why this happens: pregnancy hormones, including estrogen, cortisol, and human placental lactogen, can block insulin and make the body more resistant to insulin. Now the glucose can’t go into the cells; instead, it stays in the blood, raising the blood sugar levels (5). According to Stanford Medicine, about 3 to 9% of pregnant women develop gestational diabetes (2).
Unlike type 1 or type 2 diabetes, GDM may disappear after delivery, although having it increases the mother’s future risk of developing type 2 diabetes.
How Does Diabetes Affect Pregnancy?
Getting pregnant with type 2 diabetes can result in many risks and complications, making it difficult for both the mother and the child throughout pregnancy. Since diabetes affects important organs, it poses a greater risk if it continues to be undetected and uncontrolled.
For Mothers, this can then result in:
- Presence of an infection in the urinary tract causing fever and an increase in body temperature.
- A build-up of various ketone bodies that are harmful to the pregnancy (6).
- Hypertension and elevated blood pressure, resulting in fluid retention.
- Numbness in the hands accompanied by tingling, similar to carpal tunnel syndrome
- Swollen limbs and facial features.
- Traces of protein being present in the urine.
- Preterm delivery or the need to carry out an emergency cesarean (6).
For Developing Babies
While these risks primarily affect the mother, the baby is not spared from its effects and would face many conditions. The NHS states that a child is at a higher risk of (6):
- Developing obesity later on in life
- Developing diabetic
- The immune system takes a hit, with chances of the newborn contracting jaundice easily
- Developing the risk of high blood sugar and low blood sugar levels, requiring immediate glucose to be given
- Baby being born with birth defects, especially heart and nervous system abnormalities
- Stillbirth
Ways to Prevent Complications and Risks During Pregnancy
While getting pregnant with diabetes type 1 or even type 2 involves its set of risks, there are a few ways you can reduce these possibilities:
1. Supplementing Diet With Folic Acid
Whether a woman has diabetes or not, the inclusion of folic acid in her diet is a priority that cannot be compromised. In most cases, doctors advise taking folic acid supplements since the requirement of the foetus in the initial stage of development is quite high. Although the normal requirement is around 400 mcg, in the case of a diabetic woman, this jumps up to as much as 5mg at a time. Therefore, supporting this demand for folic acid with supplements is required for the first 3 months of pregnancy so that the child is not born with any defects (7).
2. Take the Appropriate Medicines
Medication and pregnancy rarely go hand-in-hand. Numerous medicines are meant to be avoided during pregnancy, since they can affect the mother and child quite adversely. The presence of diabetes might make it necessary to take medication; however, it should never be self-administered. Make sure you get your doctor’s go-ahead on any medicine you take, and never stray from the dosage amount.
3. Maintain a Good Exercise Schedule
In the case of a diabetic woman, an increase in weight can give rise to numerous difficulties or even cause an onset of obesity, resulting in more complications. Although weight gain is a necessity, keeping it within a healthy limit is possible by opting for simple exercises. Refer to your doctor with a list of exercises and make sure they are safe for you while you are pregnant. Engaging in movements like walking or going for a gentle swim are all good choices for you (8).
4. Choose a Healthy Diet Plan
The dietary needs of a diabetic pregnant woman differ slightly from those of a non-diabetic woman, since she also needs to maintain proper blood sugar levels along with balanced nutrition. Eat a good amount of whole fruits and vegetables, moderate amounts of healthy fats, lean proteins, and whole grains. Avoid excessive sugary foods and drinks like sweets, soft drinks, fruit juices, cookies, and cakes (9).
A dietitian can help you on this front and chart out the right food items to be included and excluded to maintain your health throughout.
5. Constant Monitoring of Blood Sugar Levels
For a pregnant mother suffering from diabetes, insulin intake might be a necessity based on the degree of diabetes. This results in random fluctuations of blood sugar levels, which can be too high or even too low. In case of a low sugar attack, it is necessary to keep a snack or a sweet item with you so that you can quickly set your sugar levels to a normal state.
6. Undertake Regular Checkups
Every pregnant woman is given a general schedule she needs to adhere to, which involves checkups that consider the growth of the baby, the state of the mother, and various biochemical elements. For a diabetic mother, these aspects tend to change quite a lot, which makes it necessary to have an increased frequency of checkups. This ensures that any complications are nipped in the bud.
7. Be Prepared in Advance
If you are aware of your diabetes, make sure to get in touch with your doctor before you decide to get pregnant. Your doctor might help you understand if you are in peak health condition to bear a baby and carry it to a full-term pregnancy. Furthermore, this gives you a good time to plan out the rest of the journey, keeping a diet plan in place, and having the chance to reduce your weight in order to prepare for the increased weight during pregnancy.
Management of Type 1 Diabetes in Pregnancy
First and foremost, close monitoring of the individual is required for managing type 1 diabetes during pregnancy. This is because insulin requirements can change substantially as pregnancy progresses
- Monitor Blood Glucose on Time: Glucose monitoring for fasting, pre-meal and post-meal is very important to track glucose patterns and identify highs or lows. ADA guidance recommends a fasting glucose of 70–95 mg/dL, with either a 1-hour post-meal level of 110–140 mg/dL or a 2-hour level of 100–120 mg/dL, although targets may be individualised to avoid significant hypoglycemia.
- Take Insulin: Insulin is the most important treatment for managing type 1 diabetes during pregnancy. The prime treatment options include multiple daily injections and insulin pump therapy.
- Eat Accordingly: A dietitian or diabetes care team can help you meet increased nutritional needs while keeping glucose levels within your individualised range.
- Watch for Low Blood Glucose: Insulin treatment can sometimes drop blood glucose levels too much, which may increase the risk of hypoglycemia.
- Regularly Attend Prenatal and Diabetes Appointments: Blood pressure, kidney health, eye health and fetal growth may require additional monitoring.
Management of Type 2 Diabetes in Pregnancy
Type 2 diabetes management during pregnancy can be easily managed by maintaining safe blood glucose levels while supporting the nutritional and developmental needs of both mother and baby. Here’s what your doctor may suggest:
- Plan Your Pregnancy Well: If you have diabetes before pregnancy and are planning to conceive, it is best to consult your doctor before getting pregnant so that your doctor can review your glucose control, medications, blood pressure, kidney function and other diabetes-related complications.
- Review Diabetes Medicines: Some medicines used to control type 2 diabetes generally may not be suitable during pregnancy. Thus, it is very important that your doctor has your medical history.
- Monitor Blood Glucose Regularly: Fasting and post-meal monitoring helps determine whether treatment is keeping glucose within the pregnancy-specific range.
- Have a Balanced Diet Plan: Make sure your daily meals are perfectly balanced with protein, carbs, and fats to keep glucose levels within the optimal range.
- Stay Physically Active: Regular moderate physical activity, such as walking, swimming, Kegel exercises, and prenatal yoga, can help support glucose management. Consult your doctor for pregnancy-safe exercises.
Which Tests Should You Expect With Diabetes in Pregnancy?
Your doctor may recommend diabetes tests during pregnancy depending on whether you have type 1, type 2 or gestational diabetes, or other health conditions.
Before Pregnancy or at the First Prenatal Visit
1. HbA1c Test
HbA1c provides an estimate of average blood glucose over the previous few months and is particularly useful when assessing diabetes control before conception.
2. Blood Glucose Testing
Fasting or other appropriate glucose tests may be performed to assess current control and, when relevant, to identify previously undiagnosed diabetes.
3. Kidney Assessment
People with pre-existing diabetes may have kidney involvement without obvious symptoms. Doctors recommend a renal assessment during pregnancy for women with pre-existing diabetes if one has not been performed within the previous three months.
4. Eye Examination
Diabetic retinopathy can worsen during pregnancy. NICE recommends retinal assessment for women with pre-existing diabetes, with additional examinations in certain circumstances.
5. Blood Pressure Assessment
Blood pressure is checked regularly because diabetes is associated with an increased risk of hypertensive disorders, including preeclampsia.
During Pregnancy
1. Regular Blood Glucose Monitoring
You may be asked to check fasting, pre-meal and/or post-meal glucose. CGM may be recommended for people with type 1 diabetes and can provide additional information about glucose patterns.
2. Gestational Diabetes Screening
If you do not already have diabetes, screening is generally performed at 24–28 weeks. Depending on the healthcare system and screening approach, this may involve a glucose challenge test and/or an oral glucose tolerance test (OGTT). People at higher risk may be tested earlier.
3. Urine and Kidney Tests
These may be used to check for protein leakage and assess kidney health, particularly when pre-existing diabetes is present.
4. Retinal Examination
People with pre-existing diabetes may need repeat eye assessments during pregnancy, particularly if diabetic retinopathy is present.
5. Ultrasound and Fetal Assessment
Because pre-existing diabetes can increase the risk of fetal complications, your obstetric team may arrange detailed ultrasound assessment and later monitoring of fetal growth and wellbeing according to your individual risk.
When to Consult a Doctor?
If you have diabetes and are planning to become pregnant, it is best to make a preconception appointment before you get pregnant. Contact your doctor if:
- You are considering pregnancy and have type 1 or type 2 diabetes.
- You have recently discovered that you are pregnant and have pre-existing diabetes.
- Your blood glucose readings are repeatedly above or below your recommended range.
- You are vomiting or unable to keep food or fluids down.
- You have symptoms that could indicate diabetic ketoacidosis, such as persistent vomiting, abdominal pain, rapid or deep breathing, unusual drowsiness or confusion.
- You develop symptoms or signs of high blood pressure or preeclampsia, such as a severe headache, vision changes, sudden swelling or significant upper abdominal pain.
FAQs
1. Can I get pregnant if I have diabetes?
Yes, you can get pregnant with diabetes. Diabetes does not prevent pregnancy, but it is great to consult with your doctor to bring your blood glucose into the recommended range before conception.
2. Can diabetes lead to birth defects?
Poorly controlled diabetes around conception can increase the risk of birth defects, particularly because the baby’s organs begin developing during the first weeks of pregnancy. Improving glucose control before conception can help reduce this risk.
3. Should I stop my diabetes medicine before trying to conceive?
No. Do not stop or change diabetes medication on your own. Some medicines may need to be changed before pregnancy, while insulin is commonly used when medication is needed during pregnancy. Your doctor should guide any medication changes.
4. Can gestational diabetes be prevented?
Gestational diabetes can’t always be prevented, but the risk may be reduced. Thus, it is important to maintain a healthy weight with a balanced meal plan and stay physically active.
Although pre-existing diabetes and pregnancy are not a great combination, it also isn’t a reason to negate the idea of conceiving. It is necessary to know that the presence of diabetes can affect the delivery of your child. Earlier, most babies of diabetic women would be delivered prematurely, leading to precautions for the newborn child. Nowadays, with the right conditions and medications, one can easily attain a full-term pregnancy. Following the delivery, the mother can also adjust the insulin levels to return to normal.
While breastfeeding your child, most doctors do recommend taking insulin shots instead of oral tablets. The latter has a higher chance of entering the breast milk and, hence, being passed on to the baby. Insulin shots can help you keep your diabetes under control, which also allows you to continue breastfeeding, leading to joyful motherhood.
Also Read:
How to Deal with Swelling during Pregnancy?
Foods to Eat while Suffering from Gestational Diabetes
Ways to Increase Chances of Getting Pregnant
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1. American College of Obstetricians & Gynecologists – Pregnancy With Type 1 or Type 2 Diabetes
2. Stanford Medicine – Diabetes During Pregnancy
3. HSE – Diabetes and pregnancy
5. MSD Manual – Diabetes During Pregnancy
6. NHS – Diabetes and pregnancy
7. Johns Hopkins Medicine – Folic Acid for a Healthy Baby
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