Diabetes in Pregnancy

What is diabetes in pregnancy?

Diabetes is a condition that causes high levels of sugar in the blood. Some women have diabetes before they become pregnant. Others develop it during pregnancy, a form called gestational diabetes.

If you develop diabetes during pregnancy, you may need to start a special diet. In some cases you may need to take insulin shots.

If you had diabetes before you became pregnant, it may be harder for you to control your sugar (glucose) levels during pregnancy. Pregnancy can make both high and low blood sugar levels happen more often. It can make diabetic eye disease and diabetic kidney disease worse. You may need to change your insulin dosage. If you were not using insulin before the pregnancy, you may need to use it while you are pregnant.

If diabetes is not treated before and during pregnancy, these problems might occur:

• The high sugar levels in your blood might cause the baby to get too big before birth. Very large babies tend to have more problems before birth, during delivery, and after birth. Babies who are large or have other problems may need to be delivered by cesarean section (C section).
• The baby might have birth defects, such as problems with the heart, kidney, spine, or brain. Some of these problems may be life threatening.
• You might have high blood pressure during the pregnancy (preeclampsia), which can cause problems for both you and the baby.
• You might go into preterm labor (before 37 weeks of pregnancy), or the baby might need to be delivered early.
• After delivery the baby may have low blood sugar problems (hypoglycemia).
• The baby might have high levels of bilirubin in the body (jaundice).
• After delivery the baby may have trouble breathing because the lungs are not fully developed.
• The baby could die in the uterus before delivery.

If you have proper treatment before and during your pregnancy, there is a good chance you will deliver a healthy baby.

How does it occur?

Insulin is a hormone produced by the pancreas. It helps your body change sugar to energy. Pregnancy hormones can change the way insulin works, so during pregnancy the pancreas needs to release more insulin than normal. If the pancreas cannot make enough insulin to control the sugar level, you become diabetic. Gestational diabetes develops in 2 to 5% of pregnancies.

No one knows why some people develop diabetes and others do not. It may be a problem you can inherit from your parents. Women with the following histories or conditions are particularly at risk for developing diabetes during pregnancy:

• a family history of diabetes
• overweight, especially over 200 pounds
• a previous baby that weighed more than 9 pounds (4000 grams) at birth
• a previous baby born dead
• a previous baby with birth defects
• previous miscarriages
• age over 35 years.

What are the symptoms?

Symptoms of diabetes include:

• excessive thirst
• weight loss
• eating too much
• urinating a lot
• unexplained fatigue.

Gestational diabetes can occur without noticeable symptoms. However, urine and blood tests during your pregnancy may show that you have diabetes.

A woman who already has diabetes and becomes pregnant will notice that her diabetes is harder to control.

How is it diagnosed?

Urine checks for diabetes are done during prenatal visits.

If you are at risk for developing diabetes, you will probably have a blood test to screen for diabetes at your first prenatal visit and again later in the pregnancy. If you are not known to be at risk, you may be screened around the 24th to 28th week of pregnancy. The screening is done by having you drink a sugar drink. A sample of your blood is then taken 1 hour later.

If the result of the first blood test is not normal, your health care provider may order a 3-hour glucose tolerance test. For this test, a sample of your blood is taken soon after you get up in the morning, when you have not eaten anything since the night before. Then you drink a sugar drink, and your blood and urine are tested every hour for 3 hours.

How is it treated?

If you develop diabetes during pregnancy, you may be able to control your blood sugar level by:

• checking your blood sugar level at home (your health care provider will tell you how often you need to check it)
• following a special diet
• getting regular, moderate exercise, as recommended by your provider.

If you have gestational diabetes, you may also need to take insulin shots to control your sugar level. You should not take oral medicine for diabetes during pregnancy because it could hurt the baby.

If you are a diabetic planning to become pregnant, you need to discuss this with your health care provider well before you try to get pregnant. You need to have good control of your blood sugar before you become pregnant. You should also have a thorough medical exam. While you are pregnant you may need extra care such as:

• more frequent checks of your blood sugar at home and by your health care provider
• a change in your diet
• frequent changes in your insulin dosage as your pregnancy progresses if you have type 1 diabetes
• a switch from oral diabetes medicines to insulin if you have type 2 diabetes (You may need to stop taking oral medicine for controlling blood sugar before you become pregnant because it can cause birth defects.)
• weekly visits with your health care provider and the doctor treating your diabetes.

More tests may be done during the later stages of your pregnancy to check the health of your baby. Examples of such tests are ultrasound scans, electronic fetal monitoring, and amniocentesis. With ultrasound, your health care provider can see if the baby is getting too big to deliver vaginally. He or she will also use ultrasound to check the amniotic sac and the development of the baby. Electronic fetal monitoring checks the heartbeat and activity of your baby and contractions of your uterus. Amniocentesis can be used to check the maturity of the baby's lungs if the baby needs to be delivered before the due date.

When you are in labor, your provider will watch your blood sugar closely and test it often. During labor you may need to have sugar water and insulin given IV (into your veins) to control your blood sugar level.

Gestational diabetes usually goes away within a few weeks after birth. To make sure, your provider will test your blood sugar 1 to 2 months after the birth of your baby.

How long will the effects last?

Most women who develop diabetes during pregnancy are not diabetic after the baby is born. The body's need for insulin usually decreases after delivery because the balance of hormones returns to normal. However, you have a good chance of becoming diabetic later in your life. In fact, 15% to 20% of women who were diabetic during pregnancy become diabetic again within the first year after delivery. To decrease this risk of becoming diabetic, you may need to lose weight after the pregnancy. Also make sure your diet is healthy and that you get enough exercise. Your health care provider will test your blood sugar level often.

If you were diabetic before pregnancy, you will probably return to your previous condition and treatment. However, complications of diabetes may worsen during pregnancy. If you did not have good control of your blood sugar before pregnancy, your baby has a higher risk of birth defects, or the baby might die before delivery. Ask your health care provider about these risks.

If you became diabetic in one pregnancy, you are more likely to be diabetic in future pregnancies. You should be tested early for diabetes the next time you are pregnant.

How can I take care of myself?

• Follow the diet, medication, and exercise program recommended by your health care provider.
• Keep your blood sugar level under control. You may need to check your blood sugar level one or more times a day.
• Always follow your prescribed treatment.
• Keep all of your appointments with your health care provider and diabetes doctor.

How can I help prevent diabetes or complications from diabetes during pregnancy?

Stay at a healthy weight. Beginning a pregnancy at a healthy weight puts less strain on your body. This takes long-range planning. "Crash diets" are always unwise, and any weight loss can be dangerous during pregnancy.

If you have diabetes not caused by pregnancy, you need to plan the pregnancy and discuss your health with your health care provider at every step along the way. If your diabetes is not under excellent control, you should prevent pregnancy with careful use of a reliable method of birth control. You should keep your blood sugar in the normal range for 3 months before you become pregnant and continue this good control throughout the pregnancy. The critical time to prevent birth defects is the first 8 to 10 weeks of pregnancy. Many women do not even know they are pregnant at this early stage.