I remember a young woman, let’s call her Sarah, sitting in my clinic. She was so excited about the thought of starting a family, but a cloud of worry hung over her. “Dr. Priya,” she said, her voice a little shaky, “I have Type 1 diabetes. Can I even have a healthy baby?” It’s a question I hear, and a concern I deeply understand. If you’re in a similar boat, managing diabetes and dreaming of or expecting a little one, please know this: while it brings unique challenges, a healthy pregnancy and a healthy baby are absolutely possible. We just need a good plan for handling diabetes in pregnancy.
Understanding Diabetes When You’re Expecting
So, what does it mean to have diabetes before you get pregnant? We often call this “pregestational diabetes” or “preexisting diabetes.” This is different from gestational diabetes, which is a type of diabetes that develops during pregnancy and usually disappears after your baby arrives.
If you’re already familiar with managing your blood sugar, that’s a great start! But pregnancy? Well, pregnancy changes the game. Your body goes through so many shifts, and these can make it trickier to keep your blood sugar in that sweet spot. Your meals, how active you are, and even your medications might need some tweaking. It’s not uncommon for your diabetes management plan to evolve several times before your due date. That’s why staying in close touch with your healthcare team is so, so important. We’re here to spot when things need to adjust.
Is Diabetes a High-Risk Pregnancy?
Yes, having Type 1 or Type 2 diabetes does mean we consider the pregnancy to be higher risk. But please don’t let that term scare you! It simply means we’ll be keeping an extra close eye on you and your developing baby. Consistently high or very low blood sugar levels can cause problems, so our goal is to minimize those risks.
You’ll likely have a team approach. Besides your obstetrician (the doctor who delivers babies), you might work with:
- An endocrinologist: That’s a doctor who specializes in hormone conditions, like diabetes.
- A registered dietitian: They’re fantastic for helping figure out what to eat to keep both you and baby healthy, while managing blood sugars.
- A diabetes educator: These specialists are experts in all things diabetes management.
Sometimes, you might also see a maternal-fetal medicine specialist (MFM), a doctor who focuses on high-risk pregnancies. It’s all about giving you the best support.
Getting Ready: Pre-Pregnancy Planning with Diabetes
If you have diabetes and you’re thinking about getting pregnant, the best first step is a chat with your doctor. Ideally, this would be about six months before you start trying. Why so early?
Well, getting your blood sugar levels as stable as possible before pregnancy is a big plus. During pregnancy, we aim for an even tighter glucose range, and it’s easier to hit that target if you’re starting from a good place. Most of us recommend an A1C (a measure of your average blood sugar over a few months) of 6.5% or lower before conceiving. This is because high blood sugar in the very early weeks, when tiny organs are forming, can affect development.
Meeting with your team beforehand helps us:
- Fine-tune your blood sugar management.
- Work with a dietitian on an eating plan that’s good for pregnancy and diabetes.
- Discuss any medication changes needed once you’re pregnant.
- Consider new tech, like a continuous glucose monitor (CGM) or an insulin pump, which can be super helpful.
- Check on your overall health – things like your eyes, kidneys, and heart – because pregnancy can sometimes worsen existing diabetes-related issues like retinopathy (eye problems) or nephropathy (kidney problems).
How Your Diabetes Care Changes During Pregnancy
Once you’re pregnant, a few key things will shift in how we manage your diabetes:
Tighter Blood Sugar Goals
This is a big one. To reduce risks, we aim for pretty specific blood sugar numbers:
- Fasting (before breakfast): Below 95 mg/dL
- One hour after eating: Below 140 mg/dL
- Two hours after eating: Below 120 mg/dL
We also talk about Time in Range (TIR). For pregnant folks with Type 1 diabetes, we generally aim for:
- At least 70% of the time between 63 and 140 mg/dL.
- Less than 5% of the time below 63 mg/dL.
- Less than 25% of the time above 140 mg/dL.
And ideally, we like to see an A1C below 6% during pregnancy.
To hit these tight targets, a CGM can be a game-changer. It gives us a much clearer picture of your glucose patterns than finger sticks alone. You’ll also likely focus on:
- Careful carbohydrate counting.
- Taking insulin 10-15 minutes (or sometimes more) before you eat.
- Using physical activity strategically.
Shifting Insulin Needs
Oh, hormones! They’re the main reason your insulin needs will likely change, sometimes quite a bit, throughout your pregnancy. Everyone is different, so this is where close teamwork really shines.
If you have Type 1 diabetes, it’s not unusual to need less insulin in the first trimester (though not for everyone!). Then, around week 16, insulin needs often start to climb. This is because the placenta (the amazing organ that nourishes your baby) makes hormones that cause insulin resistance. This happens in all pregnancies, not just those with diabetes.
You might find you need more and more insulin until about week 36 or 37, when things often level off. Many women end up needing two to three times more insulin by then compared to before pregnancy! We’ll adjust your:
- Basal or long-acting insulin (your background insulin).
- Insulin-to-carb ratio (ICR) (how much insulin you need for the carbs you eat).
- Insulin sensitivity factor (ISF) (how much one unit of insulin lowers your blood sugar).
Then, plot twist! Once you deliver your baby and the placenta, your insulin needs will drop dramatically, often right back to pre-pregnancy levels or even lower, sometimes within 30 minutes. It’s crucial to have a plan for this, which we’ll make together.
Eating for Two (Plus Diabetes)
Good nutrition is vital for any pregnancy. Juggling that with the need for tight blood sugar control can feel like a balancing act, especially if you’re dealing with morning sickness. A dietitian specializing in diabetes in pregnancy can be your best friend here, helping you create meal plans that nourish you and baby while keeping sugars steady.
Managing Type 1 Diabetes in Pregnancy
If you have Type 1, expect frequent, often weekly, adjustments to your insulin. Watching your glucose trends closely helps us make precise changes. If you’re on multiple daily injections (MDI), we might talk about switching to an insulin pump for more flexibility, but MDI can work too.
Managing Type 2 Diabetes in Pregnancy
Most oral medications and non-insulin injectables for Type 2 diabetes aren’t recommended during pregnancy, with metformin sometimes being an exception. This means you might need to start using insulin, possibly for the first time. And just like with Type 1, your insulin needs will likely increase as pregnancy progresses. A CGM can be really helpful here too.
What to Expect: More Appointments, More Care
With diabetes in pregnancy, you’ll have more prenatal appointments and tests than someone without diabetes. This isn’t to worry you; it’s so we can monitor your baby’s growth and your health very carefully. Beyond the usual blood tests and anatomy scan, you might have:
- Fetal echocardiogram: An ultrasound to check your baby’s heart structure, as preexisting diabetes can slightly increase the risk of heart conditions.
- Growth scans (ultrasounds): Often every few weeks, especially to monitor for fetal macrosomia (a larger-than-average baby). These are estimates, though!
- Nonstress tests (NSTs): Usually weekly in the third trimester, to check baby’s heart rate and movements.
- Biophysical profiles (BPPs): Also weekly, these ultrasounds look at baby’s breathing movements, muscle tone, movement, and amniotic fluid levels.
You’ll also be in frequent contact with your endocrinologist or diabetes educator. It’s a team effort!
Potential Risks and Complications: Being Aware
It’s important to be honest about potential risks. Managing your diabetes well during pregnancy is key because consistently high blood sugar can increase the chances of certain complications. Frequent or severe low blood sugar can also be risky.
For the fetus and pregnancy, risks include:
- Birth defects (congenital conditions): The risk is a bit higher (6-12%), often involving the heart or neural tube.
- Fetal macrosomia: A baby weighing over 9 lbs, 15 oz, which can make delivery trickier.
- Polyhydramnios: Too much amniotic fluid, which can lead to preterm labor.
- Preterm birth: Sometimes, if complications arise, delivering early is the safest option.
- Stillbirth: The risk is slightly increased with pregestational diabetes.
After birth, your baby might have a slightly higher chance of:
- Low blood sugar right after birth.
- Breathing difficulties.
- Jaundice.
If these occur, your baby might need a short stay in the NICU (neonatal intensive care unit). Babies born to mothers with diabetes may also have a higher likelihood of developing obesity later in life.
For you, having diabetes during pregnancy can increase your risk of:
- Preeclampsia: High blood pressure and protein in your urine. We often recommend low-dose aspirin after 12 weeks to help prevent this.
- Needing a C-section delivery, often due to a larger baby.
- Low blood sugar (hypoglycemia), because we’re aiming for such tight control.
- Diabetes-related ketoacidosis (DKA): Pregnancy hormones and morning sickness vomiting can increase this risk.
- Worsening of existing diabetes complications like retinopathy, nephropathy, or neuropathy, or these developing if you didn’t have them before.
Labor, Delivery, and Diabetes
In many cases, we recommend a scheduled induction for women with diabetes, often at or before 39 weeks. But every situation is unique, and we’ll decide what’s best for you, together.
During labor, blood sugars can be a bit unpredictable due to hormones and physical exertion. You might manage with your pump or injections, or sometimes an IV insulin drip is used. And remember that big drop in insulin needs after delivery? We’ll have a plan ready!
Taking Care of Yourself: Coping and Thriving
This journey can feel overwhelming at times. It’s okay to feel that way. Remember Sarah from my clinic? With careful planning and support, she had a beautiful, healthy baby boy. You can too. Here’s how:
- Monitor your blood sugar frequently, as we discuss.
- Stick to your target blood sugar range as much as possible.
- Follow our guidance on insulin and any other treatments.
- Don’t miss your appointments and tests!
- Stay active (we’ll talk about what’s right for you).
- Eat those healthy, balanced meals.
- Avoid alcohol and tobacco.
- And please, take care of your mental health. Talk to us, talk to loved ones.
When to Call Your Doctor
Don’t hesitate to reach out if:
- You can’t keep your blood sugar in range, despite trying.
- Your blood sugar is doing weird things you don’t understand.
- Baby is moving less.
- You have any fluid or blood leaking from your vagina.
- You experience blurred vision or increased thirst.
- You’re vomiting and can’t keep food or fluids down.
It’s always better to ask than to worry alone.
Key Takeaways for Diabetes in Pregnancy
Here’s what I really want you to remember about navigating diabetes in pregnancy:
- Teamwork is crucial: You, your OB, endocrinologist, dietitian – we’re all in this together.
- Pre-pregnancy planning helps: Aim for good blood sugar control before conceiving.
- Blood sugar goals are tighter: Expect to monitor closely and adjust often.
- Insulin needs will change: This is normal! Be prepared for adjustments up, and then a big drop after delivery.
- Extra monitoring is for safety: More appointments and tests help ensure a healthy outcome for you and baby.
- A healthy baby is the goal and very achievable: With careful management, most women with diabetes have healthy babies.
You’re embarking on an incredible journey. Yes, having diabetes adds a layer of complexity, but it doesn’t take away from the joy and wonder. We’re here to support you every single step of the way. You’re doin’ great, and you’re not alone in this.
