Having a Baby – Pre-gestational Diabetes

Diabetes affects the lives of so many individuals and is not restricted to a specific gender, ethnicity or age. It may cause difficulties, but none are insurmountable if you have the will to manage the disease. This is true whether you have been just diagnosed or have been diabetic for years. It is a matter of taking control of your diabetes and managing it from day to day, and that includes when you want to get pregnant and have a baby.

Diabetic and having a Baby

If you already have diabetes (and it does not matter what type it is) you may decide to have a child, or you may have an unplanned pregnancy. When you are diabetic before getting pregnant, it is referred to as pre-gestational diabetes. You need to learn about the various diabetes related issues that will affect not only your life but the life of the baby. It’s important to work closely with your doctor and make sure you understand these special issues and requirements. This includes talking openly and frankly with the doctor about such things as:

  • Breast feeding. Can she or can she not feed her baby in this manner?
  • What are the risks for the mother?
  • What are the risks for the child?
  • Are the complications or risks short term or will they be long term?
  • What measures can she take to minimize any negative effects that could impact upon the health and future health of the baby?

By understanding the risks, you can take control of your lifestyle to insure the baby is kept healthy during the gestational period.

Before the Pregnancy

Before becoming pregnant, you need to talk to the professionals. You need to know the facts about what may potentially occur during the pregnancy, the birth and afterwards. You need to ask plenty of questions and make sure you understand the answers because diabetes is a complex disease. Remember, your responsibility for the health of the child begins with your decision to get pregnant when you already have diabetes.

In fact, having a child is all about responsibility and your accountability to this child begins with taking care of your own health and minimizing the potential impact of diabetes on the fetus. To improve the chances of having a healthy, happy baby, you need to make sure you have done everything possible to manage your diabetes. You need to take responsibility for your diabetes and do more than manage the basics. Whenever possible, you need to be in charge of your diabetes long before you become pregnant.

Controlling diabetes means making sure your blood sugar is stable. It also means talking to your doctor and pharmacist about any medication you are currently taking. Some drugs that are used to lower blood pressure and cholesterol are not compatible with pregnancy. The prescriptions may need to be changed or temporarily stopped.  Your medical team, which includes your doctor, pharmacist, pediatrician and other involved medical professionals, can determine if it’s necessary to change or reduce dosages of specific unsuitable medications. For example, in the case of type 2 diabetes (T2D), you may have to replace any oral anti-hyperglycemic medication with insulin.

You should also reconsider the supplements you are taking. Complementary medicine often includes taking a variety of supplements as part of the diabetes treatment plan. Some, such as folic acid are recommended to help in the months and even years prior to becoming pregnant. Folic acid is described as being capable of preventing birth defects within the womb. Other supplements do not have as clear a benefit and should be researched. In this way you can learn about the potentially harmful or beneficial effects of various herbs and nutritional supplements e.g. fenugreek (harmful during pregnancy), fish oil (beneficial in some respects if you avoid the ones with high PCBs).[1]

There are other things you need to do also when you have diabetes. Make sure you see your eye doctor. Get regular eye examinations. Also have your kidney functioning checked. You need to make sure there is no protein leak affecting renal function. Rule out any instance of high cholesterol or abnormal blood lipids and take an electrocardiogram to make sure you do not have any hidden heart disease.[2] If there is any indication of a potentially serious problem in either your kidneys or eyes due to diabetes, getting pregnant may not be an option until the medical issues are stabilized.

During the Pregnancy

During the actual pregnancy, you must continue to keep your diabetes under control. In order to ensure the diabetes is being properly managed, you will need to submit yourself to more medical tests more frequently. You have the goal of keeping your baby healthy, however, and that should keep you focused on making sure your blood sugar levels are within normal range and that other biological systems are healthy. You need to continue:

  • Testing for ketones in the urine[3]
  • Testing your blood sugar up to six times daily. This includes before and following meals as well as prior to bed and during the night
  • Regularly visiting the doctor, who will make sure your blood sugar does not fluctuate significantly. The A1C, a comprehensive diabetes test, will be checked regularly as well as blood glucose logs
  • Additional ultrasounds may be necessary to ensure the fetus is growing properly

This extra care extends to your diet also. A dietician will adjust your diet while your physician will change your insulin doses in response to the body’s reactions during pregnancy. The possibility of developing hypoglycemia, resulting from tightly regulating blood sugar levels, can be minimized. You can also obtain a glucagon kit.

What about the Baby?

Being pregnant always presents some type of risk for the mother and the baby. The diabetic mother has health challenges to meet, but if the diabetes is well controlled, the risks to mother and baby should be decreased. If the mother is not careful about maintaining control of her diabetes, and fails to follow the right management plan, both non-cardiac and cardiac birth defects can result.[4] Excess blood glucose in the mother transmitted to the fetus may also result in the baby being macrosomia – larger than normal. Immediately after birth, the child will need to be closely monitored for low blood sugar.

During the Delivery

Be proactive in your management of diabetes. Make sure the doctors, midwives and staff of the hospital, or birthing room, know your condition. Everyone needs to be on the same page. Delivery room staff, obstetrician, anesthesiologist and pediatrician must be aware of your condition so they can prepare in advance for potential needs, complications or emergencies. The elevation of your insulin requirements during delivery can be met easily by a pump or a continuous intravenous drip.

Following the Delivery

Be sure your medical team is aware of the specific type of diabetes you have. Make sure you have on hand the right amount of insulin for treating your diabetes. If you have T1D, realize that once the placenta is removed, the current insulin resistance will vanish as you revert to your pre-pregnancy needs and demands. If you have T2D, you might be able to drop the insulin for oral medication once again.

It’s important to also understand the blood sugar levels of your infant will be checked as soon as possible either in the delivery room or soon after he or she is placed in a nursery or neonatal unit. Make sure a pediatrician is available to provide your baby with a careful examination for any defects or health issues.

If all goes well, you will be soon able to breast feed your child. You should not attempt to do so without consulting both your doctor and a nutritionist. Find out how much you will need to eat and what specific nutrients you need.

There’s one last consideration. You need to think of this as another challenge to be met as a diabetic mother. Take precautions against having a hypoglycemic episode. These are common following delivery. Make sure that nothing will happen to either you or your baby due to hypoglycemia. Have your partner or someone you trust around you and your child to help you with any activities during these early days after delivery until your body has time to adjust. It will help you morally, emotionally and physically as you adapt to the new stage of life.

Yet, no matter how happy or complicated your life becomes, don’t forget to monitor your diabetes. Keep it under control and follow through with getting the tests done that are meant to detect the impact of diabetes on your health.

Conclusion

Being diabetic need not interfere with having a baby. Yet, before conceiving, it’s always a good idea to talk to your doctor first. Find out all you can about what you can do to ensure your diabetes will not have a negative effect on the baby and your health while pregnant and afterwards.

References 

[1] Shane-McWhorter, L (2010). Guide to Herbs and Nutritional Supplements. Alexandria, VA: ADA.

[2] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books

[3] Stanley, K (2009). 50 Things You Need To Know About Diabetes. Alexandria, VA: ADA.

[4] Correa, C; Suzanne M. Gilboa, SM; Besser, LM;  Botto,LD; Moore, CA; Hobbs, CA; Cleves, MA; Riehle-Colarusso, TJ; Waller, DK; and Reece, EA (2008). “Diabetes Mellitus and Birth Defects.” American Journal of Obstetrics & Gynecology, 199 (3): 237.e1-237.e9.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.