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. Diabetes that starts during pregnancy is called gestational diabetes.

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 worsen diabetic eye, kidney, heart, blood vessel, and nerve problems. 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 you develop diabetes during pregnancy, you may need to start a special diet. In some cases you may need to have insulin shots or take a pill to help control your blood sugar.

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 very large or have other problems may need to be delivered by cesarean section (C section) because of an increased chance for an injury at the time of birth.
• 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.
• With very high sugars you may develop ketones in your blood and urine. This is a very serious, life-threatening condition called ketoacidosis.
• 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).
• You might have a miscarriage early in the pregnancy or the baby might 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. This process helps keep blood sugars lower. 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 about 7% (1 in 14) of pregnancies.

No one knows why some people develop diabetes and others do not. However, 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 9 pounds (4000 grams) or more at birth
• a previous stillborn baby
• a previous baby with birth defects
• multiple previous miscarriages
• age over 35 years

What are the symptoms?

Symptoms of diabetes in women who are not pregnant might 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 your blood sugar is high enough to be called 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 a higher 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 considered to have a low or average chance of developing gestational diabetes, 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 your blood sugar from the first blood test is abnormally high, your healthcare provider may order a 3-hour glucose tolerance test. For this test, a sample of your blood is taken and tested when you have not eaten anything since the night before. Then you drink a sugar drink and your blood is tested again every hour for the next 3 hours.

How is it treated?

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

• checking your blood sugar level at home (your healthcare 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 or medicine by mouth (called Glyburide or Metformin) to control your sugar level. If you need insulin, make sure you understand as much as possible about your insulin, including the right amount to use and the correct technique for giving yourself injections. It is also a good idea for another person, such as your partner, to learn how to give you insulin in case of emergencies. The timing of injections and the amount of insulin that you use should be determined by your healthcare provider.

The only way to know if you are taking the correct amount of insulin is to monitor your blood sugar closely every day. Ask your healthcare provider to recommend a blood sugar monitoring schedule. Ask when to call your provider if your blood sugar measurement is not within the range that your provider suggests.

If you are already a diabetic and planning to become pregnant, you need to discuss this with your healthcare 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 healthcare provider
• a change in your diet
• frequent changes in your insulin dosage as your pregnancy progresses if you have type 1 diabetes
• more frequent visits with your obstetric healthcare provider and the provider treating your diabetes
• additional evaluation of your heart, eye, and kidney function

If you have type 2 diabetes and are pregnant or thinking about getting pregnant, be sure to talk with your provider about your treatment choices. You may need changes in your medicine while you are trying to get pregnant and during pregnancy.

Your urine may be tested for ketones at your checkups. 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 healthcare provider can see if the baby is getting too big to deliver vaginally. He or she will also use ultrasound to check the amount of fluid in 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. If the baby needs to be delivered before the due date, amniocentesis can be used to check the maturity of the baby's lungs.

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.

Unlike women who have diabetes before pregnancy, 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 healthcare provider will test your blood sugar level often.

If you were diabetic before pregnancy, you will probably return to your previous condition and treatment plan. 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 healthcare provider about these risks.

If you develop gestational diabetes 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 healthcare provider.
• Keep your blood sugar level under control. You may need to check your blood sugar level one or more times a day.
• Make sure you and your family members know how to treat low blood sugar. A risk of keeping blood sugar in very good control is that it will sometimes go too low (hypoglycemia). Low blood sugar reactions can be dangerous for the mother, but it has not been shown that a mother's low blood sugar harms her baby.
• Keep all of your appointments with your healthcare provider and diabetes care provider.

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 healthcare 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. Keep your blood sugar in the normal range for 3 months before you become pregnant and continue good control throughout the pregnancy. Finally, taking at least 1 milligram (mg) of folic acid every day can reduce the risk of some pregnancy complications, such as certain birth defects.