Pregnancy Care for People with Type 1 or Type 2 Diabetes

People with type 1 or type 2 diabetes may wonder if they can have a healthy pregnancy. They can if their blood sugar level is well controlled, which can help to reduce the risk of pregnancy complications. Before getting pregnant, it is crucial to consult the doctor for optimal blood sugar control by adjusting or changing medications because certain medications are unsafe during pregnancies and for treating existing medical conditions such as obesity, eye problems, hypertension, or kidney disease.

Why blood glucose monitoring is important?

The risk of developing complications during pregnancy is related to blood sugar levels. High blood sugar levels can cause many problems during and after pregnancy. For example:

At the beginning of pregnancy
High blood sugar levels can lead to miscarriage, and the baby is at higher risk of congenital anomalies such as heart problems. The risk sharply increases when HbA1C is > 7 percent or the average blood glucose is >140 mg/dL.
During the pregnancy
High blood sugar levels can increase fetal size and difficulty during childbirth. A large baby weighing more than 4 kilograms can damage the mother with a vaginal birth. The mother is also at greater risk of developing preeclampsia, gestational hypertension, and polyhydramnios.
At the end of pregnancy
High blood sugar levels can cause preterm birth (when the baby is born before the 37th week of pregnancy), stillbirth, and the baby’s health problems such as low blood sugar levels, neonatal seizure, and rapid breathing rate.

Therefore, controlling blood sugar levels is a priority for pregnant women with type 1 or type 2 diabetes. To maintain the desirable blood sugar levels, they should follow these measures:

Plan a healthy diet with a nutritionist to control the calorie intake.
Exercise regularly to maintain a healthy weight and blood glucose levels.
Test blood glucose before and after a meal.
Attend every doctor’s appointment for frequent monitoring of the health of mother and baby and have an HbA1C test at least once per trimester. The goal is to keep HbA1C at or near 6 percent or an average blood glucose of 120 mg/dL.
Consult with the doctor if there is a need to switch from oral medications to insulin therapy during pregnancy. Two to five insulin injections are usually necessary for pregnant women with type 1 diabetes. The patient may require more insulin injections during the third trimester. The recommended insulin injection site is the abdomen and upper thigh because the medication can be quickly absorbed.

What test should people with diabetes have during pregnancy?

Before planning a pregnancy, people with diabetes should discuss with the doctor how to maintain their blood sugar levels in optimal control and prevent diabetes-related complications. Pregnancy care for people with diabetes requires a team effort of an obstetrician and an endocrinologist to manage diabetes and insulin use during pregnancy. While pregnant, it is essential to have the following tests.

Eye examination for diabetic retinopathy which can worsen during pregnancy, particularly in people with the highest initial HbA1C values and those with rapidly decreasing HbA1C. Pregnant women with severe diabetic retinopathy are at greater risk of developing complications. Having an eye exam every trimester can lessen the risk of vision loss. For those with mild diabetic retinopathy, the condition can return to its pre-pregnancy state a few months after childbirth.
Blood pressure monitoring at every doctor’s appointment is vital because blood pressure can elevate during pregnancy. High blood pressure can lead to preeclampsia and gestational hypertension. In severe cases, hypertension can lead to stroke, heart failure, and kidney damage.
Kidney function monitoring can be done with a urine test to check the amount of urinary protein and a blood test to assess the creatinine level. The existing diabetic nephropathy can worsen with pregnancy and increase the risk of preterm birth, preeclampsia, and growth restriction. Diabetic retinopathy and kidney disease can increase the risk of having a smaller baby because of reduced blood flow to the placenta.
Ultrasound can help screen for congenital anomalies, monitor amniotic fluid levels, which can lead to preterm birth, and determine the baby’s growth and due date. Macrosomia occurs in 15-45 % of infants of diabetic mothers because high insulin levels stimulate the fetal growth rate. Fetal growth restriction is less common in diabetic pregnancy. But those with hypertension or microvascular disease are at higher risk of growth restriction.

What types of childbirth and delivery methods are suitable for diabetic mothers?

If the levels of blood glucose and the condition of the mother and baby are satisfactory, it is okay to wait for the labor and have a natural birth. But the pregnancy should not extend beyond the 40^th week.

If there are complications such as nephropathy, aggravated diabetic retinopathy, hypertension, preeclampsia, growth restriction, macrosomia, or elevated blood sugar levels, the doctor may suggest scheduling a date for labor induction or cesarean birth.

Cesarean birth is recommended for a large baby to avoid shoulder dystocia. With controlled diabetes, the risk of stillbirth is low. However, the infant mortality rate in diabetic mothers is slightly higher than in non-diabetic ones because of the higher incidence of severe congenital anomalies.

Do infants of diabetic mothers need special care?

Newborn babies of diabetic mothers with high blood sugar levels throughout the gestation are at higher risk of developing jaundice, difficulty breathing, polycythemia, heart problems, low calcium level, and low blood sugar levels. The doctor will monitor the newborns in a specialized nursery care unit. The lungs of an infant of a diabetic mother seem to develop more slowly than usual. High blood sugar levels near the time of birth can lead to respiratory problems in infants born earlier than 39 weeks.

Children of diabetic parents are also at greater risk of having the same type of diabetes because of genes, behaviors, and environmental impact.

What is the proper postpartum care for diabetic mothers?

For the first few days after delivery and the start of breastfeeding, the doctor will order frequent checking of blood glucose for hypoglycemia. Insulin requirement may be less after delivery.